Impact of screening donor blood for alanine aminotransferase and antibody to hepatitis B core antigen on the risk of hepatitis C virus transmission

  • A. M. Jullien
  • A. M. Couroucé
  • V. Massari
  • M. Maniez
  • P. Finetti
  • D. Brevière
  • M. Girard
  • T. Andréani
  • B. Habibi
Article

Abstract

The transfusion-related risk of transmission of hepatitis C virus (HCV) was evaluated in France for the periods before and after exclusion of donor blood units with the surrogate markers elevated alanine aminotransferase (ALT) levels and antibody to hepatitis B core antigen (anti-HBc). A total of 1,412 blood recipients undergoing surgery were followed up prospectively in the period from 1986 to 1989. The stored serum samples were tested for antibodies to HCV by an enzyme immunoassay (EIA) and the result in reactive sera confirmed by a recombinant immunoblot assay (RIBA). The risk of HCV transmission was estimated by the maximum likelihood method for a subpopulation of 892 recipients divided into three groups. Of 55 (3.9 %) EIA positive patients, 56.4 % were found to be positive prior to transfusion. HCV seroconversion (positive RIBA) occurred in 22 patients (1.6 %). The risk of HCV transmission per 1,000 transfused blood units decreased significantly from 4.11 in Group 1 (receiving non-screened blood) to 3.43 in Group II (receiving ALT screened blood) and to 1.40 in Group III (receiving ALT and anti-HBc screened blood). These results demonstrate that screening of donors for surrogate markers had reduced the risk of HCV transmission before the introduction of a systematic anti-HCV screening policy in France in March 1990.

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References

  1. 1.
    Kuo G, Choo QL, Alter HJ, Gitnick GL, Redeker AG, Purcell RH, Miyamura T, Dienstag JL, Alter MJ, Stevens CE, Tegtmeier GE, Bonino F, Colombo M, Lee WS, Kuo C, Berger K, Shuster JR, Overby LR, Bradley DW, Houghton M An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science 1989, 244: 362–364.PubMedGoogle Scholar
  2. 2.
    Alter HJ, Purcell RH, Shih JW, Melpolder JC, Houghton M, Choo QL, Kuo G Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis. New England Journal of Medicine 1989, 321: 1494–1500.PubMedCrossRefGoogle Scholar
  3. 3.
    Van Der Poel CL, Reesink HW, Lelie PN, Leentvaar-Kuypers A, Choo QL, Kuo G Anti-hepatitis C antibodies and non-A, non-B post-transfusion hepatitis in the Netherlands. Lancet 1989, ii: 297–298.Google Scholar
  4. 4.
    Alter HJ, Jett BW, Polito AJ, Farci P, Melpoder JC, Shih JW, Shimizu Y, Purcell R: Analysis of the role of hepatitis C virus in transfusion-associated hepatitis. In: Hollinger FB, Lemon SM, Margolis H (ed): Viral hepatitis and liver disease. Williams and Wilkins, 1990, p. 396–402.Google Scholar
  5. 5.
    Aach RD, Szmuness W, Mosley JW, Hollinger FB, Kahn RA, Stevens CE, Edwards VM, Werch J Serum alanine aminotransferase of donors in relation to the risk of non-A, non-B hepatitis in recipients. New England Journal of Medicine 1981, 304: 989–994.PubMedCrossRefGoogle Scholar
  6. 6.
    Alter HJ, Purcell RH, Holland PV, Alling DW, Koziol DE Donor transaminase and recipient hepatitis. Impact on blood transfusion services. Journal of the American Medical Association 1981, 246: 630–634.CrossRefPubMedGoogle Scholar
  7. 7.
    Stevens CE, Aach RD, Hollinger FB, Mosley JW, Szmuness W, Kahn R, Werch J, Edwards V Hepatitis B virus antibody in blood donors and the occurrence of non-A, non-B hepatitis in transfusion recipients. Annals of Internal Medicine 1984, 101: 733–738.PubMedGoogle Scholar
  8. 8.
    Koziol DE, Holland PV, Alling DW, Melpolder JC, Solomon RE, Purcell RH, Hudson LM, Shoup FJ, Krakauer H, Alter HJ Antibody to hepatitis B core antigen as a paradoxical marker for non-A, non-B hepatitis agents in donated blood. Annals of Internal Medicine 1986, 104: 488–495.PubMedGoogle Scholar
  9. 9.
    Habibi B, Smilovici W et leGroupe Hépatites Virales du Comité de Travail de la Société Nationale de Transfusion Sanguine Rapport sur la prévention des hépatites post-transfusionnelles non-A, non-B. Revue Française de Transfusion et Immunohématologie 1988, 31: 537–586.CrossRefGoogle Scholar
  10. 10.
    Weiner AJ, Truett MA, Rosenblatt J, Han J, Quan S, Polito AJ, Kuo G, Choo QL, Houghton M, Agius C, Page E, Nelles MJ HCV testing in low-risk population. Lancet 1990, 336: 695.CrossRefPubMedGoogle Scholar
  11. 11.
    Donahue JG, Munoz A, Ness PM, Brown DE, Yawn DH, McAllister HA, Reitz BA, Nelson KE The declining risk of post-transfusion hepatitis C virus infection. New England Journal of Medicine 1992, 327: 369–373.PubMedCrossRefGoogle Scholar
  12. 12.
    Engelman L Maximum likelihood estimation. In: Dixon WJ (ed): BMDP statistical software manual. University of California Press, Berkeley, 1990, p. 721–773.Google Scholar
  13. 13.
    Kalbfleisch JD, Prentice RL Statistical analysis of failure time data. J. Wiley, New York, 1981, p. 46.Google Scholar
  14. 14.
    Esteban JI, Gonzalez A, Hernandez JM, Viladomiu L, Sanchez C, Lopez-Talavera JC, Lucea D, Martin-Vega C, Vidal X, Esteban R, Guardia J Evaluation of antibodies to hepatitis C virus in a study of transfusion-associated hepatitis. New England Journal of Medicine 1990, 323: 1107–1112.PubMedCrossRefGoogle Scholar
  15. 15.
    Van der Poel CL, Reesink HW, Schaasberg W, Leentvaar-Kuypers A, Bakker E, Exel-Oehlers PJ, Lelie PN Infectivity of blood seropositive for hepatitis C virus antibodies. Lancet 1990, 335: 558–560.CrossRefPubMedGoogle Scholar
  16. 16.
    Zuck TF, Rose GA, Dumaswala UJ, Geer NJ Experience with a transfusion recipient education program about hepatitis C. Transfusion 1990, 30: 759–761.CrossRefPubMedGoogle Scholar
  17. 17.
    Aach RD, Stevens CE, Hollinger FB, Mosley JW, Peterson DA, Taylor PE, Johnson RG, Barbosa LH, Nemo GJ Hepatitis C virus infection in post-transfusion hepatitis. An analysis with first- and second-generation assays. New England Journal of Medicine 1991, 325: 1325–1329.PubMedCrossRefGoogle Scholar
  18. 18.
    Kleinman S, Busch M, Holland P Post-transfusion hepatitis C virus infection. New England Journal of Medicine 1992, 327: 1601.PubMedCrossRefGoogle Scholar
  19. 19.
    Nelson KE, Donahue JG, Stambolis V Post-transfusion hepatitis C virus infection. New England Journal of Medicine 1992, 327: 1601–1602.PubMedCrossRefGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1993

Authors and Affiliations

  • A. M. Jullien
    • 1
  • A. M. Couroucé
    • 2
  • V. Massari
    • 3
  • M. Maniez
    • 4
  • P. Finetti
    • 5
  • D. Brevière
    • 4
  • M. Girard
    • 1
  • T. Andréani
    • 6
  • B. Habibi
    • 1
  1. 1.Fondation Nationale de Transfusion SanguineEtablissement Saint-AntoineParis Cedex 12France
  2. 2.Institut National de Transfusion SanguineParisFrance
  3. 3.Institut National de la Santé et de la Recherche Médicale U263Université Paris 7ParisFrance
  4. 4.Centre Régional de Transfusion SanguineLilleFrance
  5. 5.Centre Médico-Chirurgical de la Porte de ChoisyFondation de L'AvenirParisFrance
  6. 6.Hôpital Saint-AntoineUnité d'Hépato-Gastroentérologie, Bâtiment de l'HorlogeParisFrance

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