ABSTRACT Hepatitis B and hepatitis C threatens safety of the recipients and the community as a whole and are subject of real concern worldwide. To assess the seroprevalence of HBV and HCV among blood donors at a tertiary care hospital-based blood bank in Punjab.7000 blood donors (5450 voluntary and 1550 replacement donors) were studied. All the blood donors were screened for HBsAg and anti-HCV antibodies (third generation ELISA). Seroprevalence of HBsAg and HCV were 0.91% and 0.83% respectively. Seropositivitywas higher among replacement donors than voluntary donors in HBsAg (1.39% vs. 0.79%) and HCV (1.22% vs. 0.72%). Seroprevalence was more in age group 31-40 years and higher in rural area donors. The incidence decreased in repeat donors. Prevalence of HBsAg was higherthan anti HCV. Stringent measures need to be taken including dissemination of information andvigilant donor screening, screening of blood unit with sensitive techniques like NAT,inclusion of antibody to hepatitis B core antigen. Key words: Blood donors, HBsAg, anti-HCV, voluntary donor, replacement donor. Key message: Repeat voluntary donors are safest and inclusion of sensitive techniques like NAT, antibodies to HBcAg and HCV RNA for donor screening will improve blood safety further. Educate rural masses about the prevention of viral diseases

B L Bhardwaj

Kanchan Bhardwaj

Prasad Km

Ravisha Bhardwaj

CiteSeerX

          ISSN: 0975-8585 
October - December     2013           RJPBCS          Volume 4 Issue 4    Page No. 1272 
Research Journal of Pharmaceutical, Biological and Chemical 
Sciences 
 
Seroprevalenceof HBs Ag and HCV in Healthy Blood Donors at a Tertiary Care 
Hospital in India. 
 
 
Kanchan Bhardwaj1, Prasad KM2, Ravisha Bhardwaj3, and BL Bhardwaj4 
 
1
Assosiate Professor and In charge, Dept. of transfusion Medicine Immunohematology, Govt Medical College, 
Patiala, Punjab, India. 
2
Junior Resident, Dept of Medicine, Govt Medical College, Patiala, Punjab, India. 
3
Internee, Dept of Medicine, Govt Medical College, Patiala, Punjab, India. 
4
Professor, Dept of Medicine, Govt Medical college, Patiala, Punjab, India. 
 
 
 
 
 
ABSTRACT 
 
 Hepatitis B and hepatitis C threatens safety of the recipients and the community as a whole and are 
subject of real concern worldwide. To assess the seroprevalence of HBV and HCV  among blood donors at a 
tertiary care hospital-based blood bank in Punjab.7000 blood donors (5450 voluntary and 1550 replacement 
donors) were studied. All the blood donors were screened for HBsAg and anti-HCV antibodies (third 
generation ELISA). Seroprevalence of HBsAg and HCV were 0.91% and 0.83% respectively.  Seropositivitywas 
higher among replacement donors than voluntary donors in HBsAg (1.39% vs. 0.79%) and HCV (1.22% vs. 
0.72%). Seroprevalence was more in age group 31-40 years and higher in rural area donors. The incidence 
decreased in repeat donors. Prevalence of HBsAg was higherthan anti HCV. Stringent measures need to be 
taken including dissemination of information andvigilant donor screening, screening of blood unit with 
sensitive techniques like NAT,inclusion of antibody to hepatitis B core antigen. 
Key words: Blood donors, HBsAg, anti-HCV, voluntary donor, replacement donor. 
 
Key message: Repeat voluntary donors are safest and inclusion of sensitive techniques like NAT, antibodies to 
HBcAg and HCV RNA for donor screening will improve blood safety further. Educate rural masses about the 
prevention of viral diseases. 
 
 
 
 
 
 
 
 
 
 
 
 
*Corresponding author 
          ISSN: 0975-8585 
October - December     2013           RJPBCS          Volume 4 Issue 4    Page No. 1273 
INTRODUCTION 
 
          Hepatitis B and hepatitis C are highly infectious and pose a major public health 
problem worldwide. The problem in developing countries has increased by the poor 
economical status of the patients. About 3% of world’s population or almost 200 million 
individuals have chronic HCV infection.[1] The global seroprevalence of HCV among blood 
donors varies from 0.4-19.2%[2].Approximately 2 billion people in the world have been 
infected by HBV,[3]350 million of which are chronic carriers representing 7% of total 
population[4].The virus causes hepatitis of varying severity[5]. 
 
         The transmission of HBV and HCV occurs mainly through direct contact of blood, IV 
injections, blood transfusion and sexual relations, the latter, mainly in HBV carriers. The 
sexual transmission in HCV is controversial[6].Over many years, hepatitis was the main 
cause of transfusion associated chronic disease, liver cirrhosis, hepatocellular carcinoma and 
death[7].The discovery of these serious hazards has brought a dramatic change in the 
behaviour of patients and physicians[8]. 
 
      Various studies have been conducted in the past that provided data about the 
seroprevalence of HBsAg and HCV in different parts of the world. This study was conducted 
to evaluate the prevalence of HBsAg and HCV in healthy blood donors. 
 
MATERIALS AND METHODS 
 
 This study was conducted at blood bank of Rajindra hospital (tertiary care hospital) 
Patiala for a period of 6 months from January 2010 to June 2010. A total of 7000 blood 
donors (voluntary and replacement) who donated blood in blood bank and various outdoor 
voluntary blood donation camps were included in the study. They were carefully selected 
for donation after complete physical examination and satisfactorily answering the donor’s 
questionnaire. A thorough medical history was taken to ensure that the donor is free of all 
communicable diseases. The exclusion criteria used were history of jaundice, anemia, 
malaria, drug addiction and repeated blood transfusion and any evidence of cardiac, renal 
and pulmonary disease.  
           
  Blood samples from donors were tested for HBsAg and antibodies against HCV. The 
methodology used was third generation ELISA (Enzyme Linked Immunosorbent Assay), 
which is a quantitative assay having a sensitivity ranging from 90-97%.The use of third 
generation ELISA shortens the pre-seroconversion window period but does not distinguish 
between acute, chronic or resolved infection.  Any serum found reactive by the first assay 
was tested using second assay based on a different antigen preparation and/or different 
test principle. The serum that is reactive by both tests will be considered HBsAg/HCV 
positive. The serum that is non-reactive in the first test will also be considered HBsAg/HCV 
negative. The serum that is reactive by first test and non-reactive by second test will also be 
considered as negative for surveillance. The samples will be tested by third generation ELISA 
for these viral markers. The relation of seropositivity with age, sex, voluntary/replacement, 
first time donation & second time donation will be studied. The results were analysed 
statistically and interpreted. 
 
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RESULTS 
 
 A total of 7000 blood donors were screened for HBsAg and anti-HCV. Out of 7000 
donors 6535 (93.35%) were males and 465 (6.65%) were females with male to female ratio 
of 14.05:1. About 77.85% (5450/7000) of donors were voluntary donorsand rest 22.15% 
(1550/7000) were replacement donors. The overall seroprevalence of HBsAg was 0.91% and 
that of HCV was 0.84%.Seroprevalence of HBsAg was higher among replacement donors 
1.35% (21/1550) than voluntary donors 0.79% (43/5450). In case of anti-HCV, seropositivity 
was also higher among replacement donors 1.22% (19/1550) than voluntary donors 0.72% 
(39/5450). 
 
           The maximum seroprevalence of HBsAg and anti-HCV (1.56%  & 1.21% 
respectively)was seen in the age group of 31-40 years. The minimum seroprevalence of both 
HBsAg and anti-HCV were seen among the age group of >51years (0.49% in both the cases) 
as depicted in fig.1. 
 
Seroprevalence of HBsAg was maximum among male donors as compared to female 
donors (0.81% vs. 0.21%). None of the female donors were positive for anti-HCV but 0.88% 
of male donors were positive for anti-HCV. 
 
       As compared to unmarried donors, married donorshad maximum seroprevalence both 
in case of HBsAg (1.1% vs. 0.60%) and anti-HCV (1.03% vs. 0.48%). 
      Maximum seropositivity in case HBsAg (1.12%) was seen among donors educated 
uptointemediate level. In case of anti-HCV, seropositivity was highest among donors 
educated up to graduate level (0.91%). 
 
Seropositivity was highest among first time donors in case of both HBsAg and anti-HCV 
(0.91% & 0.88% respectively) as compared to repeat donors (fig 2). 
        Skilled workers had maximum seroprevalence in both HBsAg and anti-HCV (2.19% 
&1.75% respectively). 
 
      The maximum seroprevalence of both HBsAg and anti-HCV (1.93% & 1.78%) was seen 
among blood donors from rural area as compared to urban donors that was statistically 
significant (table 1 & 2). 
 
TABLE 1: DISTRIBUTION OF HBs Ag POSITIVE BLOOD DONORS BASED UPON AREA 
 
Area Voluntary Replacement 
Total HBsAg +ve %age Total HBsAg +ve %age 
Urban 3378 9 0.27% 1087 6 0.55 
Rural 2072 34 1.64% 463 15 3.23% 
Total 5450 43 0.79% 1550 21 1.35% 
p value <0.001; Highly Significant <0.001; Highly Significant 
 
 
 
 
 
 
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TABLE 2: DISTRIBUTION OF ANTI HCV POSITIVE BLOOD DONORS BASED UPON AREA 
 
Area Voluntary Replacement 
Total anti HCV +ve %age Total anti HCV +ve %age 
Urban 3378 10 0.30% 1087 3 0.28% 
Rural 2072 29 1.40% 463 16 3.46% 
Total 5450 39 0.72 1550 19 1.22 
p value <0.001; Highly Significant <0.001; Highly Significant 
 
DISCUSSION 
 
The transfusion of blood is a life saving procedure and benefits millions of patients 
worldwide. Human beings are the only reservoir of blood borne viruses like HBV, HCV and 
are of concern because of their prolonged viremeia and latent or carrier state. Prevalence of 
HBV and HCV among healthy blood donors or replacement donors reflects the disease 
prevalence in the community. It also estimates the risk of chance of acquisition of these 
infections during blood transfusion. Serological testing of HBV and HCV is compulsory in 
blood banks routinely. In India testing blood for HBsAg and anti-HCV was made compulsory 
on 1999 and 2001 respectively[9].These tests are must for safe blood transfusion. Blood 
donors include the healthy adult population in the 18-60 year age group.  But it is generally 
accepted that the evaluation of donors’ blood for seropositivity of HBV and HCV gives an 
idea for the epidemiology of these infections in general population[10]. 
 
HBV and HCV infections are common serious complications of blood transfusion. 
Prevention of transfusion-transmitted infections in developed countries has been achieved 
by reducing unnecessary transfusions, using only regular voluntary donors, excluding donors 
with specific risk factors and systematic screening of all donated blood for infection. By 
contrast, in many developing countries none of these interventions is applied uniformly and 
the risk of transfusion-transmitted infection remains high[11]. 
 
HBV is one of the major public health problems. HBV infection is the tenth leading 
cause of death and HBV related hepatocellular carcinoma is fifth most frequent cancer 
worldwide. Approximately 30% of the world’s population has serologic evidence of current 
or past infection with HBV. India lies in an intermediate HBVendemic zone and the number 
of HBV carriers is estimated to be 50 million, forming the second largest global pool of 
chronic HBV infections[12-14]. 
 
           HBV prevalence in general population in India is 2% to 8% and 1% to 2% in blood 
donors, according to various studies. In developed countries like USA, the risk of HBV 
transmission through blood transfusion is 1: 63,000units transfused.15 In southeast Asia 
Region, Sri Lanka has lowest HBsAg carrier rate of 0.9% in donor population[16] In the 
present study seroprevalence of HBsAg is 0.91%. An increasing incidence of HBV (2.6% in 
2006, 2.67% in 2007 and 3.43% in 2008 and overall 2.9%) was noted in blood donors in 
Bhopal[17].Healthy voluntary first time blood donors in kolkota had 1.55% 
seropositivity[18]. Voluntary blood donors in Chandigarh had 0.66% seropositivity of 
HBV[19] Even the rural population of Ambajogai, India had very high prevalence of HBV 
(4.84%), a matter of concern[20] 
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The seroprevalence in replacement donors was higher compared to voluntary donors 
(1.35% vs. 0.79%) emphasizing the fact that donor recruitment is vital and voluntary 
donations should be encouraged. 
 
          Our study shows that rural residents had higher rates of HBsAg positivity than those in 
urban areas (1.94% vs. 0.34%) thatwere significant statistically. The highest rate of HBsAg 
positivity was among the age group of 31-40 years. Also males had higher rates of HBsAg 
positivity than did females (0.94% vs. 0.21%). Similar results were reported in a study in 
Pakistan in which the prevalence was 2.5% for HBsAg and among them majority of cases 
were males[8]. 
 
         HCV infection is an evolving public health problem globally. This virus infects 
approximately 3% world’s population, placing approximately 170 million people at risk of 
developing HCV-related chronic liver disease[21].  
 
         Prevalence of HCV is 0.5% to 1% and there are about 15 million HCV carriers in 
India[9].Prevalence of anti-HCV in blood donors in developed countries ranges from 0.4-
2%[22].In USA, the risk estimate of HCV transmission is 1:103000 per donor exposure and 
with mini pool-NAT screening, the risk of HCV transmission will be as low as 1 in 2 
million[15,23].In the present study seroprevalence of anti-HCV is 0.84%. The seroprevalence 
in replacement donors was high compared to voluntary donors (1.22% vs. o.72%). 
 
         The seroprevalence of anti-HCV was higher in rural donors as compared to urban 
donors (1.77% vs. 0.29%). Also males had considerably higher rates of anti-HCV positivity 
than did females. Similar results were reported in Egypt in a cross-sectional survey in Upper 
Egypt in which the prevalence of anti-HCV was higher among males than females[24]. 
 
         In our study, the highest seroprevalence of both infections was found among manual 
workers, which may be due to their lower educational level and perhaps sharing and 
inconsistent use of clean shaving equipment. Our results are consistent with the findings of 
Darwish et al. among blood donors in Egypt, who found a higher rate co anti-HCV antibodies 
among manual workers[25]. In a study in Karachi, Pakistan seroprevalence of HBV and HCV 
infections among college going students is significantly lower (<3%) than 30% 
seroprevalence among paid donors and 7% among family/replacement donors[26].In our 
study also seroprevalence of HBsAg (1.35% vs. 0.79%) and HCV (1.22% vs. 0.72%) was higher 
among replacement donors as compared to voluntary donors. 
 
Different Asian countries had reported seropositivity in blood donors. Prevalence of 
HBV and HCV in North Pakistan was 0.82%  and 2.46% in voluntary remunerated blood 
donors[27]. Central Saudi Arabia had reported 1.5% and 0.4% HBV and HCV  with a 
tendency to increase with increase of age[28]. In Bangladesh, 1.39% were found positive for 
HBV  0.024% were positive for  anti-HCV in voluntary blood donors[29]. In Katmandu, Nepal, 
seroprevalence of HBV and HCV were observed to be 0.47% and 0.64% respectively[30]. 
        
 Additional laboratory tests of interest including anti-hepatitis B core antigen, in any 
patient with HBsAg positivity and confirmatory testing for anti-HCV antibodies including 
HCV-RNA should be done in any anti-HCV positive patients in order to differentiate between 
          ISSN: 0975-8585 
October - December     2013           RJPBCS          Volume 4 Issue 4    Page No. 1277 
active and resolved infection. The presence of anti-HBc antibody is a lifelong marker of HBV 
infection, irrespective of whether a patient has recovered from or has an ongoing chronic 
infection[31-32]. This study recommends to perform confirmatory tests for both anti-HCV 
and HBsAg to confirm the rate of positive cases and cut-off values. 
 
          In conclusion our study raises serious concerns regarding the HBV and HCV prevalence 
and the safety of the blood supply in our country. The absence of HBsAg in blood of 
apparently healthy individuals may not be sufficient to ensure lack of circulating HBV. We 
also recommend nucleic acid testing(NAT) which as the ability to detect a disease at an 
earlier stage. It reduces window period, allowing early detection of infection hence reduces 
the chances of infection via transfusion. In case of HBV it reduces window period from 36 
days to 20 days and in HCV from 65 days to 3 days[22]. 
 
Considering the vast population of the country, even low prevalence amounts to 
large number of infected people. A prevalence of even 1% leads to millions of seropositive 
patients. Stringent measures need to be taken on urgent basis including dissemination of 
information including public awareness, educational and motivational programs, better 
donor recruitment, promoting voluntary donations, safe sexual practices,proper sterilization 
of instruments, proper disposal of contaminated material, inclusion of nucleic acid 
amplification test, antibody to HBcAg and other sensitive markers to be mandatory 
screening protocol, mass immunization programme including immunization of people at 
risk, particularly health care workers. 
REFERENCES 
 
[1] Barth H, Liang TJ, Baumert TF. Hepatol 2006; 44: 527-35. 
[2] Memon MI, Memon MA. J Viral Hepat 2002; 9: 84-100. 
[3] Zuckerman JN, Zuckerman AJ. J Infect 2004; 4: 134-136. 
[4] Kao JH, Chen PJ, Lai MY, Chen DS. J Clin Microbiol 2008; 40: 4068-71. 
[5] Herman KH, Gerlich WH, Michael C, Schaefer S, Thomson R. J Clin Virol 1999;37:68-
73. 
[6] Tahan V et al. Am J Gastroenerol 2005; 100: 821-824. 
[7] Chattopadhyay S, Rao S, Das BC, Singh NP, Kar P. Haemodial Int 2005; 9:362-366. 
[8] Chaudhary IA, Ullah S, Khan SS, Masood R, Sardar MA, Malhi AA. Pak J Med Sci 2007; 
23(1): 64-67. 
[9] Chaterjee K, Sen A. Infectious Laboratory markers. Jaypee Brothers, New Delhi. 
2006; 1: 101-102. 
[10] Karki S, Ghimire P, Tiwari BR, Maharajan A, Rajkarnikar M. Jpn J Infect Dis 2008; 61: 
324-326. 
[11] Gurol E et al. European J Epidemiol 2006; 21: 299-305. 
[12] Datta S. Virol J 2008; 5:156. 
[13] Gupta N, Kumar V, Kaur A. Indian J Med Sci 2004; 58: 255-257. 
[14] Panda M, Kar K. Indian J Public Health2008; 5:43-44. 
[15] Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ. N Engl J Med 1996; 334: 1685-90. 
[16] Makroo RN, Chaudary N, Jagannathan L, Parihar-Malhotra A et al. Indian Journal 
Med Res 2008; 127 (20) : 140-147. 
[17] Sawke N, Sawke GK, Chawla S. People’s Journal of Scientific Research 2010; 3(1): 5-8. 
          ISSN: 0975-8585 
October - December     2013           RJPBCS          Volume 4 Issue 4    Page No. 1278 
[18] Das BK, Gayen BK, Aditya S, Chakrovorty SK, Datta PK, Joseph A. Ann Trop Med 
Public Health 2011; 4: 86-90. 
[19] Gupta N, Kumar V, Kaur A. Indian J Med Sci 2004; 58: 255-257. 
[20] Sonwane BR, Birare SD, Kulkarni PV. Indian J Med Sci 2003; 57: 405-7. 
[21] WHO. Report of a WHO consultation organized in collaboration with viral hepatitis 
prevention Board. Antwerp, Belgium. J Viral Hepatol 1999; 6: 35-47. 
[22] Bhardwaj K. 1stedn. Jaypee brothers. , New Delhi. 2012; 1: 109-120. 
[23] Busch MP, Glynn SA, Stramer SL, Strong DM, Caglioti S, Wright DJ et al. Transfusion 
2005; 45:254-264.  
[24] Nafeh MA et al. American J Trop Med Hyg 2000; 63: 236-241. 
[25] Darwish MA et al. Egyptian J Med Laborat Sci 2005; 14: 19. 
[26] Mujeeb SA, Aamir K, Mehmood K. J Pak Med Assoc 2006; 56:24-5. 
[27] Asif N, Khokhar N, Ilahi F. Pak J Med Sci 2004; 20:24-8. 
[28] El-Hazmi MM. Saudi Med J 2004; 25:26-33. 
[29] Ahamed MU, Begum HA, Hossain T, Chakraborty P. Journal of Armed Forces Medical 
College, Bangladesh. 2009; 5(1):4-6. 
[30] Shresta AC, Ghimire P, Tiwari BR, Rajkanikar M. J Infect Dev Countries 2009; 3:794-7. 
[31] Mboto CI et al. British J Biomed Sci 2005; 62: 89-91. 
[32] Bovet P et al. Bull World Health Org 1999;7: 923-928. 
 
 


Seroprevalenceof HBs Ag and HCV in Healthy Blood Donors at a Tertiary Care Hospital in India

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Seroprevalenceof HBs Ag and HCV in Healthy Blood Donors at a Tertiary Care Hospital in India

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