Disagreement between PCR and serological diagnosis of Trypanosoma cruzi infection in blood donors from a Colombian endemic region / Desacuerdo entre la PCR y la serología en el diagnóstico de la infección por Trypanosoma cruzi en donantes de una región endémica de Colombia

Abstract | Introduction: Chagas' disease is the leading cause of infectious myocarditis worldwide. This infection caused by Trypanosoma cruzi is usually life-long and asymptomatic; however, the third part of infected people can develop severe or even fatal cardiomyopathy. As the parasitemia in the chronic phase is both low-grade and intermittent, T. cruzi infection is principally detected by serology, although this method has sensitivity and specificity limitations. Objective: To determine the level of agreement between serologicand molecular tests in 658 voluntary blood donors from six provinces in the Colombian department of Santander. Materials and methods: We evaluated an array of diagnostic technologies by cross-section sampling performing a serological double diagnostic test for T. cruzi antibody detection (Chagas III ELISA™, BiosChile Group, and ARCHITECT Chagas CMIA™, Abbott) , and DNA detection by polymerase chain reaction (PCR). We collected the demographic, clinical, and epidemiological information of participants. The sample size was calculated using Epidat™ and the statistical analysis was done with Stata 12.1™. Results: PCR was six times more sensitive in detecting T. cruzi infection than ELISA/CMIA with prevalence values of 1.8% (12/658) and 0.3% (2/658), respectively, and kappa=0.28 (95%CI: -0.03 - 0.59). In contrast, serology showed a sensitivity of 16.7% (95%CI: 2.09 - 48.4) and a specificity of 100% (95%CI: 99.4 - 100). All seropositive samples were found to be positive by PCR. Conclusions: The implementation of PCR as a complementary method for screening donors could reduce the probability of false negative and the consequent risk of transfusional-transmission of Chagas' disease, especially in endemic regions.

Resumen | Introducción. La enfermedad de Chagas constituye la principal causa de miocarditis infecciosa en el mundo. Causada por Trypanosoma cruzi,la infección puede persistir toda la vida de manera asintomática y silenciosa, pero un tercio de los infectados desarrolla cardiomiopatía grave. Debido a que la parasitemia en la fase crónica es baja e intermitente, el diagnóstico se hace principalmente mediante la detección de anticuerpos (serología), método que tiene limitaciones de sensibilidad y especificidad. Objetivo. Determinar la concordancia entre el diagnóstico serológico y molecular de T. cruzien 658 donantes voluntarios de sangre del departamento de Santander, Colombia. Materiales y métodos. Se hizo un estudio de evaluación de tecnologías diagnósticas con muestreo transversal, utilizando un doble diagnóstico serológico para la detección de anticuerpos anti-T. cruzi (Chagas III ELISA™, BiosChile Group, y ARCHITECT ChagasCMIA™, Abbott) y la de ADN por PCR. Se recolectó la información demográfica, clínica y epidemiológica de los participantes. El tamaño de la muestra se estimó utilizando Epidat™ y el análisis estadístico se hizo mediante Stata 12.1™. Resultados. La sensibilidad de la PCR fue seis veces mayor que la de las pruebas de ELISA/CMIA, con prevalencias de 1,8 % (12/658) y 0,3 % (2/658), respectivamente, y kappa de 0,28 (IC95% -0,03 - 0,59). La sensibilidad serológica fue de 16,7 % (IC95% 2,09 - 48,4) y la especificidad de 100 % (IC95% 99,4 - 100). Todas las muestras seropositivas fueron positivas también en la PCR. Conclusiones. El uso de la PCR como método complementario para la tamización de donantes podría reducir el riesgo de falsos negativos y disminuir los casos de transmisión transfusional de la enfermedad de Chagas, especialmente en regiones endémicas.

High prevalence of blood donor test-seeking behavior among health sciences undergraduate students

Abstract INTRODUCTION This study investigated the prevalence of blood donors' test-seeking behavior and related factors among health sciences undergraduate students. METHODS A total of 750 students were invited. Data regarding sociodemographic and behavioral characteristics, blood donation practices, and test-seeking behavior were collected. RESULTS: Of the invited students, 341 (45.5%) agreed to participate and answered questions regarding test-seeking behavior. The sample comprised 83.1% females, 96.8% singles, 87.2% heterosexuals, and 32.6% of them had previously donated blood. A high prevalence of blood donor test-seeking behavior (14.4%; 95% CI: 10.8%-18.5%) was observed and associated with blood donation practices. CONCLUSIONS: Test-seeking behavior was common among the interviewed students, thereby highlighting the importance of developing a better understanding of its determinants to prevent this behavior in key populations.

Doadores de sangue envelhescentes e idosos: prevalência e reações adversas / Aging and elderly blood donors: prevalence and adverse reactions / Envejecimiento y donantes de sangre elderly: prevalencia y reacciones adversas

Verificou-se a prevalência e reações adversas às doações de sangue em doadores envelhescentes e idosos. Estudo retrospectivo, com dados do sistema informatizado de Hemocentro em Brasília. Do total de 55636 doadores, 6,3% eram envelhescentes; e 0,8%, idosos. Houve menor prevalência de reações adversas nos idosos, sem diferença significativa. Quanto à intensidade das reações, foram leves nos idosos, leves e moderados nos envelhescentes, também sem diferença significativa.

Prevalence and adverse reactions to blood donations were found in aging and elderly donors. Retrospective study with data from the computerized system of Hemocenter in Brasília. Of the 55636 donors, 6.3% were aging and 0.8% elderly. There was a lower prevalence of adverse reactions in the elderly, with no significant difference. Regarding the intensity of the reactions, they were mild in the elderly, mild and moderate in the aging, also without significant difference.

La prevalencia y las reacciones adversas a las donaciones de sangre se encontraron en donantes envejecimiento y ancianos. Estudio retrospectivo con datos del sistema computarizado de Hemocentro en Brasilia. De los 55636 donantes, 6.3% estaban envejeciendo y 0.8% ancianos. Hubo una menor prevalencia de reacciones adversas en los ancianos, sin diferencias significativas. En cuanto a la intensidad de las reacciones, fueron leves en los ancianos, leves y moderados en el envejecimiento, también sin diferencias significativas.

Prevalencia de anticuerpos anti-eritrocitarios en donantes voluntarios de sangre Ecuatorianos / Prevalence of anti-erythrocyte antibodies in Ecuadorian voluntary blood donors / Prevalência de anticorpos anti-eritrocitários em doadores de sangue voluntários equatorianos

El rastreo de anticuerpos anti-eritrocitarios es una de las pruebas pretransfusionales más importantes en medicina transfusional por su aporte en la prevención de reacciones adversas luego de la administración de hemocomponentes. Sin embargo, no todos los bancos de sangre ecuatorianos han incluido esta prueba en sus protocolos de trabajo. Para demostrar su importancia se realizó el presente estudio cuyo propósito fue alertar al sistema nacional de salud sobre la existencia de aloinmunización en la población de donantes de sangre. Se estableció una prevalencia de anticuerpos anti-eritrocitarios del 0,27% y se identificó una mayor frecuencia en el género femenino. Los anticuerpos identificados estuvieron relacionados con los sistemas eritrocitarios Rh (RH), Kell (KEL), Duffy (FY) y Kidd (JK). Una de las limitaciones para la inclusión de esta prueba en los bancos de sangre y servicios de medicina transfusional es el elevado costo de los reactivos y la falta de paneles de células eritrocitarias de composición homocigota y heterocigota para la identificación de anticuerpos anti-eritrocitarios nativos, situación que constituye una oportunidad para que el Ministerio de Salud Pública del Ecuador promueva mejores estrategias para la importación de reactivos, reducción de costos y disponibilidad de paneles de células.

The screening of anti-erythrocyte antibodies is one of the most important pretransfusion tests in transfusion medicine because of its contribution to the prevention of adverse reactions after the administration of blood components, however not all blood banks in Ecuador have included this test in their work protocols. This study has the purpose to alert the national health system about the existence of alloimmunization in the blood donour population. A prevalence of anti-erythrocyte antibodies of 0.27% was established, with a higher frequency being found in the female gender. The identified antibodies are related to the erythrocyte systems Rh (RH), Kell (KEL), Duffy (FY) and Kidd (JK). One of the limitations for the inclusion of this test in blood banks and transfusion medicine services is the excessive cost of serological and gel methodology reagents, and the lack of homozygous and heterozygous erythrocyte cell panels for the identification of native anti-erythrocyte antibodies. That situation constitutes an opportunity for the Ministry of Public Health of Ecuador to promote better strategies for the imports of reagents, cost reduction and availability in the country.

O rastreamento de anticorpos anti-eritrocitários é um dos testes pré-transfusão mais importantes na medicina transfusional pela sua contribuição na prevenção de reações adversas após a administração de componentes sanguíneos. No entanto, nem todos os bancos de sangue do Equador tem incluído esse teste em seus protocolos de trabalho. Para demonstrar a sua importância, foi realizado o presente estudo que teve como objetivo alertar o sistema nacional de saúde sobre a existência de aloimunização na população de doadores de sangue. Foi estabelecida uma prevalência de anticorpos anti-eritrocitários de 0,27%, identificando maior frequência no sexo feminino. Os anticorpos identificados estiveram relacionados com os sistemas eritrocitários Rh (RH), Kell (KEL), Duffy (FY) e Kidd (JK). Uma das limitações para a inclusão destes testes em bancos de sangue e serviços de medicina da transfusão é o alto custo dos reagentes, além da falta de painéis de células eritrocitárias de composição homozigótica e heterozigótica para a identificação de anticorpos anti-eritrocitários nativos, situação que constitui uma oportunidade para que o Ministério da Saúde Pública do Equador promova melhores estratégias para a importação de reagentes, redução de custos e disponibilidade de painéis de células.

Seroprevalencia y detección molecular de Toxoplasma gondii en donantes de un banco de sangre de Cúcuta, Colombia / Seroprevalence and molecular detection of Toxoplasma gondii among donors in a blood bank in Cúcuta, Colombia

Resumen Introducción. La infección por Toxoplasma gondii puede presentarse en los humanos con un amplio rango de manifestaciones que van desde el estado asintomático hasta la enfermedad grave, según el estado inmunológico del individuo. Los mecanismos de transmisión incluyen la transfusión sanguínea, pero poco se sabe sobre la frecuencia del parásito en los bancos de sangre de Colombia. Objetivo. Determinar la prevalencia de la infección con T. gondii en donantes de un banco de sangre de Cúcuta mediante técnicas de diagnóstico serológico y molecular. Materiales y métodos. Se determinaron los anticuerpos IgG e IgM contra T. gondii mediante un inmunoensayo en suero en 348 donantes. Se determinó la frecuencia de ADN de T. gondii utilizando la reacción en cadena de la polimerasa (PCR) en sangre total de donantes seropositivos y se analizaron las variables de interés con base en la información obtenida durante la selección de donantes. Resultados. De los 348 donantes participantes, 134 (38,5 %) presentaron anticuerpos IgG contra T. gondii; dos (0,6 %) de ellos presentaron tanto IgG como IgM y, en dos (1,5 %), se detectó ADN del parásito en la sangre. Un análisis bivariado evidenció una asociación entre la seropositividad para T. gondii y tener más de 26 años de edad (p=0,020). Conclusiones. La prevalencia de la infección con T. gondii encontrada en los donantes de sangre sugiere una exposición significativa al agente, la cual adquiere relevancia al detectarse la parasitemia.

Abstract Introduction: Toxoplasma gondii infection manifests differently in humans according to their immunity ranging from asymptomatic profiles to severe disease. There are multiple transmission mechanisms including blood transfusions, but little is known about the frequency of T. gondii infection in Colombia's blood banks. Objective: To determine the prevalence of T. gondii infection in blood donors of a blood bank in the city of Cúcuta by serological and molecular diagnostic techniques. Materials and methods: We identified IgG and IgM antibodies against T. gondii by immunoassay in serum from 348 donors. The frequency of T. gondii DNA was determined by polymerase chain reaction (PCR) in whole blood from seropositive donors and relevant variables were analyzed based on the information obtained from surveys during blood donor selection. Results: Out of the 348 enrolled donors, 134 (38.5%) showed IgG antibodies against T. gondii; two of them (0.6%) had both IgG and IgM, and in two of them (1.5%), parasite DNA was detected in blood samples. A bivariate analysis indicated an association between seropositivity to T. gondii and being over 26 years of age (p=0.020). Conclusions: The prevalence of T. gondii infection found in the blood donors of this study suggests a significant exposure to the infectious agent that becomes relevant when parasitemia is detected.

Serorreacción y prevalencia de sífilis en donantes de un banco de sangre de Barranquilla, Colombia / Seroreactivity and prevalence of syphilis in donors at a blood bank in Barranquilla, Colombia

Resumen Introducción. La sífilis es una enfermedad de interés en salud pública por sus elevadas tasas de morbilidad y mortalidad. Objetivo. Determinar la serorreacción y la seroprevalencia de sífilis según las variables sociodemográficas de los donantes de un banco de sangre del distrito de Barranquilla, Colombia, durante 2015 y 2016. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal basado en los resultados de las pruebas treponémicas y no treponémicas. Se analizaron las variables sociodemográficas de la población estudiada y se hizo un análisis univariado en el que se determinaron las frecuencias absoluta y relativa de cada una de las variables categóricas. Se determinó la serorreacción a Treponema pallidum y la prevalencia de la infección activa. Se utilizó la prueba de ji al cuadrado de Pearson para evaluar las diferencias entre las proporciones. Resultados. Se encontró una serorreacción de 1,86 % para la infección previa con T. pallidum y una prevalencia de 0,93 % para la infección activa, las cuales fueron más altas en hombres adultos y en adultos mayores, viudos, desempleados y personas residentes en otros municipios del departamento de Atlántico diferentes de Barranquilla y su área metropolitana. Se encontró una asociación significativa entre la sífilis y las variables de sexo y ocupación. Conclusión. Se registró una serorreacción elevada a T. pallidum en donantes de sangre, comparada con el promedio nacional. Se encontró asociación entre la sífilis, y las variables sociodemográficas de sexo y ocupación, principalmente.

Abstract Introduction: Syphilis is a public health concern given its high impact on morbidity and mortality. Objective: We aimed to determine the association of syphilis seroreactivity and seroprevalence with sociodemographic variables of donors at a blood bank in the district of Barranquilla, Colombia, during 2015 and 2016. Materials and methods: We conducted a descriptive cross-sectional study based on the results of the treponemal and nontreponemal tests and the sociodemographic variables of the study population. We performed a univariate analysis to determine the absolute and relative frequencies for each categorical variable. We determined the seroreactivity against Treponema pallidum and the prevalence of active syphilis infection, and we used Pearson's chi-square test to evaluate the differences between the proportions. Results: We found a seroreactivity of 1.86% in individuals with previous T. pallidum infection, and a prevalence of 0.93% in those with active T. pallidum infection. These values were higher in adult men and older adults, widowers, the unemployed, and people living in municipalities of the Department of Atlántico other than Barranquilla and its metropolitan area. The incidence of syphilis infection showed a significant association with sex and occupation. Conclusion: In comparison to the national average, syphilis seroreactivity was high among blood donors. There was an association between syphilis infection incidence and sociodemographic variables such as sex and occupation.

La donación y la transfusión de sangre en función del envejecimiento poblacional de Cienfuegos, 2010-2016 / Blood donation and transfusion according to the population aging of Cienfuegos, 2010-2016

Introducción: La provincia de Cienfuegos es autosuficiente para satisfacer su demanda transfusional actual. Sin embargo, esta situación podría modificarse por los efectos que sobre la asistencia sanitaria ejerce el envejecimiento poblacional. Objetivos: Identificar la relación entre donaciones y transfusiones de sangre en función de los cambios en la dinámica poblacional. Métodos: Estudio descriptivo transversal desarrollado mediante revisión documental. Se incluyó como variables el número de habitantes agrupados según la edad regulada en Cuba para donar sangre, la cantidad de donaciones y de pacientes transfundidos durante el periodo de estudio. se utilizó el coeficiente de correlación de Spearman ( ρ)para establecer el grado de relación entre ellas. Se calcularon tasas, porcientos y el cambio relativo entre años extremos de las series. Resultados: La composición de los grupos de edades de la población mostró preferencia hacia el envejecimiento con una disminución del 5 por ciento en el número de habitantes de 0 a 19 años junto a un incremento del doble de ese valor en los adultos mayores. Las donaciones decrecen en cerca del 8 por ciento, mientras que el número de pacientes transfundidos aumentan en el 33 por ciento. Se comprueba la existencia de correlaciones directas e inversas, estadísticamente significativas, entre los indicadores estudiados. Conclusiones: Los resultados de la investigación son sugerentes a una relación entre los indicadores de donaciones, transfusiones de sangre y los cambios en la estructura por edad de la población que, de mantenerse la tendencia actual, podrían conducir a periodos de escasez de sangre para transfusiones(AU)

Introduction: The province of Cienfuegos is self-sufficient to satisfy the actual transfusion demand. However, this situation could be modified due to the effects of population aging on health care service. Objective: To identify the relationship between donations and blood transfusions based on changes in population dynamics. Methods: Transversal descriptive study developed through documentary review. The number of inhabitants grouped according to the regulated age in Cuba to donate blood, the number of donations and transfused patients during the study period were included as variables, using the Spearman correlation coefficient ( ρ) to establish the degree of relationship between them. The rates, percent and relative change between the extreme years of the series were calculated. Results: The composition of the age groups of the population was inclined towards aging with a 5 percent decrease in the number of inhabitants from 0 to 19 years, together with an increase of twice that value in the elderly. Donations decrease by about 8 percent, while the number of patients transfused increases by 33 percent. The existence of statistically significant direct and inverse correlations between the indicators studied is verified. Conclusions. The results of the research are suggestive of a relationship between the blood donationand blood transfusion indicators and the changes in the age structure of the population observed which, if the current trend continues, lead to periods of blood shortage for transfusions(AU)

Profile of blood donors who presented adverse reactions to the donation / Perfil de los donantes de sangre que presentaron reacciones adversas a la donación / Perfil dos doadores de sangue que apresentaram reações adversas à doação

ABSTRACT Objective: identify the adverse reactions presented by blood donors and outline their sociodemographic profile. Method: a quantitative, cross-sectional retrospective study of 780 records of blood donors from a public hemocenter in the southern region of Brazil, from December 2015 to January 2016. For the analysis the descriptive statistics was used. Results: it was identified that throughout 12 months, the total blood donors corresponded to 27,300 people, in which 780 developed at least one reaction. They were characterized by female and recurrent donors, single, with a complete average level of education, ranging from 16 to 30 years, who triggered between 1 and 3 reactions. Mild reactions were more frequent, followed by moderate and severe reactions. Conclusion: There is a high rate of adverse reactions from donors emphasizing the need for changes in hemotherapy care practices.

RESUMEN Objetivo: identificar las reacciones adversas presentadas por los donantes de sangre y trazar su perfil sociodemográfico. Método: una investigación cuantitativa, retrospectiva transversal, realizada en 780 registros de donantes de sangre de un hemocentro público de la región sur de Brasil, en el período de diciembre de 2015 a enero de 2016. Para el análisis se procedió a la estadística descriptiva. Resultados: se identificó que, en el período de 12 meses, el total de donantes de sangre correspondió a 27.300 personas, en el cual 780 desarrollaron al menos una adversidad. Se caracterizaron por donantes de repetición, del género femenino, solteros, con nivel de escolaridad promedio completo, en el grupo de edad de 16 a 30 años, que desencadenaron entre 1 y 3 adversidades. Las reacciones lleves fueron más recurrentes, seguidas de las reacciones moderadas y graves. Conclusión: se señala un alto índice de reacciones adversas por parte de los donantes enfatizando la necesidad de cambios en las prácticas de los cuidados en hemoterapia.

RESUMO Objetivo: identificar as reações adversas apresentadas pelos doadores de sangue e traçar o seu perfil sociodemográfico. Método: pesquisa quantitativa, retrospectiva transversal, realizada em 780 registros de doadores de sangue de um hemocentro público da região sul do Brasil, no período de dezembro de 2015 a janeiro de 2016. Para análise procedeu-se à estatística descritiva. Resultados: identificou-se que, no período de 12 meses, o total de doadores de sangue correspondeu a 27.300 pessoas, no qual 780 desenvolveram ao menos uma adversidade. Caracterizaram-se por doadores de repetição, do gênero feminino, solteiros, com nível de escolaridade médio completo, na faixa etária de 16 a 30 anos, que desencadearam entre 1 e 3 adversidades. As reações leves foram mais recorrentes, seguidas das reações moderadas e graves. Conclusão: Aponta-se um alto índice de reações adversas por parte dos doadores enfatizando a necessidade de mudanças nas práticas dos cuidados em hemoterapia.

Avaliação de marcadores sorológicos treponêmicos e não-treponêmicos em doadores inaptos para sífilis atendidos em um hemocentro brasileiro / Evaluation of treponemal and non-treponemal serological markers in unfit blood donors for syphilis in a brazilian blood center

Introdução: A sífilis é uma doença infecciosa sistêmica de evolução crônica, causada pela bactéria Treponema pallidum, que pode ser transmitida por transfusões de sangue. A avaliação dos marcadores sorológicos na triagem para sífilis em doadores de sangue é fundamental para confirmar se o sangue doado pode estar contaminado com T. pallidum ou se há descarte por reações inespecíficas. Métodos: A população foi composta por doadores de sangue atendidos em todas as unidades do Hemopa, que atenderam aos critérios do estudo. Houve análise dos resultados obtidos através do VDRL e ELISA e informações socioeconômicas sobre a população: sexo, idade, escolaridade e estado civil, obtidos a partir do registro de doadores. Resultados: Durante o período do estudo, houve 103.187 doações de sangue. Um total de 883 doadores foram considerados inaptos para sífilis no teste de triagem (0,86%) e 271 pessoas (30,69%) compareceram ao hemocentro para realização de testes confirmatórios: 50,6% homens; 49,4% mulheres; idade média de 34 anos. Mais da metade declarou ter ensino médio completo e a maioria (75,6%) relatou ser solteiros. Mais de 50% dos doadores apresentaram titulação menor que 1/16; 91,5% também apresentou reatividade em ELISA. 15 pessoas (5,5%) apresentaram outro resultado reagente além da sífilis. Conclusão: Houve mais de 90% de resultados concordantes entre teste treponêmico e não treponêmico em nossa triagem laboratorial. Esses resultados podem auxiliar instituições na estratégia de triagem para sífilis em doadores de sangue. (AU)

Introduction: Syphilis is a chronic systemic infectious disease caused by Treponema pallidum, which can be transmitted by blood transfusions. The evaluation of serological markers for syphilis screening in blood donors is crucial to confirm whether the donated blood may be contaminated with T. pallidum or if it is discarded by nonspecific reactions. The aim of this study was to describe results obtained between nontreponemal and treponemal serological tests and sociodemographic profile of blood donors in a Brazilian blood center. Methods: The population consisted of all blood donors attended at Fundação Hemopa, who met the study criteria. The results obtained through the VDRL and ELISA tests, as well as socioeconomic information about the population ­ gender, age, education and marital status ­ were analyzed. Results: During the study period, there were 103,187 blood donations. 883 donors were considered unfit for syphilis in the screening test (0.86%) and 271 of these (30.69%) attended the blood center for confirmatory testing: 50.6% men; 49.4% women; average age 34 years. More than half reported having completed high school and 75.6% reported being single. More than 50% of donors had titers less than 1/16; 91.5% also had ELISA reactivity. Fifteen people (5.5%) presented another reagent result in serological screening besides syphilis. Conclusions: There were more than 90% concordant results between treponemal and non-treponemal testing in our laboratory screening. These results may assist institutions in the screening strategy for syphilis in blood donors. (AU)

Seroprevalence of trypanosoma cruzi infection among blood donors in the state of Bahia, Brazil

Abstract INTRODUCTION: Chagas disease (CD) affects 5.7-7.0 million individuals worldwide, and its prevalence reached 25.1% in the state of Bahia, Brazil. There is an association between the prevalence of CD, the socioeconomic status of the population, and the risk of re-emergence due to non-vectorial transmission, such as blood transfusion. This study determined the seroprevalence of T. cruzi infection among blood donors in the state of Bahia, located in northeastern Brazil, and their epidemiological profile during a 10-year period. METHODS: We performed a descriptive cross-sectional study involving a database review. Data were collected from patients with non-negative results for T. cruzi infection during a 10-year period. RESULTS: A total of 3,084 (0.62%) samples were non-negative for T. cruzi infection in an initial serological screening, and 810 (0.16%) samples were non-negative in the second screening. The correlation between infection and age (30 years or older) and between infection and lower educational level (12 years or less) in the first and second screening was statistically significant. The seroprevalence of T. cruzi infection was higher in men in the first screening. In addition, 99.52% of the municipalities of Bahia had at least one case of CD. Livramento de Nossa Senhora and Salvador presented the highest disease prevalence and recurrence, respectively. CONCLUSIONS: The seroprevalence of T. cruzi infection in these populations was lower than that found in other studies in Brazil but was comparatively higher in densely-populated areas. The demographic characteristics of our population agreed with previous studies.

Prevalência da doença de Chagas entre doadores de sangue do Estado do Piauí, Brasil, no período de 2004 a 2013 / Prevalence of Chagas disease among blood donors in Piauí State, Brazil, from 2004 to 2013 / Prevalencia de la enfermedad de Chagas entre donadores de sangre del estado de Piauí, Brasil, durante el período de 2004 a 2013

Apesar do declínio na prevalência da doença de Chagas no Brasil, a Região Nordeste apresenta condições propícias ao seu recrudescimento. O objetivo deste estudo foi analisar a positividade por doença de Chagas entre doadores de sangue do Piauí entre 2004 e 2013. A prevalência de sorologia reagente para doenças de Chagas na triagem de doadores foi de 1%, variando de 0,4% na Regional de Saúde de Uruçuí a 2,4% na Regional de Saúde de São Raimundo Nonato. Dos 220 municípios, 58,6% apresentaram casos. Apenas 34,5% das amostras positivas na triagem foram encaminhadas para testes complementares e entre estes, 84,4% apresentaram resultados negativos. Nossos resultados indicam a possibilidade da manutenção da transmissão vetorial em áreas do Estado do Piauí e a necessidade da implantação de ações que melhorem o índice de realização dos testes complementares referentes aos casos positivos na triagem.

Despite the decline in prevalence of Chagas disease in Brazil, the Northeast region of the country has favorable conditions for its resurgence. The study aimed to analyze positive Chagas disease serology rates among blood donors in Piauí State from 2004 to 2013. Prevalence of positive Chagas disease serology in blood donor screening was 1%, ranging from 0.4% in the Uruçuí Regional Health District to 2.4% in the São Raimundo Nonato Regional Health District. Of the state's 220 municipalities, 58.6% reported cases. Only 34.5% of the positive samples in screening were referred for complementary tests, and 84.4% of these showed negative results. Our findings suggest the possibility of persistent vector-borne transmission in areas of Piauí State and the need for measures to improve complementary testing in positive cases detected by screening.

A pesar del declive en la prevalencia de la enfermedad de Chagas en Brasil, la Región Nordeste presenta condiciones propicias para su recrudecimiento. El objetivo de este estudio fue analizar la positividad por enfermedad de Chagas entre donadores de sangre de Piauí entre 2004 y 2013. La prevalencia de la serología reactiva para la enfermedad de Chagas en la clasificación de donadores fue de un 1%, variando de 0,4% en la Regional de Salud de Uruçuí, a 2,4% en la Regional de Salud de São Raimundo Nonato. De los 220 municipios, un 58,6% presentaron casos. Sólo un 34,5% de las muestras positivas en la clasificación fueron dirigidas a test complementarios y entre estos, un 84,4% presentaron resultados negativos. Nuestros resultados indican la posibilidad del mantenimiento de la transmisión vectorial en áreas del Estado de Piauí y la necesidad de la implantación de acciones que mejoren el índice de realización de los test complementarios referentes a los casos positivos en la clasificación.

Prevalencia de anticuerpos anti Toxoplasma gondii en hemodonantes en la ciudad de Buenos Aires, desde 1967 a 2017 / Prevalence of anti-Toxoplasma gondii antibodies in blood donors in Buenos Aires city, from 1967 to 2017

Se estudió la prevalencia de anticuerpos anti Toxoplasma gondii a los dadores voluntarios de sangre que concurrieron durante el primer cuatrimestre de los años 1997, 2007 y 2017 al Servicio de Hemoterapia del Hospital Alemán de Buenos Aires y se compararon los resultados con el estudio efectuado en el año 1967. Los sueros fueron procesados con el Sabin Feldman Dye Test. La seroprevalencia promedio en 1967 fue 67.0% (IC95%, 64.4%-69.6%), en 1997, 35% (IC95%, 33.3%-38.3%), en 2007, 31.9 % (IC95%, 29.6%-34.2%) y en 2017, 21.2% (IC95%, 19.0%-23.3%). En los cincuenta años que abarca el estudio la disminución de la prevalencia fue de 45.8%, que representa una declinación anual promedio del 0.9%. El descenso fue estadísticamente significativo entre los años 1967 y 1997 y entre 2007 y 2017. En los cuatro estudios se observó un incremento de la prevalencia de infección en función de la edad. La tasa de infección calculada para el año 1967 fue 1.0% y disminuyó en los estudios posteriores, a 0.8% en 1997, 0.7% en 2007 y 0.5% en 2017. Los donantes del último estudio respondieron una encuesta que mostró una correlación estadísticamente significativa entre seroprevalencia de anticuerpos anti-Toxoplasma gondii y la carencia de agua corriente, estudios secundarios no concluidos o la residencia en zona oeste o sur del conurbano bonaerense. No se encontró una asociación significativa con tener un gato como mascota, consumo de carne poco cocida o práctica de jardinería.

A prevalence study of antibodies anti Toxoplasma gondii in voluntary blood donors who attended the hemotherapy service at the Hospital Alemán during the first four months of the years 1997, 2007 and 2017 was carried out and the results were compared to the study carried out in 1967. The sera where processed with the Sabin Feldman Dye Test. The global average seroprevalence in 1967 was 67.0% (CI95%, 64.4%-69.6%); in 1997, 35.0% (CI95%, 33.3%-38.3%); in 2007, 31.9% (CI95%, 29.6%-34.2%) and in 2017, 21.2% (CI95%, 19.0%-23.3%). In the fifty years covered by the study the decline in prevalence was 45.8%, which represents an average annual decline of 0.9%.The decline was statistically significant between 1967 and 1997, and between 2007 and 2017. The four studies demonstrate that infection prevalence increased depending on age. The infection rate for 1967 was 1.0% per year and declined in the next studies to 0.8% in 1997, 0.8% in 2007, and 0.5% in 2017. Donors from the last study responded to a survey that showed a statistically significant correlation between seroprevalence of Toxoplasma gondii antibodies and lack of tap water, unfinished secondary studies or residence in the western or southern part of the Buenos Aires metropolitan area. No significant association was found with having a cat as a pet, the consumption of undercooked meat or the practice of gardening.

Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up

ABSTRACT OBJECTIVE To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation. METHODS Blood donors from 1994 to 2012, identified with positive anti- HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up. RESULTS Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95%CI 1.15–1.71), age under or equal to 50 years (PR = 1.36; 95%CI 1.12–1.65) and non-Caucasians (PR = 1.53; 95%CI 1.27–1.84). CONCLUSIONS About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments.

Benznidazole therapy for Chagas disease in asymptomatic Trypanosoma cruzi -seropositive former blood donors: evaluation of the efficacy of different treatment regimens

Abstract: INTRODUCTION: Chagas disease currently affects 5.7 million people in Latin America and is emerging in non-endemic countries. There is no consensus concerning the efficacy of trypanocidal therapy for patients with the chronic form of the disease. We evaluated cardiac function and sociodemographic, clinical, and serologic characteristics of a group of asymptomatic Trypanosoma cruzi-seropositive former blood donors, and compared the effects of benznidazole treatment applied for different lengths of time. METHODS: Blood donors who screened positive for T. cruzi between 1998 and 2002 were recruited 10 years later for follow-up (n = 244); 46 individuals had received treatment. Three subjects had terminated treatment prematurely. The remaining 43 individuals were divided into two groups: individuals who had received benznidazole therapy for 50-60 days (n = 28; BT ≤60 group) or more than 60 days (n = 15; BT >60). Serologic assays, biochemical tests, electrocardiographic, echocardiographic, and clinical examinations were performed on all participants. Parasite loads were determined by qualitative and quantitative polymerase chain reaction. RESULTS: Parasitemia was significantly reduced in the BT ≤60 and BT >60 groups compared with the untreated group. There were no differences in epidemiologic profiles or clinical, biochemical, electrocardiographic, or echocardiographic data between any of the groups. CONCLUSIONS: Despite elimination or significant reduction in parasitemia in patients with chronic Chagas disease who received benznidazole, there was no clinical difference between those who were treated for >60 days and those treated for a shorter duration. Furthermore, the adverse effects of benznidazole appear to be less severe than previous reports would suggest.

Novos critérios para doações de sangue no Brasil: impacto no perfil dos doadores e na quantidade de doações realizadas em uma unidade de coleta de Santa Catarina / New criteria for blood donation in Brazil: impact on donor profile and number of donations in a blood collection center of Santa Catarina

Introdução: Recentemente, o Ministério da Saúde implementou mudanças nos critérios de doação de sangue, com intuito de ampliar o número de doações. Objetivo: Avaliar o impacto da ampliação da faixa etária elegível para doação no perfil dos doadores e no número de doações em uma unidade de coleta de Santa Catarina. Métodos: Estudo transversal que avaliou as fichas de cadastro dos doadores de sangue do Hemocentro de Tubarão/SC (Hemosc) do período 2011 a 2013. Resultados: 15.528 doações foram realizadas no período, 56% de caráter espontâneo. Os doadores foram em sua maioria (68%) homens, entre 30 e 69 anos. Do total de doações, 0,29% em 2011 e 0,49% em 2013 foram de jovens de 16 a 18 anos. Conclusão: Não foi possível detectar na unidade de Tubarão o esperado aumento na proporção de doadores na população com a ampliação da faixa etária elegível(AU)

Background: Recently, the Ministry of Health has implemented changes in blood donation criteria, aiming to increase the number of blood donations. Objective: To evaluate the impact of expanding the eligible age for donation on donor profile and number of donations in a blood collection center of Santa Catarina. Methods: A cross-sectional study that evaluated the registration records of blood donors in HEMOSC, a blood collection center in Tubarão, SC, in the 2011-2013 period. Results: 15,528 donations were made in the period, 56% spontaneously. Donors were mostly men (68%), between 30 and 69 years of age. Of total donations, 0.29% in 2011 and 0.49% in 2013 were from young people between 16 to 18 years of age. Conclusion: We failed to detect the expected increase in the proportion of donors in the population of Tubarão with the expansion of the eligible age for donation(AU)

Risk factors for deferral due to low hematocrit and iron depletion among prospective blood donors in a Brazilian center

OBJECTIVE: Deferral of blood donors due to low hematocrit and iron depletion is commonly reported in blood banks worldwide. This study evaluated the risk factors for low hematocrit and iron depletion among prospective blood donors in a large Brazilian blood center.METHOD: A case-control study of 400 deferred donors due to low hematocrit and 456 eligible whole blood donors was conducted between 2009 and 2011. Participants were interviewed about selected risk factors for anemia, and additional laboratory tests, including serum ferritin, were performed. Bivariate and multivariate analyses were performed to assess the association between predictors and deferral due to low hematocrit in the studied population and iron depletion in women.RESULTS: Donors taking aspirins or iron supplementation, those who reported stomachache, black tarry stools or hematochezia, and women having more than one menstrual period/month were more likely to be deferred. Risk factors for iron depletion were repeat donation and being deferred at the hematocrit screening. Smoking and lack of menstruation were protective against iron depletion.CONCLUSION: This study found some unusual risk factors related to gastrointestinal losses that were associated with deferral of donors due to low hematocrit. Knowledge of the risk factors can help blood banks design algorithms to improve donor notification and referral.

Rates and reasons for blood donor deferral, Shiraz, Iran. A retrospective study / Taxas e razões para o diferimento de doadores de sangue, Shiraz, Irã. Um estudo retrospectivo

CONTEXT AND OBJECTIVE: Knowledge of the reasons for donor deferral can help in planning more efficient recruitment strategies and evaluating donor selection criteria. This study aimed to investigate the rates and reasons for donor deferral. DESIGN AND SETTING: Retrospective study at Shiraz Blood Transfusion Center, Shiraz, Iran. METHODS: 141,820 volunteers were interviewed confidentially by physicians before blood donation. The rate of and reasons for donor deferral were investigated according to demographic characteristics. The data were analyzed using the comparison-of-proportions test of the MedCalc statistical software. RESULTS: 43,839 people (30.9%) who had come for blood donation were deferred, 1,973 (4.5%) of them permanently. The deferral rate was significantly higher among women, single individuals and first-time donors, compared with men, married individuals and those with a history of previous donation (P < 0.0001). The deferral rate was significantly higher in the 17 to 30-year-old group (P < 0.05). The reasons for deferral were divided into five categories: risk factors possibly related to HIV or hepatitis (43.6%), underlying diseases (31.9%), non-eligible conditions (13.5%), medications that interfere with blood donation (7.8%) and risk factors that may relate to bacterial or viral infections except HIV and hepatitis infections (3.2%). CONCLUSION: Effective measures are required for documenting the impact of deferral on blood availability, monitoring the effectiveness of and need for deferral, and determining the reasons and rates of deferral. .

CONTEXTO E OBJETIVO: Conhecimentos sobre os motivos do adiamento da doação de sangue podem ajudar a planejar estratégias mais eficientes de recrutamento e avaliar critérios de seleção de doadores. O objetivo foi investigar as taxas e os motivos para o adiamento da doação. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo no centro de transfusão de sangue de Shiraz, Irã. MÉTODOS: 141.820 voluntários foram entrevistados confidencialmente por médicos antes da doação de sangue. A taxa e as razões para o adiamento da doação foram pesquisadas de acordo com características demográficas. Os dados foram analisados com o teste de comparação de proporções do software estatístico MedCalc. RESULTADOS: 43.839 pessoas (30.9%) encaminhadas para doação tiveram sua doação diferida, sendo 1.973 permanentemente. A taxa de adiamento foi significativamente maior entre as mulheres, solteiras e doadoras de primeira vez, em comparação com os homens, casados e os com história de doação anterior (P < 0,0001). A taxa de adiamento foi significativamente maior no grupo de 17-30 anos de idade (P < 0,05). As razões para o adiamento foram divididas em cinco categorias: fatores de risco que podem estar relacionados com HIV ou hepatite (43,6%), doenças subjacentes (31,9%), condições não elegíveis (13,5%), medicamentos que interferem na doação (7,8%) e fatores de risco que podem estar relacionados com infecções bacterianas ou virais, exceto infecções de HIV e hepatite (3,2%). CONCLUSÃO: São necessárias medidas eficazes para documentar ...

Hcv infection trrough perforating and cutting mterial among candidates for bloood donation in belém, Brazilian amazon / Infecção pelo HCV através de materiais cortantes e perfurantes entre candidatos à doação de sangue em Belém, Amazônia Brasileira

This study evaluated epidemiological factors for HCV infection associated with sharing perforating and cutting instruments among candidates for blood donation (CBD) in the city of Belém, Pará, Brazilian Amazon. Two definitions of HCV infection cases were used: anti-HCV positivity shown by EIA, and HCV-RNA detection by PCR. Infected and uninfected CBD completed a questionnaire about possible risk factors associated with sharing perforating and cutting instruments. The information was evaluated using simple and multiple logistic regressions. Between May and November 2010, 146 (1.1%) persons with anti-HCV antibodies and 106 (0.8%) with HCV-RNA were detected among 13,772 CBD in Belém. Risk factors associated with HCV infection based on the EIA (model 1) and PCR (model 2) results were: use of needles and syringes sterilized at home; shared use of razors at home, sharing of disposable razors in barbershops, beauty salons etc.; and sharing manicure and pedicure material. The models of HCV infection associated with sharing perforating and cutting instruments should be taken into account by local and regional health authorities and by those of other countries with similar cultural practices, in order to provide useful information to guide political and public strategies to control HCV transmission.

Este estudo avaliou fatores epidemiológicos para infecção pelo HCV associados ao compartilhamento de instrumentos cortantes e perfurantes em candidatos à doação de sangue (CDS) na cidade de Belém, Pará, Amazônia Brasileira. Duas definições de infecção pelo HCV foram utilizadas: positividade por anti-HCV detectada por EIA, e HCV-RNA detectado por PCR. CDS infectados e não-infectados preencheram questionário sobre possíveis fatores de risco associados com o compartilhamento de instrumentos cortantes e perfurantes. As informações foram avaliadas usando regressão logística simples e múltipla. Entre maio e novembro de 2010, 146 (1,1%) indivíduos com anticorpos anti-HCV e 106 (0,8%) com HCV-RNA foram detectadas entre 13.772 CDS em Belém. Os fatores de risco associados à infecção pelo HCV baseado em resultados de EIA (modelo 1) e PCR (modelo 2) foram: uso de agulhas e seringas esterilizadas em casa, uso compartilhado de lâminas em casa, compartilhamento de lâminas em barbearias, salões de beleza, etc., e compartilhamento de material de manicure e pedicure. Os modelos de infecção pelo HCV associados com o compartilhamento de instrumentos cortantes e perfurantes devem ser considerados pelas autoridades de saúde local e regional e de países com práticas culturais semelhantes, a fim de fornecer informações uteis para direcionar estratégias e políticas públicas de controle da transmissão do HCV.

Pesquisa de marcadores sorológicos para doença celíaca nos doadores de sangue da cidade de Ponta Grossa - Paraná - Brasil / Search serological markers for celiac disease in blood donors in the city of Ponta Grossa - Paraná - Brazil

A Doença Celíaca é uma patologia autoimune, caracterizada por lesões na mucosa do intestino delgado, em indivíduos geneticamente predispostos, desencadeada pela ingestão de glúten. Além dos fatores genéticos, a presença de fatores ambientais e imunológicos contribui para o desenvolvimento da doença. Portadores desta patologia não podem realizar doação de sangue por esta ser considerada uma doença autoimune. Objetivos: determinar a prevalência do anticorpo antitransglutaminase associado à doença celíaca em candidatos a doadores de sangue. Método: o desenho foi descritivo do tipo corte transversal, com a participação de 300 candidatos a doadores de sangue, residentes na cidade de Ponta Grossa, com idade entre 18 e 65 anos. Todos os participantes responderam a um questionário a respeito da presença de diarreia, constipação e dor abdominal nos três meses que antecederam a doação. A dosagem do anticorpo antitransglutaminase tecidual IgA foi realizada em todos os indivíduos pela metodologia ELISA, e àqueles com teste positivo foram convidados a realizar biópsia de intestino delgado por endoscopia digestiva alta. Resultados: em um total de 300 candidatos a doadores de sangue foram encontrados três casos positivos, com confirmação em triplicata do teste de antitransglutaminase IgA. Conclusão: a pesquisa precoce de doença celíaca é uma questão de prevenção na Saúde Pública, visto que casos não diagnosticados tendem a evoluir para complicações graves, o que gerariam custos elevados e desnecessários ao sistema público e privado de saúde.

Celiac disease is an autoimmune disease characterized by lesions on the small intestine mucosa in genetically predisposed individuals, triggered by gluten ingestion. Besides genetic factors, presence of environmental and immunological factors contribute to the development of the disease. Patients with this condition cannot donate blood, as this is considered an autoimmune disease. Objectives: establish prevalence of antitransglutaminase associated with celiac disease in prospective blood donors. Methods: the design was cross-sectional escriptive involving 300 prospective blood donors resident in the city of Ponta Grossa, aged between 18 and 65 years. All participants answered a questionnaire about the presence of diarrhea, onstipation and abdominal pain within three months previous to donation. The dosage of IgA tissue transglutaminase antibody was performed in all subjects by ELISA methodology, and those testing positive were invited to perform small intestine biopsies by endoscopy. Results: in a total of 300 prospective blood donors, there were three (3) positive cases with confirmation in triplicate test of transglutaminase IgA. Conclusions: early celiac cisease scanning is a matter of prevention in Public Health, as undiagnosed cases tend to progress to serious complications that generate high and unnecessary costs to the public and private health systems.

Accuracy of a probabilistic record-linkage methodology used to track blood donors in the Mortality Information System database / Acurácia da metodologia de relacionamento probabilístico de registros na identificação de doadores de sangue no banco de dados do Sistema de Informações sobre Mortalidade / La exactitud del método probabilístico de relación para identificar a donantes de sangre en la base de datos del Sistema de Información sobre Mortalidad

The probabilistic record linkage (PRL) is based on a likelihood score that measures the degree of similarity of several matching variables. Screening test results for different diseases are available for the blood donor population. In this paper, we describe the accuracy of a PRL process used to track blood donors from the Fundação Pró-Sangue (FPS) in the Mortality Information System (SIM), in order that future studies might determine the blood donor’s cause of death. The databases used for linkage were SIM and the database made up of individuals that were living (200 blood donors in 2007) and dead (196 from the Hospital das Clinicas de São Paulo that died in 2001-2005). The method consists of cleaning and linking the databases using three blocking steps comparing the variables “Name/Mother’s Name/ Date of Birth” to determine a cut-off score. For a cut-off score of 7.06, the sensitivity and specificity of the method is 94.4% (95%CI: 90.0-97.0) and 100% (95%CI: 98.0-100.0), respectively. This method can be used in studies that aim to track blood donors from the FPS database in SIM.

O relacionamento probabilístico se baseia em um escore que é calculado levando em consideração a similaridade do pareamento de diversas variáveis. Dados de resultados de testes de triagem para diferentes doenças estão disponíveis para a população de doadores de sangue. Neste artigo descrevemos a acurácia de um processo de relacionamento probabilístico para identificar doadores de sangue da Fundação Pró-Sangue (FPS) no Sistema de Informações sobre Mortalidade (SIM). Os bancos utilizados para o relacionamento foram o SIM e o banco formado por indivíduos vivos (200 doadores de sangue em 2007) e mortos (196 pacientes do Hospital das Clínicas de São Paulo que morreram entre 2001-2005). O método consistiu em limpar e relacionar probabilísticamente os bancos em três passos de blocagem comparando as variáveis “Nome/Nome Mãe /Data de Nascimento” para determinar um escore de corte. Para um escore de corte de 7,06 a sensibilidade e especificidade do método é de 94,4% (IC95%: 90-97) e 100% (IC95%: 98-100), respectivamente. Este método pode ser utilizado em estudos para identificar pacientes da FPS no SIM.

La relación probabilística (RP) se basa en una puntuación que se calcula en función de la similitud entre variables de emparejamiento. Los resultados de los tests sobre diferentes enfermedades están a disposición de la población de donantes de sangre. En el presente artículo se describe la precisión de un proceso de RP para identificar a donantes de sangre de la Fundação Pró-Sangue (FPS) en el Sistema de Información de Mortalidad (SIM). Se llevó a cabo la RP del SIM y de un banco compuesto por individuos vivos (200 donantes de sangre en 2007) y muertos (196 pacientes del Hospital de Clínicas de São Paulo, que murieron entre 2001 y 2005). El método consistió en depurar los bancos de datos y RP en tres etapas de bloqueo, comparando las variables nombre, nombre de la madre y fecha de nacimiento para determinar un punto de corte. Para el punto de corte 7:06, la especificidad y sensibilidad del método fue de un 94,4% (IC95%: 90,0-97,0) y 100% (IC95%: 98,0-100,0), respectivamente. Este método puede ser utilizado en más estudios con el fin de identificar a los pacientes FPS en el SIM.