Hepatitis B virus prevalence in first-time blood donors in Flanders, Belgium: Impact of universal vaccination and migration.
Adolescent
Adult
Age Factors
Belgium
/ epidemiology
Blood Donors
Cross-Sectional Studies
Emigrants and Immigrants
/ statistics & numerical data
Female
Hepatitis B
/ blood
Hepatitis B Antibodies
/ blood
Hepatitis B Core Antigens
/ immunology
Hepatitis B Surface Antigens
/ blood
Hepatitis B Vaccines
Hepatitis B virus
/ isolation & purification
Humans
Male
Middle Aged
Prevalence
Risk Factors
Sex Factors
Transfusion Reaction
/ prevention & control
Urban Population
Vaccination
Viremia
/ blood
Young Adult
blood donation
hepatitis B
migration
sexual risk behavior
vaccination
Journal
Transfusion
ISSN: 1537-2995
Titre abrégé: Transfusion
Pays: United States
ID NLM: 0417360
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
24
03
2021
received:
08
10
2020
accepted:
30
03
2021
pubmed:
7
5
2021
medline:
14
8
2021
entrez:
6
5
2021
Statut:
ppublish
Résumé
Transfusion-transmissible infections such as hepatitis B virus (HBV) remain a major concern for the safety of blood transfusion. This cross-sectional study aimed to assess the trend of HBV prevalence and associated risk factors among a first-time donor population in a low endemic country. Between 2010 and 2018, blood samples were collected from first-time donors presented at donor collection sites of Belgian Red Cross-Flanders. They were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibodies (anti-HBc), and HBV DNA, HIV and hepatitis virus C (HCV) antibodies and RNA, and syphilis antibodies. A total of 211,331 first-time blood donors (43.7% males, median age 25 years) were analyzed. HBsAg prevalence decreased from 0.06% in 2010 to 0.05% in 2018 (p = .004) and this declining trend was accompanied by an increased number of donors in the HBV vaccinated birth cohort (p < .001). HBsAg prevalence was 0.33% in foreign-born donors and 0.02% in Belgian natives (p < .001). Multivariate risk profiling showed that anti-HBc positivity was significantly associated with mainly foreign-born donors (odds ratio [OR] = 9.24) but also with older age (OR = 1.06), male gender (OR = 1.32), year of blood donation (OR = 0.94), and co-infections with HCV (OR = 4.31) or syphilis (OR = 4.91). The decreasing trend in HBV prevalence could mainly be explained by the introduction of the universal HBV vaccination. Being born in endemic areas was the most important predictor for HBV infection while the co-infections with syphilis suggest unreported sexual risk contacts.
Sections du résumé
BACKGROUND
Transfusion-transmissible infections such as hepatitis B virus (HBV) remain a major concern for the safety of blood transfusion. This cross-sectional study aimed to assess the trend of HBV prevalence and associated risk factors among a first-time donor population in a low endemic country.
STUDY DESIGN AND METHODS
Between 2010 and 2018, blood samples were collected from first-time donors presented at donor collection sites of Belgian Red Cross-Flanders. They were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibodies (anti-HBc), and HBV DNA, HIV and hepatitis virus C (HCV) antibodies and RNA, and syphilis antibodies.
RESULTS
A total of 211,331 first-time blood donors (43.7% males, median age 25 years) were analyzed. HBsAg prevalence decreased from 0.06% in 2010 to 0.05% in 2018 (p = .004) and this declining trend was accompanied by an increased number of donors in the HBV vaccinated birth cohort (p < .001). HBsAg prevalence was 0.33% in foreign-born donors and 0.02% in Belgian natives (p < .001). Multivariate risk profiling showed that anti-HBc positivity was significantly associated with mainly foreign-born donors (odds ratio [OR] = 9.24) but also with older age (OR = 1.06), male gender (OR = 1.32), year of blood donation (OR = 0.94), and co-infections with HCV (OR = 4.31) or syphilis (OR = 4.91).
DISCUSSION
The decreasing trend in HBV prevalence could mainly be explained by the introduction of the universal HBV vaccination. Being born in endemic areas was the most important predictor for HBV infection while the co-infections with syphilis suggest unreported sexual risk contacts.
Substances chimiques
Hepatitis B Antibodies
0
Hepatitis B Core Antigens
0
Hepatitis B Surface Antigens
0
Hepatitis B Vaccines
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2125-2136Subventions
Organisme : Foundation for Scientific Research of the Belgian Red Cross
Informations de copyright
© 2021 AABB.
Références
Blachier M, Leleu H, Peck-Radosavljevic M, Valla D-C, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58(3):593-608.
Trépo C, Chan HLY, Lok A. Hepatitis B virus infection. Lancet. 2014;384(9959):2053-63.
Liu J, Liang W, Jing W, Liu M. Countdown to 2030: eliminating hepatitis B disease, China. Bull World Health Organ. 2019;97(3):230-8.
World Health Organization. Fact-sheet: Hepatitis B 2019. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. Accessed 3 Mar 2020.
Hatzakis A, Van Damme P, Alcorn K, et al. The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference. J Viral Hepat. 2013;20(s2):1-20.
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546-55.
Mahoney FJ. Update on diagnosis, management, and prevention of hepatitis B virus infection. Clin Microbiol Rev. 1999;12(2):351-66.
Quoilin S, Hutse V, Vandenberghe H, et al. A population-based prevalence study of hepatitis A, B and C virus using oral fluid in Flanders, Belgium. Eur J Epidemiol. 2007;22(3):195.
Beutels M, Van Damme P, Aelvoet W, et al. Prevalence of hepatitis A, B and C in the Flemish population. Eur J Epidemiol. 1997;13(3):275-80.
Koc ÖM, Kremer C, Bielen R, et al. Prevalence and risk factors of hepatitis B virus infection in Middle-Limburg Belgium, year 2017: importance of migration. J Med Virol. 2019;91(8):1479-88.
Van Kerschaver E. The Belgian Expanded Programme on Immunization (EPI) and hepatitis B vaccination. S Afr J Infect Dis. 2008;23(1):40-4.
Borra V, Vandewalle G, Van Remoortel H, Compernolle V, De Buck E, Vandekerckhove P. Blood donor deferral: time for change? An evidence-based analysis. Int J Clin Transfus Med. 2016;4:55-66.
De Kort W, Mayr W, Jungbauer C, et al. Blood donor selection in European Union directives: room for improvement. Blood Transfus. 2016;14(2):101-8.
Offergeld R, Kamp C, Heiden M, Norda R, Behr-Gross M-E. Sexual risk behaviour and donor deferral in Europe. Vox Sang. 2014;107(4):420-7.
De Buck E, Dieltjens T, Compernolle V, Vandekerckhove P. Is having sex with other men a risk factor for transfusion-transmissible infections in male blood donors in Western countries? A systematic review. PLoS One. 2015;10(4):e0122523.
Van Remoortel H, Matthysen W, Avau B, Compernolle V, Vandekerckhove P, De Buck E. Is sexual risk behaviour associated with an increased risk of transfusion-transmissible infections in blood donors from Western and Pacific countries? A systematic review and meta-analysis. Vox Sang. 2020;115:107-123.
Van Remoortel H, Moorkens D, Avau B, Compernolle V, Vandekerckhove P, De Buck E. Is there a risk of transfusion-transmissible infections after percutaneous needle treatments in blood donors? A systematic review and meta-analysis. Vox Sang. 2019;114:297-309.
Charbonneau J, Daigneault S. Engaging ethnic minority blood donors. ISBT Sci Ser. 2016;11(S1):140-7.
Al-Riyami AZ, Al-Marhoobi A, Al-Hosni S, et al. Prevalence of red blood cell major blood group antigens and phenotypes among Omani blood donors. Oman Med J. 2019;34(6):496-503.
Allain J-P. Occult hepatitis B virus infection: implications in transfusion. Vox Sang. 2004;86(2):83-91.
Allain J-P, Mihaljevic I, Gonzalez-Fraile MI, et al. Infectivity of blood products from donors with occult hepatitis B virus infection. Transfusion. 2013;53(7):1405-15.
Hoofnagle JH, Seeff LB, Bales ZB, Zimmerman HJ. Type B hepatitis after transfusion with blood containing antibody to hepatitis B core antigen. N Engl J Med. 1978;298(25):1379-83.
van de Laar TJ, Van Gaever VA, Swieten PV, Muylaert A, Compernolle V, Zaaijer HL. Phylogenetic analysis reveals three distinct epidemiological profiles in Dutch and Flemish blood donors with hepatitis B virus infection. Virology. 2018;515:243-9.
Lin C-C, Li C-I, Hsiao C-Y, et al. Time trend analysis of the prevalence and incidence of diagnosed type 2 diabetes among adults in Taiwan from 2000 to 2007: a population-based study. BMC Public Health. 2013;13(1):318.
Stolz M, Tinguely C, Fontana S, Niederhauser C. Hepatitis B virus DNA viral load determination in hepatitis B surface antigen-negative Swiss blood donors. Transfusion. 2014;54(11):2961-7.
Houareau C, Offergeld R. Anti-HBc screening - is it worth the effort? Results of a 10-year surveillance programme covering more than 30 million donations in Germany. Vox Sang. 2019;114(5):459-66.
van de Laar TJ, Marijt-van der Kreek T, Molenaar-de Backer MW, Hogema BM, Zaaijer HL. The yield of universal antibody to hepatitis B core antigen donor screening in the Netherlands, a hepatitis B virus low-endemic country. Transfusion. 2015;55(6):1206-13.
Roth WK, Seifried E. The German experience with NAT. Transfus Med. 2002;12(4):255-8.
Atsma F, Veldhuizen IJT, Verbeek ALM, de Kort W, de Vegt F. Healthy donor effect: its magnitude in health research among blood donors. Transfusion. 2011;51(8):1820-8.
Hofstraat S, Falla A, Duffell E, et al. Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol Infect. 2017;145(14):2873-85.
Ahmad AA, Falla AM, Duffell E, et al. Estimating the scale of chronic hepatitis B virus infection among migrants in EU/EEA countries. BMC Infect Dis. 2018;18(1):34.
Mitchell T, Armstrong GL, Hu DJ, Wasley A, Painter JA. The increasing burden of imported chronic hepatitis B-United States, 1974-2008. PLoS One. 2011;6(12):e27717.
Slot E, Janssen MP, Marijt-van der Kreek T, Zaaijer HL, van de Laar TJ. Two decades of risk factors and transfusion-transmissible infections in Dutch blood donors. Transfusion. 2016;56(1):203-14.
Marschall T, Kretzschmar M, Mangen M-JJ, Schalm S. High impact of migration on the prevalence of chronic hepatitis B in The Netherlands. Eur J Gastroenterol Hepatol. 2008;20(12):1214-25.
Koc ÖM, Van Damme P, Busschots D, et al. Acute hepatitis B notification rates in Flanders, Belgium, 2009 to 2017. Euro Surveill. 2019;24(30):1900064.
Romano L, Paladini S, Van Damme P, Zanetti AR. The worldwide impact of vaccination on the control and protection of viral hepatitis B. Dig Liver Dis. 2011;43:S2-7.
Zheng X, Ye X, Du P, et al. High prevalence of anti-hepatitis B core antigen in hepatitis B virus-vaccinated Chinese blood donors suggests insufficient protection but little threat to the blood supply. Transfusion. 2015;55(4):890-7.
Koc ÖM, Kuypers D, Dupont LJ, et al. The effect of universal infant vaccination on the prevalence of hepatitis B immunity in adult solid organ transplant candidates. J Viral Hepat. 2021;28(1):105-11.
Theeten H, Hutse V, Hoppenbrouwers K, Beutels P, Van Damme P. Universal hepatitis B vaccination in Belgium: impact on serological markers 3 and 7 years after implementation. Epidemiol Infect. 2014;142(2):251-61.
del Canho R, Grosheide PM, Mazel JA, et al. Ten-year neonatal hepatitis B vaccination program, The Netherlands, 1982-1992: protective efficacy and long-term immunogenicity. Vaccine. 1997;15(15):1624-30.
Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust. 2009;190(9):489-92.
Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States; recommendations of the Advisory Committee on Immunization Practices (ACIP); Immunization of adults; Part II. MMWR Recomm Rep. 2006;55(RR-19):1-25.
Zhang J, Zou S, Giulivi A. Epidemiology of hepatitis B in Canada. Can J Infect Dis. 2001;12(6):345-50.
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Infect. 2013;40(3):187-93.
Meffre C, Le Strat Y, Delarocque-Astagneau E, et al. Prevalence of hepatitis B and hepatitis C virus infections in France in 2004: social factors are important predictors after adjusting for known risk factors. J Med Virol. 2010;82(4):546-55.
Karvonen T, Auranen K, Kuusi M, Leino T. Epidemiology of hepatitis B infection in Finland: implications for immunisation policy. Vaccine. 2017;35(3):412-8.
Ramachandran S, Groves JA, Xia G-l, et al. Recent and occult hepatitis B virus infections among blood donors in the United States. Transfusion. 2019;59(2):601-11.
Stramer SL, Notari EP, Krysztof DE, Dodd RY. Hepatitis B virus testing by minipool nucleic acid testing: does it improve blood safety? Transfusion. 2013;53(10 Pt 2):2449-58.