APPNA Hepatitis C Conference by Adisweet77

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									     HEP C & TRANSFUSION
   TRANSMITTED INFECTIONS
SITUATION ANALYSIS IN PAKISTAN
   APPNA Hepatitis C Conference
     March 5-6, 2012, Lahore

               Dr. Anwar
 Assistant Professor, Incharge Blood Bank
               JPMC Karachi
                       Overview
TTI’s Facts & Figures in Pakistan
 Donor Prevalence of HCV, HBV & HIV among
 different cities
Safe blood transfusion practices in blood banks of
 Karachi
 Prevalence of TTIs, experience at JPMC Blood Bank
 Incidence of HCV in Heamophilic patients of
 Karachi
 Challanges
 Conclusion
    TTI’s Facts & Figures in Pakistan

• Condition of healthcare sector in Pakistan
  o Poor documented data on blood donations
  o Reliability of data is questionable


• More than 1.5 million pints of blood are donated
  each year in Pakistan
  o 10% is from voluntary donors
  o 80% from replacement donors
  o About 10% from professional donors
   TTI’s Facts & Figures in Pakistan…
• Blood transufion is life saving procedure
  o Associated with risks of adverse reactions
  o May responsible for the transmission of infection from
    an infected donor to the recipient
• The WHO recommends screening for four TTIs
  worldwide as mandatory
  o HIV
  o HBV
  o HCV
  o Syphilis
    TTI’s Facts & Figures in Pakistan…
• There are certains seasional infections which
  potentially may be spread by transfusing infected
  blood     which    includes   Malaria,    Dangue
  Haemorrhagic fever virus
• Also showed significance Sero-positivity against
  cytomegalo virus (CMV) and Toxoplasma
• Care should be excercised when blood is to be
  transfuse to an immuno-suppressed patient
    TTI’s Facts & Figures in Pakistan…
• Screening Quality
  o Only 47% of the blood donated in developing countries
    has screened with basic quality assurance measures.


• Prevalence of TTIs In Blood Donation
  o HIV - very low
  o HBV - 3 to 7 %
  o HCV - 2 to 6 %
   TTI’s Facts & Figures in Pakistan…
• According to global fund to Fight AIDS, Tuberculosis
  and Malaria (GFATM) in 2008, 43 NGO’s run blood
  banks were evaluated.
  o Screening of blood, blood products
  o Disposal of infectious blood banks wastage
  o High Satisfacory      - 04 blood banks (9.3%)
  o Satisfactory          - 29 blood banks (67.4%)
  o Unsatisfactory        - 04 blood banks (9.3%)
  o Highly unsatisfactory - 06 blood banks (14%)
        Development of National Testing Strategy, NBTP, August 2011
Donor Prevalence of HCV, HBV & HIV
      Among Different Cities
• A study was carried out in healthy blood donors in
  the Lady Reading Hospital
• Out of 1,27,828 sample of blood donors, recorded
  mean prevalence were
  o HBs Ag      - 2.68%
  o Anti-HCV    - 2.46%
  o Anti-HIV    - 0.06%
  o Syphilis   - 0.43%
          Reference: Journal of Translational Medicine 2012
               Corresponding Author: Sobia Attaullah
   Donor Prevalence of HCV, HBV &
    HIV Among Different Cities…
• Study conducted at Ghurki Trust Teaching Hospital,
  Lahore Blood Bank from 1st January to 31st
  December 2008.
• A total of 6659 donors were screened
  o 512 donors (7.69%) were seropositive for Hepatitis C
  o 113 (1.70%) for Hepatitis B
  o 35 (0.5%) for syphilis
  o Only 3 (0.05%) for HIV

       Reference: D:/Biomedica Vol.25, Jul. – Dec. 2009/Bio-10.Doc
                  Corresponding Author: Iram Manzoor
   Donor Prevalence of HCV, HBV &
    HIV Among Different Cities…
• 5 years study conducted from Jan 2002 to Dec 2006 in
  eight blood units of Rawalpindi district, total of
  140,291 donors were screened to estimate the
  prevalence amongst healthy blood donors.
• Following results were found
  o HIV - 0%
  o HBV - 2.31%
  o HCV - 4.87%
  o HCV was 2.1 times more prevalent than HBV in healthy
    blood donors
          Reference: International Journal of Pathology, 2007
              Corresponding Author: Zeeshan Tariq Khan
  Safe Blood Transfusion Practices in
        Blood Banks of Karachi
• The study was conducted during the year 2007 -
  2008.

• Out of 40 government-registered blood banks in
  Karachi, 26 were randomly selected and
  administered a questionnaire and a checklist were
  based on current WHO guidelines on Safe Blood
  Transfusion (SBT).
  Safe Blood Transfusion Practices in
       Blood Banks of Karachi…
• The questionnaire covered the components on
  o General blood bank information
  o Aspects of donor physical and clinical examination
  o Nature and quality of blood products and other facilities
    available in the blood bank
  o The checklist evaluated storage temperature of blood,
    blood products and sterility of the equipments
  Safe Blood Transfusion Practices in
       Blood Banks of Karachi…
• Practices for donations
  o 21 blood banks recruited non-remunerated donors
  o 2 (9%) blood banks admitted giving monetary
    compensation occasionally
  o 14 (61%) blood banks claimed to promote donor
    motivation through information brochures
  o 16 (70%) blood banks kept track of healthy donors, who
    were frequently asked to donate blood
  Safe Blood Transfusion Practices in
       Blood Banks of Karachi…
• Availability of trained manpower

  o All blood banks claimed to have trained technicians
     22 (96%) reported to have pathologists
     11 (48%) reported to have certified physician
     12 (52%) reported to have hematologist
     2 (9%) reported to have paramedic staff
     3 (13%) reported to have trained data managers
  Safe Blood Transfusion Practices in
       Blood Banks of Karachi…
• Clinical history and physical examination
  o 15 (65%) blood banks gathered adequate information
    about sexual practices
  o 16 (70%) blood banks questioned about the history of
    sexually transmitted diseases
  o 4 (17%) blood banks ignored medication history
  o Only 7 (30%) blood banks questioned regarding travel
    history
  o Only 15 blood banks were found to profile donor clinical
    history
  o Only 14 blood banks performed donor's physical
    examination
  Safe Blood Transfusion Practices in
       Blood Banks of Karachi…
• Quality control of blood products
  o Among the 17 blood banks surveyed, the available
    blood products included platelets, fresh frozen plasma,
    cryoprecipitate and packed cells
  o Of the 23 blood banks surveyed
     17 stored blood at temperatures between 4 and 6 °C
     3 stored at temperatures higher or lower than normal range
• Nineteen (83%) facilities claimed to incinerate used
  equipment and expired blood, the rest, not complying
  with the SBT practice legislation, disposed them in
  waste bags
       Reference: Transfusion Medicine Volume 21, February 2011,
      Author: M. Kassi, A. K. Afghan, M. R. Khanani, I. A. Khan, S. H. Ali
     Prevalence of TTIs in JPMC Blood
        Bank among Family Donors
PARTICULARS   YEAR YEAR YEAR        YEAR YEAR YEAR        YEAR YEAR      YEAR    YEAR
              2002 2003 2004        2005 2006 2007        2008 2009      2010    2011
FAMILY        19612 19779 21244     24048 29439 3557      38681 37316    42689   43005
DONORS
HCV REACTIVE 750     766    664     797    1207   1500    1745   1470    1676    1756
             3.8%    3.9%   3.1%    3.3%   4.1%   4.2%    4.5%   3.9%    3.9%    4.1%
HBV REACTIVE 1017    759    624     672    964    1301    1438   1276    1259    1294
             5.2%    3.8%   2.9%    2.8%   3.3%   3.6%    3.7%   3.4%    2.9%    3.0%
HIV REACTIVE 01      02     01      06     06     08      05     07      13      28
             0.004   0.01   0.003   0.02   0.02   0.02%   0.01   0.02%   0.03%   0.06%
             %       %      %       %      %              %
     Prévalence of TTIs in JPMC Blood
      Bank among Voluntary Donors
PARTICULARS   YEAR   YEAR   YEAR   YEAR   YEAR   YEAR   YEAR YEAR     YEAR   YEAR   YEAR
              2001   2002   2003   2004   2005   2006   2007 2008     2009   2010   2011
VOLUNTARY    1732    1620 3297 3994 2455 1218 666              930    2543 2232 1782
DONORS
HCV REACTIVE 21   15        33     43     22     11     7      8      33     22     19
             1.2% 0.9%      1.0%   1.1%   0.8%   0.9%   1.1%   0.8%   1.3%   0.9%   1.1%
HBV REACTIVE 35   31        66     76     44     24     12     14     48     42     27
             2.0% 1.9%      2.0%   1.9%   1.8%   1.9%   1.8%   1.5%   1.9%   1.8%   1.5%
HIV REACTIVE 0    0         0      0      0      0      0      0      0      0      0
   Incidence of TTI’s in Heamophilic
          patients of Karachi
• The aim of the study was to assess the prevalence of
  infections among the patients with hemophilia.
• Seroprevalence was compared from 5717 exchange
  healthy blood donors for same markers.
• A total of 173 multi transfused male hemophiliacs
  showed prevalence of TTI’s were
  o HCV - 51.4%
  o HBV - 1.73%
  o HIV - 0%
Incidence of TTI’s in Heamophilic
      patients of Karachi..
• In blood donors,
  o HCV - 1.9%,         HBV - 1.81%,                 HIV - 0%
• Prevalence of anti-HCV-Ab was significantly high
  in patients with hemophilia than normal donors
  This study showed that HCV infection was more
  frequently identified than HBV and HIV infections
  in multi transfused hemophiliacs. The frequency
  of hepatitis C among blood donors is also higher
  than that of hepatitis B which is showing
  downward trend.
            Reference: SAGE Journals, Feb 16, 2012
                   Author: Munira Borhany
Prevalence of HCV Infection
    Receipient of Blood
• Pakistan     45% - 51%

• India        17% - 28%

• Bangladesh   13%

• Srilanka     33%
HCV Infection by Age & Sex in
          Paksitan
•   Male         3.2%
•   Female       4.33%
•   Age Group:
•   17-23        2.09%
•   24-30        3.52%
•   31-37        3.91%
•   38-60        5.23%
            Current Challenges
• Voluntary Blood Donations        - Poor
• Blood Transfusion Services       - Fragmented
• Screening Coverage                - Low
• Screening kits standardization - Poor
• Non availability of 100% sensitive and specific test
• Growing cost of NAT
• High prevalence of blood transmitted infection,
  increasing cost and risks
• Existence of Commercial Blood Donation
• Lack of trained manpower
                      Conclusion
• Effective screening for most common and dangerous
  TTIs can reduce the risk of transmission to very low
  levels
• Concerted efforts are still required to achieve 100%
  screening of donated blood for TTIs within quality systems
• Currently in Pakistan, regional ordinances exist but there is
  no single entity unifying them
• Pakistan needs a national blood service system that
  regulates SBT acts and ensures compliance through regular
  audits

								
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