title: Seroprevalence of transfusion-transmissible infections and evaluation of the pre-donation screening performance at the Provincial Hospital of Tete, Mozambique.
abstract: BACKGROUND
  The World Health Organization recommends universal and quality-controlled screening of blood donations for the major transfusion-transmissible infections (TTIs): human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis. The study objectives were to determine the seroprevalence of these TTIs among blood donors at the Provincial Hospital of Tete, Mozambique, and to assess the local pre-donation screening performance.
  
  
  METHODS
  All consenting voluntary and replacement candidate blood donors were consecutively included from February to May 2009. Sera of all candidates, independent of deferral by questionnaire, were submitted to screening with quality-assured rapid or simple assays for HIV, HBV surface antigen (HBsAg), HCV and syphilis. Assays locally used by the blood bank for HBV and syphilis screening were run in parallel to quality-assured external assays supplied during the study, and all discordant samples were submitted to confirmation testing in reference laboratories in Mozambique and Belgium.
  
  
  RESULTS
  Of 750 consenting candidates (50.5% of voluntary donors), 71 (9.5%) were deferred by the questionnaire, including 38 specifically because of risk behavior for TTI. Of the 679 non-deferred candidates, 127 (18.7%) had serological confirmation of at least one TTI, with a lower prevalence in voluntary than in replacement donors (15.2% versus 22.4%, p = 0.016). Seroprevalence of HIV, HBsAg and syphilis infections was 8.5%, 10.6 % and 1.2%. No confirmed HCV infection was found. Seroprevalence of TTIs was similar in the 38 candidates deferred for TTI risk as in the non-deferred group, except for HBsAg (26.3 % versus 10.6 %; p = 0.005). The local assays used for HBV and syphilis had sensitivities of 98.4% and 100% and specificities of 80.4% and 98.8% respectively. This resulted in the rejection of 110 of the 679 blood donations (16.2%) because of false positive results.
  
  
  CONCLUSIONS
  The seroprevalence of TTIs after questionnaire screening is high in Tete, Mozambique, but HCV infection does not appear as a major issue. The questionnaire did not exclude effectively HIV-infected donor candidates, while the locally used assays led to unnecessary rejection of many safe donations. A contextualized questionnaire and consistent use of quality-assured assays would considerably improve the current screening procedure for blood donation.
authors: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Jocelijn
authors: J
authors: Stokx
authors: Philippe
authors: P
authors: Gillet
authors: Anja
authors: A
authors: De Weggheleire
authors: Esther C
authors: EC
authors: Casas
authors: Rosa
authors: R
authors: Maendaenda
authors: Adelino J
authors: AJ
authors: Beulane
authors: Ilhes V
authors: IV
authors: Jani
authors: Solon
authors: S
authors: Kidane
authors: Carla D
authors: CD
authors: Mosse
authors: Jan
authors: J
authors: Jacobs
authors: Emmanuel
authors: E
authors: Bottieau
references: Bull World Health Organ. 2004 Jun;82(6):439-46
references: 15356937
references: J Med Virol. 2007 Dec;79(12):1832-40
references: 17935167
references: Expert Rev Mol Diagn. 2005 Jan;5(1):31-41
references: 15723590
references: Transfusion. 2009 Apr;49(4):669-75
references: 19170991
references: Transfusion. 2009 Oct;49(10):2237-40
references: 19903285
references: Biologicals. 2010 Jan;38(1):59-64
references: 20079664
references: Transfusion. 2008 Feb;48(2):273-81
references: 18005323
references: AIDS Res Hum Retroviruses. 2007 Dec;23(12):1491-8
references: 18160006
references: Transfusion. 2008 Jun;48(6):1256-61
references: 18713111
references: Trop Med Int Health. 2006 Jun;11(6):951-4
references: 16772018
references: J Clin Pathol. 2007 Oct;60(10):1073-5
references: 17412874
references: Transfus Clin Biol. 2009 Nov-Dec;16(5-6):444-7
references: 19896404
references: Transfusion. 2005 Feb;45(2):133-40
references: 15660820
references: Transfusion. 2009 Aug;49(8):1600-8
references: 19527479
references: J Med Virol. 2001 Sep;65(1):1-5
references: 11505436
references: Transfus Med. 2007 Dec;17(6):434-42
references: 18067647
references: Croat Med J. 2003 Oct;44(5):639-50
references: 14515429
references: Transfusion. 2010 Feb;50(2):433-42
references: 19843290
references: Curr Opin Hematol. 2007 Nov;14(6):671-6
references: 17898573
references: Int J Tuberc Lung Dis. 2009 Mar;13(3):277-8
references: 19275783
references: PLoS Med. 2007 Oct 16;4(10):e297
references: 17941715
references: Lancet Infect Dis. 2002 May;2(5):293-302
references: 12062995
references: BMC Public Health. 2006 Jan 30;6:21
references: 16445860
references: Med Decis Making. 1999 Jul-Sep;19(3):296-306
references: 10424836