Viral safety of recovered plasma for contract fractionation; an Iranian experience, 2006-2015.

OBJECTIVE: The current study analysed the viral safety among Iranian blood donors. BACKGROUND: Plasma products demand is increasing in the world. With contract plasma fractionation, the plasma wastage decreases and the access of patients to plasma-derived medicines (PDM) improves. STUDY AND DESIGN METHOD: Screening results including hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), and human immunodeficiency virus (HIV) Ag/Ab of 19 054 036 donations from 2006 to 2015 were analysed. The plasma for fractionation was tested for HBV DNA, HCV RNA, HIV RNA, HAV RNA, and Parvovirus B19 DNA by fractionators. New samples were collected from the positive donors and retested. The prevalence of serological and nucleic acid testing (NAT) markers per 105 donations, 95% confidential interval (CI), and p-values were calculated. RESULTS: The prevalence of markers was as follows: 250/105 donations for HBsAg from 516 in 2006 to 116/105 donations in 2015; 74/105 donations for HCV, decreasing from 127 to 41/105 and 3.6/105 for HIV during current study. During 10 years, 5 713 641 units of recovered plasma were shipped for contract fractionation to produce PDM; 0.26/105 donations for HBV DNA and 0.14/105 for HCV RNA were reported positive. The results of five retested samples for HBV and one sample for HCV were negative. CONCLUSION: The prevalence of HBV, HCV, and HIV in blood donations was extremely low. Thanks to the availability, high quality and safety of recovered plasma as a result of the improvements in the quality system at IBTO, this plasma could be used for the production of PDMPs.

COVID-19 related callback in blood donors; Outcomes in blood donors and patients.

Call back as a procedure to report post donation symptoms or illness by donors has been established since 2009 in Iranian Blood Transfusion Organization (IBTO). During the first phase of COVID-19 outbreak, all blood donors were requested to report any respiratory infection symptoms after donation. The study investigated the callback data of COVID-19 in Tehran Blood Center during the first 3 months of the outbreak in Iran. The purpose of this study was to estimate the frequency of post donation COVID-19 related call back reports and determine its implications for blood donors and patients. A telephone interview was conducted with donors who had reported COVID-19 symptoms. Some questions were asked to evaluate donor's health at the time of blood donation. The donors categorized into three groups: laboratory-confirmed, suspected, and COVID-19 irrelevant based on their answers. In cases that the blood component obtained from a laboratory-confirmed donor had been released, the hospital was notified and asked to follow up the recipient for COVID-19. The results showed 30 donors (0.08 %) had callback related to COVID-19 and 76.63 % of the obtained component was disposed. The results also showed that only one donor had a laboratory-confirmed result with the RBC unit processed from her whole blood released for transfusion. The RBC unit recipient did not show any signs or symptoms of infection during a 46-day follow-up. Concluded that callback system was effective to remove most of the components obtained from the donors who reported to be COVID-19 suspected or confirmed. Moreover, the result did not support virus transmission through blood transfusion.

Phylogenetic analysis of HTLV-1 in Iranian blood donors, HIV-1 positive patients and patients with beta thalassemia.

Human T-cell lymphoma virus (HTLV) has been associated with various disease types. Since the discovery of the virus in 1980, seven subtypes of the virus have been identified. HTLV is widespread and endemic in some regions, such as Japan, Africa, South America, and northeast Iran. This study aimed to identify HTLV-1 genotype and also to analyze the nucleotide sequence of the LTR region in three groups, including blood donors, HIV-1+ patients, and ß-thalassemia patients. In this cross-sectional study, 2200 samples were collected from blood donors in Tehran (2000 samples), HIV-1+ patients (100 samples) and ß-thalassemia patients (100 samples). All samples were screened for anti-HTLV-I&II antibodies by ELISA. Then, genomic DNA was extracted from repeatedly positive samples, and nested PCR was performed for both the TAX and LTR regions. Purified PCR products were sequenced and analyzed, and finally, a phylogenetic tree was constructed using Mega7 software. The prevalence of the anti-HTLV-I&II antibody among blood donors and HIV-1+ patients was 1.7% (34/2000) and 12% (12/100), respectively. The PCR results confirmed that 0.05% (1/2000) of blood donors, 5% (5/100) of HIV-1+ patients, and 8% (8/100) of ß-thalassemia patients were HTLV-I positive. All sequences were matched to HTLV-1 subtype a, subgroup A. Our phylogenetic analysis revealed that all sequenced samples belong to the endemic clusters of Iran. HTLV-1 genotypes in all samples were similar in three groups and were derived from the strains, which had been previously reported from Iran (AF00300/Mashhad and KT190712.1/Sabzevar).

Risk factor analysis of hepatitis C virus seropositivity in Iranian blood donors: a case-control study.

BACKGROUND: Due to blood screening and blood donor selection, the prevalence of hepatitis C virus (HCV) is expected to be lower among blood donors compared to the general population. The effective control of blood-transmitted infectious diseases should be one of the goals of public health. Thus, this case-control study was conducted to evaluate the risk factors of HCV in a representative sample of blood donors in Iran. STUDY DESIGN AND METHODS: A case-control study was conducted on HCV-negative and on serologically confirmed HCV-positive donors across the country from 2009 to 2013. Univariate logistic regression, multiple logistic regression, and subgroup analyses were performed to assess the risk factors in first-time blood donors (FTs) and repeat blood donors (RDs) independently. RESULTS: A total of 970 cases and 1542 controls were selected from the cohort of Iranian blood donors registered in the Iran Blood Transfusion Organization. Intravenous (IV) drug abuse (ORFT , 6.42; 95% CI, 3.34-12.34; and ORRD , 27.62; 95% CI, 12.58-60.62), living with an IV drug abuser (ORFT , 3.47; 95% CI, 1.26-9.55; and ORRD , 6.95; 95% CI, 1.54-31.34), prison history (ORFT , 2.4; 95% CI, 1.48-3.88; and ORRD , 2.42; 95% CI, 1.38-4.27), sharing personal razors (ORFT , 2.00; 95% CI, 1.01-3.96; and ORRD , 5.62; 95% CI, 2.65-11.89), and medical exposure (ORFT , 1.97; 95% CI, 1.15-3.37; and ORRD , 2.19; 95% CI, 1.27-3.76) were significant independent risk factors in both types of blood donation. CONCLUSION: The findings of this analytic study on HCV exposure in Iranian blood donors conforms to those of international studies. Behavioral and medical factors should be examined in the donor health screening process.

The return rate of deferred blood donors in Iran.

BACKGROUND AND OBJECTIVES: The process of selecting blood donors is crucial for keeping the health of donors and ensuring the safety of the blood supply. However, it may create unpleasant feeling in those who are deferred. In this study, we aim to explore the return rates of Iranian deferred donors in comparison with eligible donors. MATERIALS AND METHODS: The study included all whole blood donors referred between March 2017 and March 2018, who experienced temporary deferral for any reason. Donors who successfully donated blood during this period were also part of the study. Participants were followed up until their next donation attempt, spanning 4.8 years after initial inclusion. Then odds of return and median return time for both deferred and eligible donors were calculated. RESULTS: From 993,824 volunteers, 733,153 (73.77%) were eligible and 192,332 (19.35%) temporary deferred. The return rate in the eligible and deferred donors was 74.77% vs. 51.77%, respectively (OR:2.78; 99%CI: 2.71-2.81). Odds of return among deferred regular (OR = 7.02, 99%CI:6.64-7.42), men (OR: 2.57, 99%CI:2.45-2.69), and over 45 years (OR: 1.15, 99% CI: 1.09-1.20), was higher than first-time, women, and younger donors. The median return time for eligible and deferred donors was 315 (99%CI: 313-316) and 1,467(99%CI: 1,412-1,524) days, respectively. CONCLUSION: This study revealed the negative effect of deferral on the return rate, that led to a 23% reduction in the return of deferred donors. Avoiding unnecessary deferral through adherence to the standard operating procedure of donor selection and effective counselling which clarifies the purpose of deferral and encourages them to return after the deferral period ends are recommended.

A change in standard of minimum hemoglobin for male blood donors in Iran.

BACKGROUND: The minimum Hb for blood donation varies from nation to nation. This study assessed the impact of blood donation on donors' iron stores based on different Hb levels. An estimation of drop in the blood collection was made with the new suggested Hb cut-off value. MATERIALS AND METHODS: 2017 male donors were studied. A questionnaire was filled out to gather demographic data, history of donation and risk factors of iron loss. Their blood samples were analyzed for RBC parameters, serum iron, TIBC, and ferritin level. The iron status of all first-time and regular donors was determined for each Hb level. The impact of changing the Hb cut-off value on annual blood collection was assessed. RESULTS: All of the regular donors with Hb levels <13.1g/dL and 75% of those donors with Hb levels of 13.1-13.5 g/dL had abnormal iron stores. Iron deficiency dropped to 35% in donors with Hb levels of 13.5-14 g/dL. It was estimated that increasing the Hb cut-off from 12.5 g/dL to 13 g/dL or to 13.5 g/dL would cause a drop of 0.82% and 2.77% in the annual blood collection, respectively. DISCUSSION: A modification in the minimum Hb level for blood donation is necessary when Hb is used as the single criterion for screening donors. Increasing the minimum Hb level will lead to an increase in donor deferral; therefore a comprehensive donor retention program will be needed.

The impact of pre-donation viral markers screening of new blood donors on blood safety.

BACKGROUND: The risk of transfusion-transmissible infections (TTIs) remains a concern in transfusion medicine. Since the rate of infection among first-time blood donors is higher than repeated donors, strategies to enhance blood safety can focus on new donors. The aim of the study was to investigate the effect of pre-donation viral screening of new donors on blood safety. METHODS AND MATERIALS: The pre-donation screening of new donors was implemented in the Kurdistan blood center. In this program, new donors who met the blood donation criteria were informed about the program and only a blood sample was donated for HBs Ag, HCV Ab, and HIV Ab testing. New donors with negative results were invited to donate blood after 12 weeks. A unit of blood was collected from eligible returned donors. Laboratory tests were performed again using the same methods. Finally, the prevalence of confirmed positive TTI results among donated blood in Kurdistan blood center was compared before and after the establishment of program. RESULTS: During the study, 4,434 new donors were screened for viral markers. A total of 41 new donors (0.92%, 95% CI, 0.007-0.13) had repeatedly reactive results and infection was confirmed in blood sample of 24 donors (0.54%, 95% CI, 0.003-0.008). Overall, 56% of new donors returned for blood donation. Prevalence of confirmed TTIs markers in collected blood units was 0.27% and 0 before and after implementing program, respectively. CONCLUSIONS: This study indicated that Pre-donation screening can reduce the risk of TTI transmission by identifying infected donors at the pre-donation phase.

Estimate of anti-SARS-CoV-2 spike IgG antibodies prevalence among Iranian population based on blood donations: A serial cross-sectional study during the third wave of the pandemic.

OBJECTIVES: Iran is one of the countries that have been confronted with the SARS-CoV-2 epidemic since February 2020. This study aimed to determine the levels of specific IgG antibodies against SARS-CoV-2 among healthy blood donors to estimate the burden of the epidemic. MATERIAL AND METHODS: A serial cross-sectional study was conducted on blood donors who referred to 31 main blood donation centers in different provinces during the third weeks of September, October, and November 2020. A questionnaire was filled out to collect socio-demographic characteristics, history of contact with COVID-19 patients, and history of COVID-19. A blood sample was collected from each participant to assess the antibodies against SARS-CoV-2 using the ELISA method. The crude prevalence of anti-SARS-CoV-2 IgG was calculated. Then it was weighted based on the gender and age groups of the general population in each province and adjusted for test sensitivity and specificity. RESULTS: During three time points of the study, 3840, 3697, and 3152 participants enrolled. The seroprevalence of SARS-CoV-2 IgG antibodies was 19.59% (17.18-22.00), 22.67% (20.70-24.65), and 32.63% (29.93-35.33) over the three rounds of the study. We found an association between the seropositivity and the highest educational level; AOR 0.76 (0.63-0.93), history of close contact with COVID-19 patients; AOR 1.69 (1.35-2.11), and history of confirmed SARS-CoV-2 infection; AOR 8.86 (5.38-14.60). CONCLUSION: This study showed that about one-third of the population had been infected with COVID-19. Furthermore, a significant upward trend in seroprevalence was observed. The predisposing factors indicate the importance of public health.

Gut microbiota intervention by pre and probiotics can induce regulatory T cells and reduce the risk of severe acute GVHD following allogeneic hematopoietic stem cell transplantation.

BACKGROUND: Acute graft-versus-host disease (aGVHD) is one of the leading causes of limitation and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Numerous studies have shown that changes in the gut microbiome diversity increased post-transplant problems, including the occurrence of aGVHD. Probiotics and prebiotics can reconstitute the gut microbiota and thus increase bacterial metabolites such as short-chain fatty acids (SCFAs) that have immunomodulatory effects preventing aGVHD in recipients of allo-HSCTs. METHODS/STUDY DESIGN: We conducted a pilot randomized clinical trial to investigate whether oral synbiotics are associated with the prevention or reduction in occurrence/severity and mitigate complications of aGVHD following allo-HSCT. A commercially available synbiotic mixture containing high levels of 7 safe bacterial strains plus fructo-oligosaccharides as a prebiotic was administered to allo-HSCT recipients. Out of 40 allo-HSCT patients, 20 received daily a synbiotic 21 days prior to transplantation (days -21 to day 0). In contrast, in the control group 20 recipients of allo-HSCT did not receive a symbiotic therapy. RESULTS: Within first 100 days of observation, the incidence of severe (grade III/IV) aGVHD in the a synbiotic-therapy group was 0% (0 out of 20 patients), whereas it was 25% (5 out of 20 patients) in the control group (P = 0.047). The median percentage of CD4 + CD25 + Foxp3+ regulatory T cells (Tregs) among CD4+ lymphocytes on day 28 after HSCT in the synbiotic group was higher (2.54%) than in control group (1.73%; P = 0.01). There was no difference in Treg cells on day 7 after HSCT between two groups. However, the median percentage and the absolute count of Tregs in patients who experience aGVHD was significantly lower on days 7 and 28 after HSCT (both P < 0.05). The overall 12-month survival (OS) rate was higher (90%) in the symbiotic-treated patients than in the control group (75%), but the difference was not statistically significant (P = 0.234). CONCLUSION: Our preliminary findings suggest that synbiotic intake before and during the conditioning regimen of allo-HSCT patients may lead to a reduction in the incidence and severity of aGVHD through the induction of CD4 + CD25 + Foxp3+ regulatory T cells, thus contributing to the improvement of transplant outcomes. Much larger studies are needed to confirm our observations.

The potential effect of leukocyte filtration methods on erythrocyte-derived microvesicles: One step forward.

By harmonizing the pre-preparation conditions and also removing some donors' variations, the current study took one step forward to investigate whether different leukocyte filtration sets influence the quality of RBCs throughout the storage time. Twelve whole blood units were collected, and each unit was split into three equal parts. Thirty-six divided bags were filtered using three different leukocyte-filtration sets including Red Cell and Whole Blood Filters (12 units per filter). The prepared RBCs were refrigerated for up to 42 days and assessed for microvesicle count and size, clotting- and prothrombin time, hemolysis index, and biochemical parameters. A significant increment in erythrocytes microvesicle count (EMVs/µL) was observed during the time in the three filtration sets. The number of EMVs in WBF-RBCs was higher (~1.6 fold) than in F-RCF on day 42 (p=0.035). Interestingly the median fluorescence intensity of EMVs decreased during the storage. The size of MVs rose during the time without any significant differences among the filters. Coagulation time decreased in RBCs over the storage, with no significant differences among the filters. Hemolysis index and lactate concentration increased while glucose level decreased significantly throughout the time. The changes in WBF-RBCs were more drastic rather than RCF-RBCs. The only significant difference in the count of EMVs was between WBF and F-RCF components on day 42. Though the changes in WBF products were more drastic, all the values fell within the standard limits. Accordingly, all three filtration sets can be considered.

Evaluation of the effects of nanoparticles on the therapeutic function of platelet: a review.

OBJECTIVES: Nanotechnology and nanoparticles are used in different applications in disease monitoring and therapy in contact with blood. Nanoparticles showed different effects on blood components and reduced or improved the function of therapeutic platelet during the storage time. This review study was performed to evaluate the impacts of various sizes and charges of nanoparticles on platelet function and storage time. The present review contains the literature between 2010 and 2020. The data have been used from different sites such as PubMed, Wiley, ScienceDirect and online electronic journals. KEY FINDINGS: From the literature survey, it has been demonstrated that among various properties, size and charge of nanoparticles were critical on the function of therapeutic platelet during the storage and inhibition of their aggregation. Overall, this study described that nanoparticles with smaller size and negative charge were more effective in increasing the survival time, inhibition of aggregation and improving the function of therapeutic platelet. SUMMARY: Based on the current review, it can be confirmed that nanoparticles such as dendrimer, Au, Ag and iron oxide nanoparticles with smaller size and negative charge have significant advantages for improving the efficacy of platelets during the storage chain and inhibition of their aggregation.

Prevalence of Hepatitis B and C Infections and Associated Risk Factors in Pars Cohort Study, Southern Iran.

BACKGROUND Hepatitis B and C virus (HBV and HCV) infections rank among the most frequent infectious diseases with a rising worldwide burden. However, their epidemiology and risk factors are understudied in many regions, including Iran. METHODS This study was conducted as part of the Pars Cohort Study (PCS) in Valashahr district, Fars province (2012-2014). Participants received venipuncture for HBsAg and HCV antibody, followed by Polymerase Chain Reaction (PCR) testing. All infected people and their comparison groups completed a risk assessment questionnaire. RESULTS Overall, 9,269 people participated in the study; the majority were women and of Fars ethnicity. Prevalence of HBsAg and HCV antibody was 2.3% (n = 215) and 0.3% (n = 26), from whom 23% (n = 47) and 13% (n = 3) had indications for treatment, respectively. During follow-up, among HBsAg-positive individuals who were not on treatment, 62% tested negative for HBsAg, and in 2% HBV DNA had risen to treatment levels. Risk factors for HBV infection were illiteracy [OR = 3.43, 95% CI = 1.1, 10.3], and Turk ethnicity compared to Fars [OR = 1.58, 95% CI = 1.1, 2.3]. History of blood transfusion [OR = 2.00, 95% CI = 1.1, 3.5] and history of drug use [OR = 2.85, 95% CI = 1.1, 7.4] were associated with HCV infection, after adjustment. CONCLUSION Further epidemiological studies are needed to identify at-risk populations in different regions. Preventive interventions, including educational programs and transfusion safety strategies, are crucial for reducing the hepatitis burden.

Epidemiology of Hepatitis B in Iran from 2000 to 2016: A Systematic Review and Meta-Regression Analysis.

BACKGROUND: Hepatitis B infection is the major risk factor for liver cancer in Iran. There is no comprehensive population-based study on the prevalence of hepatitis B by regional distribution. Moreover, systematic reviews of hepatitis B prevalence lack knowledge of some regions. We aimed to estimate the prevalence of hepatitis B and its temporal trends over 17 years by sex, age and geographical distribution. METHODS: We used the Iranian Blood Donors data in addition to systematic reviews on population-based studies at national and provincial levels and statistical methods (A two-stage spatio-temporal model and crosswalk approach) to address the missing points of hepatitis B prevalence among the general population. The direct age-standardized approach was applied using Iran's national population in 2016. RESULTS: At national level, age-standardized hepatitis B prevalence in Iran decreased from 3.02% (95% uncertainty interval; 2.26 to 3.96) in 2000 to 1.09% (95% uncertainty interval; 0.85 to 1.37) in 2016, with a total -64.84% change. Hepatitis B prevalence was more than 1.3 times greater in males than females in 2016. Overall, the prevalence of hepatitis B increased with increasing age. At provincial level, in 2016, the province with the highest prevalence had a nearly 11-time greater rate compared to the lowest prevalence. The declining annual percent change (APC) of the prevalence trend varied between -11.53% to -0.5% at provincial level from 2000 to 2016. Only one province did not witness a downward trend in which the APC was 0.5% (95% UI:0.47-0.54). CONCLUSION: The downward trend in prevalence of hepatitis B infection indicates the effectiveness of strategies and preventive measures adapted in Iran. Nevertheless, we need to eradicate this infection. In this regard, re-evaluating preventive measures, especially in high-risk age groups of the population, is recommended.

The prevalence of hepatitis B surface antigen and anti-hepatitis B core antibody in Iran: a population-based study.

BACKGROUND: Hepatitis B virus infection is a very common cause of chronic liver disease worldwide. It is estimated that 3% of Iranians are chronically infected with hepatitis B virus. Current population-based studies on both rural and urban prevalence of hepatitis B virus infection in Iran are sparse with results that do not always agree. We performed this study to find the prevalence of hepatitis B surface antigen, anti-hepatitis B core antibody, and associated factors in the general population of three provinces of Iran. METHODS: We randomly selected 6,583 subjects from three provinces in Iran, namely Tehran, Golestan, and Hormozgan. The subjects were aged between 18 and 65 years. Serum samples were tested for hepatitis B surface antigen and anti-hepatitis B core antibody. Various risk factors were recorded and multivariate analysis was performed. RESULTS: The prevalence of hepatitis B surface antigen and anti-hepatitis B core antibody in Iran was 2.6% and 16.4%, respectively. Predictors of hepatitis B surface antigen or anti-hepatitis B core antibody in multivariate analysis included older age, not having high-school diploma, living in a rural area, and liver disease in a family member. We did not find any significant differences between males and females. CONCLUSION: In spite of nationwide vaccination of newborns against hepatitis B virus since 1992, hepatitis B virus infection remains a very common cause of chronic liver disease in Iran which should be dealt with for at least the next 30-50 years.

In vitro assessment of platelet lesions during 5-day storage in Iranian Blood Transfusion Organization (IBTO) centers.

BACKGROUND AND OBJECTIVES: Platelet concentrates (PC) are used in thrombocytopenia and inherited or acquired platelet dysfunction disorders. Thus, retaining the platelets quality and function during storage will lead to desirable outcomes in treatment of such patients.  METHODS:  In this study, we evaluated 40 PC bags, prepared by PRP method in IBTO centers. We applied an array of assays, on first, third and fifth days of storage for PC quality control, including swirling, cell counting, bacterial contamination, measurement of CD62P, pH, and platelet aggregation test, to evaluate platelet lesion during storage.  RESULTS:  All units were negative for bacterial contamination. Swirling was positive for all units on various days; platelet count was in the acceptable range. Measurement of CD62P on fifth day was not significantly higher than third or first day (P > 0.15) (P > 0.05). pH on fifth day was significantly lower than first day (P < 0.01) (P < 0.05). Platelet aggregation with arachidonic acid and ristocetin showed significant decrease on fifth day compared to third day (P < 0.01) (P < 0.05). CONCLUSIONS: CD62P associated with other platelet function tests can be used as an activation marker in evaluation of PC functions during storage.

Low dose ribavirin for treatment of hepatitis C virus infected thalassemia major patients; new indications for combination therapy.

BACKGROUND: Treatment guidelines contraindicate ribavirin for treatment of hepatitis C virus (HCV) infection in thalassemia major patients. Nevertheless, the current evidence suggests that ribavirin might be tolerated by these patients. OBJECTIVES: Despite this evidence, low dose ribavirin combination therapy has not been compared with peginterferon monotherapy in these patients so far. PATIENTS AND METHODS: Two hundred eighty thalassemia patients with detectable HCV-RNA PCR (≥ 50 IU/mL) and liver histology consistent with chronic HCV infection were self-assigned to receive peginterferon alfa-2a (n = 81) monotherapy or its combination therapy with ribavirin, 600-800 mg QD, according to hemoglobin levels (n = 199). Treatment experienced patients were eligible for this study. RESULTS: Sustained virological response (SVR) was significantly higher in patients who received ribavirin (51 % vs. 38 % P = 0.02). In multivariate regression, OR of ribavirin for prediction of SVR was 2.2 (95 % CI 1.24-3.91). The SVR was significantly higher in the ribavirin group in subgroups of patients with more than 24 years of age, elevated ALT, ferritin < 2006 ng/mL, previous treatment failure, genotype 1, positive history of splenectomy, fibrosis score of 0-4 HAI and viral load < 600,000 IU/mL. Treatment discontinuations due to the safety concerns were comparable between the treatment groups (6.5 and 8 %). Furthermore, transfusion intervals were almost halved in patients who received low dose ribavirin. CONCLUSIONS: According to the present study, adult thalassemia patients with HCV infection can be treated successfully with low dose ribavirin. Hence, we strongly advise combination therapy in thalassemia patients with aforementioned clinical characteristics. Moreover, ribavirin does not seem to be beneficial in thalassemia patients below 18 years of age.

Seroprevalence and risk factors of hepatitis A virus infection in Iran: a population based study.

BACKGROUND: In older studies, the seroprevalence of hepatitis A virus infection has been reported to be over 95% in Iranians. Most of these studies were performed on volunteer blood donors. Studies on the general population are sparse. The purpose of this study was to determine the current seroprevalence of hepatitis A virus infection in the general population of Iran. METHODS: During 2006, 1869 subjects between 18 and 65 years of age were randomly selected from the general population of three Iranian provinces (Tehran, Golestan, and Hormozgan). Subjects were interviewed and a plasma sample was obtained for serologic testing for anti-hepatitis A virus. Univariate and multivariate analysis was performed to identify risk factors. RESULTS: The seroprevalence of hepatitis A virus in Tehran, Golestan and Hormozgan was 85%, 99%, and 96%, respectively. The overall seroprevalence of hepatitis A virus in the general population of the three provinces studied was 86% and did not differ between the two genders. The prevalence in younger subjects and in urban populations was under 70%. In multivariate analysis, older age, being married, and level of the father's education was associated with hepatitis A virus seropositivity. CONCLUSION: The seroprevalence of hepatitis A virus still appears to be too elevated for recommending routine vaccination in the general population. However, the trend towards a lower prevalence in younger age groups and people from urban areas points towards the possible benefit of vaccination in these subgroups.

Seroprevalence of hepatitis C virus: the first population-based study from Iran.

OBJECTIVE: Early studies on blood donors point to a seroprevalence of approximately 0.25% for hepatitis C virus (HCV) infection in Iran. However, the true prevalence in the general population is unknown. The objective of this study was to determine the prevalence of HCV infection in the general population of Iran. METHODS: We randomly selected 6583 subjects from three provinces in Iran for inclusion in the study. Subjects were aged between 18 and 65 years. Anti-hepatitis C antibody was tested by a third-generation ELISA test. A recombinant immunoblot assay (RIBA) test was used to confirm the results. Risk factors were recorded and a multivariate analysis was performed. RESULTS: A total of 5684 plasma samples were tested. After confirmatory tests, we found 50 cases of HCV. The overall weighted prevalence of anti-HCV was 0.5%. The rate was significantly higher in men (1.0%) than in women (0.1%). In multivariate analysis, male sex, history of intravenous drug abuse, and imprisonment were significantly associated with anti-HCV. CONCLUSIONS: We found the prevalence of HCV infection in Iran to be higher than previous estimates. It appears that the rate is rising, and in the future, hepatitis C will replace hepatitis B as the most common cause of chronic viral liver disease in Iran.