青岛地区无偿献血人群HIV筛查结果回顾性调查

目的了解和掌握青岛地区无偿献血人群HIV感染情况,比较分析3种检测方法的结果,为加强血液管理提供决策依据。方法将本中心2013年6月14日-2014年6月14日采集的血液样本100 885人份进行血清学检测,其中99 637例ALT正常,TP抗体阴性的献血者样本进行了NAT,抗-HIV初筛阳性样本送往市疾病控制中心做确证实验,对3种方法的检测结果进行回顾性分析。结果抗-HIV反应性59例(阳性率为0.06%),其中抗-HIV和核酸同时反应性16例(阳性率为0.016%),43例抗-HIV单项反应性,未检出HIV核酸单项反应性样本,59例经确证阳性18例(感染率为17.84/10万),1例不确定,其中16例抗-HIV和核酸同时反应性样本经确证全部HIV阳性,43例抗-HIV单项反应性确证阳性2例,1例不确定。在16例血清学反应性(S/CO值大于15)、NAT阳性样本中,核酸检测的阳性预测值为100%。流行病学调查发现18例确证阳性献血者全部为男性,未婚11例(61.11%),已婚6例(33.33%),1例不祥;首次献血者8例(44.44%),重复献血者10例(55.56%)。结论 NAT的假阳性率远远低于血清学检测方法,针对HIV感染检测准确度高。为了保证血液质量和输血安全,除了加强实验室管理,提高HIV检测水平,我们应积极普及无偿献血知识和艾滋病相关知识的宣传教育,加强未婚男性青年的艾滋病防治工作。     

Dot enzyme‐linked immunosorbent assay strip as a screening tool for detection of autoantibody to interferon gamma in sera of suspected cases of adult‐onset immunodeficiency

Background

Being able to detect the presence of autoantibodies to interferon (IFN)‐γ in serum is essential for evaluating patients with suspected adult‐onset immunodeficiency (AOID) with unusual intracellular infections. Most reported patients with AOID have been Asian, although the exact prevalence of this illness is unknown. To date, no standard assay exists to detect autoantibodies to IFN‐γ. An easy‐to‐use, low‐cost assay that can be performed in any laboratory would be a valuable tool for clinical management of AOID, as well as better reveal its prevalence.

Methods

Our experimental study exploited a dot enzyme‐linked immunosorbent assay (Dot‐ELISA) strip to detect autoantibodies to IFN‐γ. Sera from 66 HIV‐negative patients having autoantibodies to IFN‐γ as determined by indirect ELISA were tested.

Results

Dot enzyme‐linked immunosorbent assay was sensitive (100%) and specific (94.5%), with a positive predictive value of 97.6% and a negative predictive value of 100%.

Conclusion

This simple method provides prompt qualitative results that can be read visually and used in facilities with limited testing capabilities.

     

海南地区无偿献血者不规则抗体筛查结果分析

目的调查分析本地区无偿献血者不规则抗体的发生频率和分布特点。方法随机抽取本中心2010年1月-2014年6月,无偿献血者血液标本344 148例,应用盐水法、凝聚胺法和抗球蛋白法筛查献血者不规则抗体。结果 344 148名无偿献血者中共检出不规则抗体78例,阳性率0.0227%。女性不规则抗体的检出率(0.0431%)明显高于男性(0.0129%)(P0.05)。抗体阳性献血者,以18-24岁年龄段人群比率最高,达到47.44%。检出的不规则抗体包括ABO亚型16例,抗-M 9例,抗-D 3例,抗-P11例,抗-Tja1例,冷自身抗体20例和非特异性不规则抗体28例。结论海南地区无偿献血人群中有一定比例的红细胞不规则抗体检出率,因此加强和重视不规则抗体筛查和鉴定工作,对保障临床安全用血具有重要意义。     

Risk factor analysis of hepatitis C virus infection among Chinese blood donors in Hong Kong

Background: Hepatitis C virus (HCV) infection can result in serious hepatic complications and hence potentially significant burden to the society. Despite advances in technology, transfusion‐transmitted HCV infection still exists. To further minimise the risk, a review on the epidemiology of HCV infection among Chinese blood donors in Hong Kong was conducted. Methods: All donations associated with HCV infection confirmed by positive serologic diagnosis with or without molecular confirmation during the period from 2003 to 2010 were studied. Demographic data were retrieved and risk factors were identified. Results: HCV infection was more commonly seen in first time donors and donors with blood transfusion history before the availability of HCV testing, whereas its association with intravenous drug use was noted to be decreasing. Interestingly, half of the HCV positive donors in 2008–2010 were young donors aged below 21, which was also the group with the highest rate of no known source of infection. Conclusion: A subgroup of younger age donors was found to have no known risk factor. To develop better screening strategy, it is recommended that a more detailed analysis of this group of donors is required.     

马达加斯加某医院献血员情况及 HIV 抗体筛查分析

目的：了解马达加斯加某医院2008～2009年献血员的基本情况和艾滋病毒抗体筛查情况，为以后更好的医疗援助马达加斯加及促进其临床输血领域的发展提供参考信息。方法口头询问方式获取献血员的基本信息，采用快速法检测 HIV 抗体，记录结果，计算数据的构成比，并进行χ2检验。结果2008～2009年共2298名献血员，有15岁及以下的献血者，女性献血员多于男性，其中有366名是孕妇；农村多于城市，文化程度以中学为主，占51．65％。2008年有22名结核病患者，2009年为0。两年艾滋病毒抗体阳性检出率为0．04％。结论非洲地区对献血者的保护不容乐观，存在孕妇和青少年献血的现象。     

Application of a new enzyme-linked immunosorbent assay for detection of total hepatitis C virus core antigen in blood donors

Recent studies have shown that total hepatitis C virus (HCV) core antigen, both free and antibody bound, is an accurate indirect marker of viral replication that can be used in clinical practice. The aim of the present study was to evaluate the performance of a new total HCV core antigen enzyme-linked immunosorbent assay (ELISA) for detection and quantification of total core antigen in blood donors, testing positive for anti-HCV antibodies and for prospective low-risk population screening. A population comprising 257 samples, from blood donors detected reactive for anti-HCV antibodies [137 recombinant immunoblot assay (RIBA) positive and 120 RIBA indeterminate], were tested by using a new total HCV core antigen ELISA. HCV-RNA was quantified by using quantitative polymerase chain reaction (PCR) assays in all RIBA-positive samples and RIBA-indeterminate samples that were positive for the total core antigen. Specificity of the assay was studied in 1070 healthy blood donors negative for anti-HCV antibodies. Compared with quantitative PCR assays, the total HCV core antigen assay showed 97.37% sensitivity. The three HCV-RNA-positive samples, which tested negative for the total core antigen, had a low viral load (< 1.4 x 10(4) IU mL(-1)). All samples with more than 1.4 x 10(4) IU mL(-1) of viral RNA were positive for total core antigen, independent of the HCV genotype. Concentration of total core antigen correlated significantly with those of HCV-RNA (r = 0.614, P < 0.0001). Overall specificity in freshly collected blood donor specimens was 99.63%. Our data indicate that the total HCV core antigen ELISA has a sensitivity close to PCR assays in diagnosing HCV infection in blood donors with anti-HCV antibodies and shows an excellent specificity in volunteer donors. This assay, in combination with anti-HCV antibodies screening tests, could be an alternative to molecular assays for HCV infection screening in blood donors.     

Significance of detecting anti‐HBc among Egyptian male blood donors negative for HBsAg*

Background: Screening for hepatitis B virus surface antigen (HBsAg) reduces the risk of transfusion‐transmitted hepatitis B viral (HBV) infection. However, the absence of HBsAg in the blood of apparently healthy individuals may not be sufficient to ensure the lack of circulating HBV. Blood containing anti‐hepatitis B core antibody (anti‐HBc) without detectable presence of HBsAg might be infectious; therefore, screening for anti‐HBc has been implemented in some countries resulting in a decrease in the risk of post‐transfusion HBV infection. Aim: To study the seroprevalence of anti‐HBc. The relationship between anti‐HBc positivity and the presence of circulating HBV among healthy blood donors negative for HBsAg will be helpful to decide whether supplemental testing may bring additional safety to blood products. Material and methods: A total of 1026 serum samples collected from HBsAg‐negative Egyptian healthy male donors were tested for the presence of anti‐HBc (both IgM and IgG types) using the competitive enzyme‐linked immunosorbent assay technique. Anti‐HBc‐positive samples were subjected to real‐time polymerase chain reaction to confirm the presence of HBV DNA. Results: Of the 1026 samples tested, 80 (7·8%) blood samples were found to be reactive to anti‐HBc. Of those, HBV DNA was detected in five of the samples (6·25%). The levels of detected viraemia were variable among the five donors. Conclusion: This study shows the insufficient effectiveness of HBsAg screening in protecting blood recipients from HBV infection. Inclusion of anti‐HBc testing should be considered in the screening of blood donors.     

我国5城市合格献血者血液HIV及HCV残余风险研究

目的研究我国献血者血液HIV及HCV残余风险;评估我国开展血液核酸检测(NAT)的可行性和必要性。方法采集乌鲁木齐、昆明、北京、广州、杭州5城市献血者血样,用Chiron Procleix HIV-1/HCV Assay血液核酸检测体系,对各项血清学筛查均合格的89 467份血液作16人份混合血样NAT检测,凡筛查不合格血样再作单人份检测;对于抗-HCV阴性而HCV RNA NAT阳性者,用备用管作抗-HCV、ALT、及HCV RNA NAT复检。结果共检出HCV RNA NAT阳性但抗-HCV EIA阴性标本3例,未检出HIV RNA NAT阳性但抗-HIV EIA阴性标本;在87 034份血清学筛查合格献血者中,检出HCV NAT阳性2例,其中1例复检ALT为254U/L,未检出HIVNAT阳性;在2 613份血清学筛查不合格者中,检出1例HCV NAT阳性但抗-HCV EIA阴性标本,该献血者抗-HIV阳性、ALT 372U/L;未检出HIV NAT阳性但抗-HIV EIA阴性的标本。结论血清学筛查使我国的血液安全性已有相当高的保障;而NAT技术可进一步提高血液的安全性,但在我国是否可应用于常规血液筛查,需考虑成本与效益比。此外,ALT筛查对排除抗-HCV漏检血液仍有一定的作用。     

The significance of repeat testing in Turkish blood donors screened with HBV,HCV and HIV immunoassays and the importance of S/CO ratios in the interpretation of HCV/HIV screening test results and as a determinant for further confirmatory testing

The purpose of this study was to investigate the intra‐assay correlations amongst initial reactive and repeat screening results used in enzyme immunoassays (EIAs) for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV in blood donors. This study evaluated the value of using the power of the signal to cut‐off (S/CO) ratio index for confirming anti‐HCV/HIV reactive screening results, thereby touching upon the utility of S/CO indices in determining whether further confirmatory testing was necessary. Screening test results of the 72 695 blood donors were evaluated over a 1‐year period. Correlation analysis among each initial test and retests was done by Pearson r test. Appropriate S/CO values to determine the need of the confirmation testing was investigated by ROC analyses. EIA intra‐assay correlations were of statistical significance and were determined as follows: 0·948 for anti‐HCV, 0·827 for anti‐HIV and 0·948 for HBsAg. The threshold S/CO ratio values which predicted more than 95% of the confirmation test result were 3·8 for HCV and 5·6 for HIV. We were able to demonstrate a strong level of intra‐assay correlation amongst EIAs, thereby eliminating the need for repetition of the screening test. Hence, we suggest that repeat screening should only be limited to HBV and HIV tests with low EIA S/CO ratios. Thus, using the power of the S/CO ratio in determining the need for HCV confirmation testing can be a cost‐effective measure, especially if the S/CO value is ≥3·8.     

Integrating women's perspectives on prenatal human immunodeficiency virus screening: Toward a socially just policy

The purpose of this study was to include the voices of laywomen at risk for or living with human immunodeficiency virus (HIV) in the ongoing debate on prenatal and newborn HIV screening. A phenomenological approach based on Moustakas's heuristic model was used in order to explore women's lived experience. The investigator interviewed 33 women, half of whom were HIV-positive, using an open-ended, loosely structured interview guide. Two major domains were identified related to the women's views and experiences of HIV testing: the importance of a woman's awareness of her HIV status for both her own and her child's sake, and the need to maintain voluntary choice. Common themes emerging from the stories included paradoxical dimensions of living with the virus, such as fear of death, worry about health, concern over the pandemic itself, and loneliness, interspersed with faith and hope. Implications for health care providers include an enhanced understanding of the impact of the diagnosis, improvement in counseling techniques, and the importance of the establishment of trust. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21:499–509, 1998     

Risk factors for chronic hepatitis B virus infection among blood donors in Bangalore,India

Objectives and Aim: We performed a study of hepatitis B virus (HBV) risk factors among blood donors in Bangalore, India. Background: HBV infection is prevalent in India and poses a potential risk of transmission by blood transfusion, but studies of risk factors for hepatitis B surface antigen (HBsAg) carriage among Indian blood donors are lacking. Methods/Materials: Using a case‐cohort design, we enrolled 71 cases with repeatedly reactive HBsAg results and a cohort of 212 contemporaneous blood donors with unknown HBsAg status. Questionnaire data were analysed using multivariable logistic regression. Results: In our multivariate analysis controlling for age, HBsAg positivity was associated with repeat donor status (OR = 0·34, 95% CI 0·17–0·71 vs first‐time donor status), residence outside Bangalore and Hosur (rural areas) (OR = 15·66, 95% CI 3·60–68·07vs Bangalore residence), having been a customer at a local barber shop (OR = 4·07, 95% CI 2·06–8·03), close contact with a person who had jaundice (OR = 13·64, 95% CI 3·71–50·24) and cigarette smoking (OR = 3·25, 95% CI 1·39–7·60). Conclusion: In addition to recognised demographic risk factors, associations with patronage of local barbers and contact with jaundiced individuals suggest behavioural risk factors that could be adopted as exclusionary criteria for blood donation in India.     

Blood safety begins with safe donations: update among blood donors in Yaounde, Cameroon

Blood safety continues to be an issue of concern in most countries of the African region. An important contributing factor to blood insecurity is the absence of regular, voluntary and nonremunerated blood donors. An update is provided on blood donors in Yaoundé, Cameroon. Raising the alarm through the dissemination of alarming statistics and continuous sensitization of the community remain strategies for attempting to provide a solution to a long-standing but dangerous problem.     

广东中山地区献血人群人类嗜T淋巴细胞病毒感染状况调查

目的了解中山地区人类嗜T淋巴细胞病毒(HTLV)在无偿献血人群中的感染情况。方法对2016年3-12月40 874份在中山地区无偿献血的血液标本,采用酶联免疫吸附试验方法(ELISA)进行HTLV抗体筛查,筛查呈反应性的标本进行双孔复查,复查仍阳性的标本使用免疫化学发光法(CLIA)检测,检测阳性的标本使用免疫蛋白印迹法(WB)进行确证,确证阳性的视为感染。结果中山地区40 874份无偿献血者中HTLV抗体ELISA检测阳性21例,ELISA检测阳性率为0.05%,免疫化学发光法检测阳性5例,WB确证阳性1例,感染率为0.002 4%。结论为了保证输血安全,降低输血感染HTLV,有必要对中山地区的初次献血者进行HTLV的筛查。     

献血员人类免疫缺陷病毒(HIV)筛检措施的系统评价的研究方案

背景 艾滋病(AIDS)已经成为人类目前所面临的危害最为严重的疾病之一。艾滋病病毒(HIV)主要有三个传播途径:血液、性行为和母婴垂直传播;而通过输血传播的效率更高。由于缺乏有效的HIV筛检方法或方法应用不当以及缺乏严格的管理,通过输血传播HIV的危险极为严重,特别是在一些发展中国家。自从1985年FDA批准第一个HIV试剂用于献血员筛检以来,迄今已经生产出第4代筛检试剂。最初HIV检测试剂仅用于筛检献血员,后来成为了HIV预防工作的重要方面。目前HIV筛检已被视为国家艾滋病预防和治疗策略的重要内容。目的 评价用于献血员HIV筛检所有方法的有效性,从而找出最合适的方法,以减少HIV通过输血传播的危险。检索策略 以“HIV”、“AIDS”、“screening”、“test”、“blood donor”、“blood bank”等为主题,检索了MEDLINE、CENTRAL/CCTR、AID-SLINE、EMBASE、CBM等数据库;同时检索了WHO、UNAIDS、CDC、FDA及其相关网站,并与该领域的专家和机构联系,以获得未发表的文献。资料纳入标准 纳入了所有与献血员HIV筛检方法有关的随机对照试验(RCT)、临床对照试验(CCT);同时一些观察性研究,如队列研究、病例对照研究和历史对照研究等纳入用于敏感性分析。评价方法参照Cochrane系统评价的原则,选择纳入的研究,并对其进     

Interventions to reduce vasovagal reactions in blood donors: a systematic review and meta‐analysis

Vasovagal reactions (VVRs) in blood donors have significant implications for the welfare of donors, donor retention and the management of donor sessions. We present a systematic review of interventions designed to prevent or reduce VVRs in blood donors. Electronic databases were searched for eligible randomised trials to March 2015. Data on study design and outcomes were extracted and pooled using random effects meta‐analyses. Sixteen trials met the inclusion criteria: five trials (12 042 participants) of pre‐donation water, eight trials (3500 participants) of applied muscle tension (AMT) and one trial each of AMT combined with water, caffeine, audio‐visual distraction and/or social support. In donors receiving pre‐donation water, the relative risk (RR) compared with controls for VVRs was 0·79 [95% confidence interval (CI) 0·70–0·89, P < 0·0001] and the mean difference (MD) in severity of VVRs measured with the Blood Donation Reactions Inventory (BDRI) score was ?0·32 (95% CI ?0·51 to ?0·12, P < 0·0001). Excluding trials with a high risk of selection bias, the RR for VVRs was 0·70 (95% CI 0·45–1·11, P = 0·13). In donors who received AMT, there was no difference in the risk of chair recline in response to donor distress from controls (RR 0·76, 95% CI 0·53–1·10, P = 0·15), although the MD in BDRI score was ?0·07 (95% CI ?0·11 to ?0·03, P = 0·0005). There was insufficient data to perform meta‐analysis for other interventions. Current evidence on interventions to prevent or reduce VVRs in blood donors is indeed limited and does not provide strong support for the administration of pre‐donation water or AMT during donation. Further large trials are required to reliably evaluate the effect of these and other interventions in the prevention of VVRs.