Annals of Hematology

, Volume 72, Issue 1, pp 35–39 | Cite as

Risk of hepatitis C virus (HCV) transmission by anti-HCV-negative blood components in Austria and Germany

  • J. Riggert
  • D. W. M. Schwartz
  • A. Uy
  • G. Simson
  • F. Jelinek
  • H. Fabritz
  • W. R. Mayr
  • M. Köhler
Original Article


In order to estimate the residual risk of transfusion-transmitted HCV infection, we have analyzed data from two transfusion centers in Austria (Vienna) and Germany (G6ttingen) from 1990 to 1995. In Vienna, the seroprevalence (RIBA-confirmed third-generation anti-HCV tests) was 0.28% in first-time donors (FTD) and the incidence of seroconversion in repeat donors (RD) was 0.049 (per 100 person years) from 1994 to 1995. In Göttingen, the prevalence of a PCR-confirmed positive third-generation anti-HCV test was 0.22% in FTDs and the incidence was 0.093 (per 100 person years). A continuous decline of the rate of anti-HCV-positive donations and donors was observed with first- and second-generation anti-HCV tests in the years 1990–1994. The introduction of the third-generation anti-HCV test resulted in increased numbers of anti-HCV positive repeat donors, mainly due to false-positive results. Only 9% of anti-HCV-positive repeat donors were either PCR positive or RIBA positive or indeterminate. Based on a mathematical model which takes (a) the window period, (b) the false-negative rate of anti-HCV tests, and (c) human and operational errors into consideration, we have calculated the residual risk of HCV infection. We used a window period of 74 days, a sensitivity of 98%, and an error rate of 0.1%. The residual risk (for third-generation anti-HCV test-negative blood components) was calculated to be 1:9000 (95% confidence interval 1:16390–1:6210) and 1:4800 (95% confidence interval 1:40000–1:1320) for Vienna and Göttingen, respectively, in 1994 and 1995. Since this conservative approach does not take the impact of ALAT screening into account, the actual risk is probably lower.

Key words

HCV Risk Blood transfusion PCR RIBA Incidence Prevalence 


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  1. 1.
    Aach RD, Stevens CE, Hollinger FB, Mosley JW, Peterson DA, Taylor PE, Johnson RG, Barbosa LH, Nemo GJ (1991) Hepatitis C virus infection in post-transfusion hepatitis. An analysis with first- and second-generation assays. N Engl J Med 325:1325–1329Google Scholar
  2. 2.
    Allander T, Gruber A, Naghavi M, Beyene A, Söderström T, Björkholm M, Grillner L, Persson MAA (1995) Frequent patient-to-patient transmission of hepatitis C virus in a haematology ward. Lancet 345:603–607Google Scholar
  3. 3.
    Alter HJ (1995) To C or not to C: these are the questions. Blood 85:1681–1695Google Scholar
  4. 4.
    Alter HJ, Purcell RH, Shih JW, Melpolder JC, Houghton M, Choo QL, Kuo G (1989) Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis. N Engl J Med 321:1494–1500Google Scholar
  5. 5.
    Alter MJ, Margolis HS, Krawczynski K, Judson FN, Mares A, Alexander WJ, Hu PY, Miller JK, Gerber MA, Sampliner RE, Meeks EL, Beach MJ, for the Sentinel Counties Chronic non-A, non-B Hepatitis Study Team (1992) The natural history of community-acquired hepatitis C in the United States. N Engl J Med 327:1899–1905Google Scholar
  6. 6.
    Baele PL, De Bruyere M, Deneys V, Dupont E, Flament J, Lambermont M, Latinne D, Steensens L, van Camp B, Waterloos H (1994) Bedside transfusion errors. A survey by the Belgium SANGUIS group. Vox Sang 66:117–121Google Scholar
  7. 7.
    Barrera JM, Francis B, Ercilla G, Nelles M, Achord D, Darner J, Lee SR (1995) Improved detection of anti-HCV in post-transfusion hepatitis by a third-generation ELISA. Vox Sang 68:15–18Google Scholar
  8. 8.
    Blajchman MA, Bull SB, Feinman SV, for the Canadian Post-Transfusion Hepatitis Prevention Study Group (1995) Posttransfusion hepatitis: impact of non-A, non-B hepatitis surrogate tests. Lancet 345:21–25Google Scholar
  9. 9.
    Bresters D, Cuypers HT, Reesink HW, Shasberg WP, van der Poel CL, Mauser-Bunschoten EP, Houghton M, Choo QL, Kuo G, Lesniewski R (1992) Enhanced sensitivity of a second-generation ELISA for antibody to hepatitis C virus. Vox Sang 62:213–217Google Scholar
  10. 10.
    Clemens JM, Taskar S, Chan K, Vallari D, Shih JWK, Alter HJ, Schleicher JB, Mimms LT (1992) IgM antibody response in acute hepatitis C viral infection. Blood 79:169–172Google Scholar
  11. 11.
    Courouce AM, Barin F, Botte C, Lunel F, Maisonneuve P, Maniez M, Trepo C (1995) A comparative evaluation of seven anti-hepatitis C virus screening tests. Vox Sang 69:213–216Google Scholar
  12. 12.
    Da Silva Cardoso M, Koerner K, Epple S, Kubanek B (1993) Prevalence of HCV-RNA-positive blood donors and correlation to ELISA and RIBA status. Ann Haematol 66:147–151Google Scholar
  13. 13.
    Dodd RY, Reesink HW, Busch MP, Petersen LR, Lackritz EM, Blajchman MA, Barbara JAJ, Kuehnl P, Knoedler B, Schönitzer D, Högman CF, Lindholm A, Sekiguchi S, Wendel S (1995) International Forum. Do surrogate tests improve the safety of the blood supply? Vox Sang 69:280–291Google Scholar
  14. 14.
    Donahue JG, Munoz A, Ness PM, Brown DE, Yawn DH, McAllister HA, Reitz BA, Nelson KE (1992) The declining risk of post-transfusion hepatitis C virus infection. N Engl J Med 327:369–373Google Scholar
  15. 15.
    Esteban JI, Gonzalez A, Hernandez JM, Viladomiu L, Sanchez C, Lopez-Talavera JC, Lucea D, Martin-Vega C, Vidal X, Esteban R, Guardia J (1990) Evaluation of antibodies to hepatitis C virus in a study of transfusion-associated hepatitis. N Engl J Med 323:1107–1112Google Scholar
  16. 16.
    Esteban JI, Lopez-Talavera JC, Genasca J, Gonzalez A, Vargas V, Buti M, Guardia J, Esteban R (1992) Evaluation of anti-HCV positive blood donors identified during routine screening. Arch Virol 4 [Suppl]: 244–246Google Scholar
  17. 17.
    Fabrizi F, Lunghi G, Guarnori I, Raffaele L, Crepaldi M, Pagano A, Locatelli F (1994) Incidence of seroconversion for hepatitis C virus in chronic haemodialysis patients: a prospective study. Nephrol Dial Transplant 9:1611–1615Google Scholar
  18. 18.
    Garson JA, Tedder RS, Briggs M, Tuke P, Glazebrook JA, Trute A, Parker D, Barbara JAJ, Contreras M, Aloysius S (1990) Detection of hepatitis viral sequences in blood donations by “nested” polymerase chain reaction and prediction of infectivity. Lancet 335:1419–1422Google Scholar
  19. 19.
    Geberding JL (1994) Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and cytomegalovirus among health care personnel at risk for blood exposure: final report from a longitudinal study. J Infect Dis 170:1410–1417Google Scholar
  20. 20.
    Koerner K, da Silva Kardosos M, Dengler T, Kerowgan M, Kubanek B (1995) Look back on hepatitis C-virus infections of HCV-RIBA-2-positive blood donors and their respective recipients (letter). Vox Sang 69:78–79Google Scholar
  21. 21.
    Miyamura T, Saito I, Katayama T, Kikuchi S, Tateda A, Houghton M, Choo QL, Kuo G (1990) Detection of antibody against antigen expressed by molecularly cloned hepatitis virus cDNA: application to diagnosis and blood screening for post-transfusion hepatitis. Proc Natl Acad Sci U S A 87:983–987Google Scholar
  22. 22.
    Nelson KE, Donahue JG, Stambolis V (1992) Post-transfusion hepatitis C virus infection (letter). N Engl J Med 327:1601–1602Google Scholar
  23. 23.
    Nübling CM, Willkommen H, Lower J (1995) Hepatitis C transmission associated with intravenous immunoglobulins (letter). Lancet 345:1174Google Scholar
  24. 24.
    Schwartz DWM, Simson G, Baumgarten K, Fabritz H, Riggert J, Neumeyer H, Mayr WR, Kohler M (1995) Risk of human immunodeficiency virus (HIV) transmission by anti HIV-negative blood components in Germany and Austria. Ann Haematol 70:209–213Google Scholar
  25. 25.
    Seeff LB, Buskell-Bales Z, Wright EC, Durako SJ, Alter HJ, Iber FL, Hollinger FB, Gitnick G, Knodell RG, Perillo RP, Stevens CE, Hollingsworth CE, and the National Heart, Lung, and Blood Institute Study Group (1992) Long-term mortality after transfusion-associated non-A, non-B hepatitis. N Engl J Med 327:1906–1911Google Scholar
  26. 26.
    Shimizu YK, Weiner AJ, Rosenblatt J, Wong DC, Shapiro M, Popkin T, Houghton M, Alter HJ, Purcell RH (1990) Early events in hepatitis C virus infection of chimpanzees. Proc Natl Acad Sci U S A 87:6441–6444Google Scholar
  27. 27.
    Silva AE, Hosein B, Boyle RW, Fang CT, Shindo M, Waggoner JE, Hoofnagle JA, DiBisceglie AM (1994) Diagnosis of chronic hepatitis C: comparison of immunoassays and the polymerase chain reaction. Am J Gastroenterol 89:493–496Google Scholar
  28. 28.
    Tong MJ, El-Farra NS, Reikes AR, Co RL (1995) Clinical outcomes after transfusion-associated hepatitis C. N Engl J Med 332:1463–1466Google Scholar
  29. 29.
    Uyttendaele S, Claeys H, Mertens W, Verhaert H, Vermylen C (1994) Evaluation of third-generation screening and confirmatory assays for HCV antibodies. Vex Sang 66:122–129Google Scholar
  30. 30.
    Vallari DS, Jett BW, Alter HJ, Mimms LT, Holzman R, Shih JWK (1992) Serological markers of post-transfusion hepatitis C virus infection. J Clin Microbiol 30:552–556Google Scholar
  31. 31.
    Vrielink H, van der Poel CL, Reesink HW, Zaijer HL, Scholten E, Kremer LCM, Cuypers HTM, Lelie PN, van Oers MHJ (1995) Look-back study of infectivity of anti-HCV ELISA-positive blood components. Lancet 345:95–96Google Scholar
  32. 32.
    Vrielink H, van der Poel CL, Reesink HW, Zaijer HL, Lelie PN (1995) Transmission of hepatitis C virus by anti-HCV-negative blood transfusion. Vox Sang 68:55–56Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • J. Riggert
    • 1
  • D. W. M. Schwartz
    • 2
  • A. Uy
    • 1
  • G. Simson
    • 1
  • F. Jelinek
    • 2
  • H. Fabritz
    • 1
  • W. R. Mayr
    • 2
  • M. Köhler
    • 1
  1. 1.Department of Transfusion Medicine, and Department of MicrobiologyUniversity of GöttingenGöttingenGermany
  2. 2.University Clinic for Blood Group Serology and Transfusion Medicine and Austrian Red Cross Blood Donation Center for Vienna, Lower Austria and BurgenlandUniversity of ViennaViennaAustria

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