title: The persistence of hepatitis C virus transmission risk in China despite serologic screening of blood donations.
abstract: BACKGROUND
  A total of 2%-2.9% of the population in China is infected with hepatitis C virus (HCV). This study estimated the prevalence and incidence of HCV among Chinese blood donors.
  
  
  METHODS
  We examined whole blood and apheresis platelet donations at five Chinese blood centers in 2008 to 2010. All donations were screened using two rounds of testing for alanine aminotransferase, antibody to human immunodeficiency virus Types 1 and 2, hepatitis B surface antigen, anti-HCV, and syphilis. Screening reactivity is defined by a reactive result in one or both rounds of screening tests. Confirmatory tests (Ortho third-generation HCV enzyme immunoassay, Johnson & Johnson) were performed on anti-HCV screening-reactive samples. Confirmatory positive rates among first-time donors (prevalence) and repeat donors (incidence) were calculated by blood center and demographic categories. Donor characteristics associated with HCV confirmatory status among first-time donors were examined using trend test and multivariable logistic regression analysis.
  
  
  RESULTS
  Among 821,314 donations, 40% came from repeat donors. The overall anti-HCV screening-reactive rate was 0.48%. Estimated HCV prevalence was 235 per 100,000 first-time donors; incidence was 10 per 100,000 person-years in repeat donors. In multivariable logistic regression analysis, first-time donors older than 25 years displayed higher HCV prevalence than the younger donors. Less education is associated with higher HCV prevalence. Donors 26 to 35 years old and those above 45 years displayed the highest incidence rate.
  
  
  CONCLUSIONS
  High prevalence and incidence in donors indicate high residual risks for transfusion-transmitted HCV in Chinese patients. Implementation of minipool nucleic acid testing in routine donation screening may prevent a substantial number of transfusion-transmitted HCV infections.
authors.affiliation: Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China; Johns Hopkins School of Medicine, Baltimore, Maryland; Westat, Inc., Rockville, Maryland; Guangxi Blood Center, Liuzhou, Guangxi, P.R. China; Kunming Blood Center, Kunming, Yunnan, P.R. China; Urumqi Blood Center, Urumqi, Xinjiang, P.R. China; Mianyang Blood Center, Mianyang, Sichuan, P.R. China; Luoyang Blood Center, Luoyang, Henan, P.R. China; Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Jingxing
authors.initials: J
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
authors.forename: David J
authors.initials: DJ
authors.lastname: Wright
authors.forename: Julin
authors.initials: J
authors.lastname: Li
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Zhou
authors.forename: Weilan
authors.initials: W
authors.lastname: He
authors.forename: Tonghan
authors.initials: T
authors.lastname: Yang
authors.forename: Fuzhu
authors.initials: F
authors.lastname: Yao
authors.forename: Xiangming
authors.initials: X
authors.lastname: Zhu
authors.forename: Guoxin
authors.initials: G
authors.lastname: Wen
authors.forename: Xinhong
authors.initials: X
authors.lastname: Bi
authors.forename: Mei-hei-li
authors.initials: MH
authors.lastname: Tiemuer
authors.forename: Xiuqiong
authors.initials: X
authors.lastname: Wen
authors.forename: Mei
authors.initials: M
authors.lastname: Huang
authors.forename: Ru'an
authors.initials: R
authors.lastname: Cao
authors.forename: Zhongqiao
authors.initials: Z
authors.lastname: Yun
authors.forename: Yunlai
authors.initials: Y
authors.lastname: Lü
authors.forename: Hongli
authors.initials: H
authors.lastname: Ma
authors.forename: Nan
authors.initials: N
authors.lastname: Guo
authors.forename: Qilu
authors.initials: Q
authors.lastname: Yu
authors.forename: Paul
authors.initials: P
authors.lastname: Ness
authors.forename: Hua
authors.initials: H
authors.lastname: Shan
mesh_terms: D000328:Adult; D000368:Aged; D001782:Blood Donors / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012698:Serologic Tests / Q000706:statistics & numerical data; D065227:Transfusion Reaction; D055815:Young Adult