Hepatitis E virus prevalence in Egyptian children with transfusion-dependent thalassemia

ABSTRACT Hepatitis E virus (HEV) infection is one of the major public health problems in developing countries. HEV can cause chronic infections in immunocompromised individuals e.g. thalassemic patients with increased risk of morbidity and mortality. In addition there is possibility of HEV transmission through blood transfusion. Therefore, the present study aimed to investigate the seroprevalence and risk factors of HEV infection in β-thalassemic children. Methods: This cross-sectional study was conducted on 140 Egyptian children suffering from β-thalassemia, attending the hematology outpatient clinic from April to October 2016. Serum samples from patients were collected and anti-HEV antibodies; Immunoglobulin G (IgG) and Immunoglobulin M (IgM)were measured by enzyme-linked immunosorbent assay (ELISA). Results: The seroprevalence of HEV in β-thalassemic chidren was relatively high (27.15%). Anti-HEV IgG prevalence was 24.29% while that of IgM was 2.86%. There was significant association between HEV infection and age, residence, liver enzymes and amount of blood transfusion per year. Conclusions: Thalasemic patients are vulnerable to chronicity and increased risk of morbidity and mortality from HEV infection. Frequent assessment of liver enzymes in thalassemic patients to monitor subclinical HEV is recommended. Close monitoring and HEV screening of blood donations should be taken in consideration. Public awareness about HEV endemicity, modes of transmission, and risk hazards especially in high risk group should be done to reduce the disease burden.

Hepatitis B surface antigen carrier rate in unvaccinated and vaccinated children with thalassaemia major at Bahawal Victoria Hospital, Bahawalpur, Pakistan

Screening of blood reduces but does not eliminate the risk of hepatitis B virus [HBV] infection in multi-transfused thalassaemia patients. This study was done to evaluate efficacy of HBV vaccination on hepatitis B virus surface antigen [HBsAg] carrier rate in children with thalassaemia major receiving multiple blood transfusions. In a cohort study conducted at a hospital in Bahawalpur, Pakistan, during 2009-10, children with thalassaemia major aged < 60 months who received more than 24 blood transfusions and were HBsAg negative at the time of first blood transfusion were included. Of 196 unvaccinated children, the seropositive rate was 12.2%; while among 218 children vaccinated during the first year of life via the Pakistan Expanded Programme on Immunization, the seropositive rate was only 0,9%. The HBV vaccine was highly effective in reducing the HBsAg carrier rate in children with thalassaemia aged < 5 years

[Trace back of thalassemic patients with positive HCV markers to their donors in adult thalassemia center]

Transfusion transmitted infection is one of the most important transfusion reactions. In this study, we tried to find new cases of HCV in thalassemic patients having referred to Adult Thalassemia Clinic after 1996 and to trace them back for sources of infection. This was a descriptive study in which all patients were studied; census method of data collection was used. Those patients with no test record before 1996 that appeared to be positive in their first test attempt were not considered a new HCV positive case. The new cases were just those whose past negative HCV Ab test results changed into positive in new test. For data analysis, SPSS version 14 was used. Out of 395 file records, 274[69.4%] were thalassemia major, and 110 [27.8%] intermediate. We had 109 HCV positive cases [27.5%] out of whom 21 were those infected after 1996. Out of the latter, 5 had complete medical records by which 54 blood donors were identified; however, only 37 [68.5%] were traced and found to be negative for HCV Ab. Noteworthy that 81% of these safe donors were shown to be repeated donors. Since there had been one or more donors whose donations had been administered to each patient with no possibility for them to be traced, we were not able to prove the transmission of HCV from donors to recipients. Other possibilities including hospital transmission, patient to patient transmission, and transmission by nurses involved in blood administration should be taken into account

Determination of hepatitis C genotypes and the viral titer distribution in children and adolescents with major thalassemia

Hepatitis C virus [HCV] is an etiological agent responsible for occurrence of post-transfusion hepatitis in thalassemic patients. This study identified hepatitis C genotypes in pediatric and adolescent thalassemic patients and their correlation with age, blood transfusion, HCV RNA viral titer and liver function. This study considers cross-sectional data from the Center for Thalassemia in Zahedan [Iran] carried out between August 2005 and September 2007, Twenty multitransfused patients suffering from p-thalassemia major and chronic HCV infection [13 males, 7 females] were included in the study, Patients were considered eligible for the study if they were seropositive for HCV RNA polymerase chain reaction [PCR] before initiation of evaluation. Blood sample was taken for HCV genotype and viral titer as well as biochemical markers. Type specific primer and real-time RT-PCR HCV were used for determination of viral genotype and HCV-RNA titer. There was a significant positive correlation between serum HCV RNA titer and genotypes [P<0001]. Serum HCV RNA levels were found higher in genotype 3a than in others. The most prevalent genotype in thalassemic patients was genotype 3a [40%] followed by 1b [25%], unclassified [20%] and 1a [15%]. There was no meaningful relationship between genotype, Alanine aminotranferease, ferritin and alkaline phosphatase. Age, serum HCV RNA titer and number of transfusions were the only significant factors associated with genotypes [P<015, P<0.0001 and P<0.001 respectively]. This study showed that HCV genotype and viral titer are related to the number of blood transfusions received by thalassemic patients. Screening donated blood in blood banks would prevent the occurrence of hepatitis C in this high-risk group

Prevalence of hepatitis-C virus [HCV] among thalassemia patients in khuzestan province, southwest Iran

The aim of this study was to determine the prevalence of HCV infection among thalassemia patients in Khuzestan province, southwest Iran. A retrospective cross-sectional study was conducted on 206 thatassemia patients referred to the Research Center of Thalassemia and Hemoglobinopathy [RCTH] of Ahvaz Shafa Hospital during March 2006 to April 2007. Demographic data were obtained from the patient files at the hospital. Serum specimens were tested with anti-HCV assays and a nested-PCR technique to assess HCV infection. Out of 206 patients, 97 [47.1%] and 109 [52.9%] were male and female, respectively, with a mean +/- SD age of 16.4 +/- 6.42 years. The overall prevalence rate of anti-HCV was 28.1% [58/ 206, 95% CI: 22.4-34.6]. Forty six of anti-HCV positive patients [46/58, 79.3%] were also HCV RNA positive. HCV-positive patients were significantly older from HCV-negative ones [p<0.001]. In addition, the results indicate that higher prevalence of anti-HCV or HCV RNA were significantly associated with longer duration of transfusion [p<0.003 and p<0.001, respectively]. Although it seems blood donor screening project reduced HCV infection, using more accurate technique is necessary in order to find viral infection and treat thalassemia patients with HCV infection more carefully

Seroepidemiologic HGV in blood donors haemodialysis patients, haemophiliacs and major beta thalassemics with history of liver disease

The prevalence of GBV-C and HGV in blood donor populations in developd countries based on HGV detection and anti-E2 screening ranges from 1 to 5 and 3 to 14% respectively. The aim of this study was to investigate seroepidemiologic hepatitis G virus [HGV] in blood donors, heamodialysis patients, hemophiliacs, and beta thalassemics with a history of liver disease by Elisa technique. In this descriptive study, blood samples of 330 volunteer blood donors, 44 heamodialysis patients, 16 haemophiliacs, and 40 beta major thalassemics with a history of liver disease were studied by Elisa technique for their seroepidemiologic status of hepatitis G virus and their past record HGV infection. For data analysis, Ch-square, Fisher exact test, and SPSS version 11.5 were used. This study showed that out of 330 healthy blood donors 14[4.2%], out of 44 heamodialysis patients 10[22.7%], out of 16 haemophiliacs 5 [30.3%] and out of 40 beta thalassemics 10 [25%] were positive for HGV-anti-E2. These data are significant evidence for HGV to be considered as a transfusion-transmitted infection. The prevalence of anti-HGV and anti-HCV [co-infection] was found to involve 10 [30.3%] of heamodialysis patients, 4 [28.6%] of haemophiliacs and 9 [23.7%] of beta thalassemics. It was also found that 1 [8.3%] of heamodialysis patients, 1 [33.3%] of haemophiliacs, and 1 [50%] of beta thalassemics were infected with anti-HGV and HBsAg co-infection. The prevalence of HGV was high in multitransfused individuals including heamodialysis patients, haemophiliacs, and thalassaemics. Therefore, HGV was a transfusion-transmittable agent. Co-infection of anti-HGV with HCV was observed in viruses. It is recommended that further studies focus on evaluating sexual and vertical transmission routes so as to cast light on relatively high rate of HGV in donor population

Frequency of hepatitis C in thalassemic patients and its association with liver enzyme, Mofid Hospital, Iran, 2002

Patients with thalassemia major are classified as high risk group for blood-born viral infection due to multiple transfusions. We investigated the frequency of hepatitis C virus among thalassemic patients referring to Mofid Hospital in 2002. Meanwhile, the association between HCV infection and liver enzyme level was determined.During this retrospective study, 110 patients who had referred for transfusion to our department were included. Initial data including anti-HCV, HCV-RNA [if anti-HCV was positive], alanine transferase, aspartate transferase, and ferritin were gathered.Anti-HCV was positive in 13 [11.8%] subjects among whom 11 [84.6%] were positive for HCV-RNA. All transfusions had been achieved prior to the National Program of Blood Product Screening for HCV [in Iran] that was commenced in 1996. Anti-HCV positive subjects revealed to have significantly higher ALT level [p=0.03], meanwhile, elevated liver enzyme [regardless of anti-HCV status] was more frequently found among patients with increased level of ferritin [p < 0.001].Frequency of HCV was dramatically decreased among thalassemic patients following the screening program in 1996. However, routine investigations are still advisable. Iron overload due to multiple transfusions may contribute to impaired liver enzymes