Prevalence of hepatitis B & hepatitis C virus infections in potential blood donors in rural Vietnam
Le Viet1, Nguyen Thi Ngoc Lan2, Phung Xuan Ty2, Björn Björkvoll3, Hedda Hoel3, Tore Gutteberg4, Anne Husebekk5, Stig Larsen6, Eystein Skjerve6, Hans Husum7
1 Quang Tri Provincial Preventive Medicine Centre, Quang Tri Health Service, Vietnam; Faculty of Health Sciences, University of Tromsoe, Norway
2 Quang Tri Provincial Preventive Medicine Centre, Quang Tri Health Service, Vietnam
3 Tromsoe Mine Victim Resource Centre, University Hospital North Norway, Tromsoe, Norway
4 Institute of Medical Biology, University of Tromsoe; Department of Microbiology & Infectious Control, University Hospital North Norway, Tromsoe, Norway
5 Institute of Medical Biology, University of Tromsoe; Department of Immunology & Transfusion Medicine, University Hospital North Norway, Tromsoe, Norway
6 Centre of Epidemiology & Biostatistics, Norwegian School of Veterinary Science, Tromsoe, Norway
7 Tromsoe Mine Victim Resource Centre, University Hospital North Norway, Tromsoe; Faculty of Health Sciences, University of Tromsoe, Norway
PO Box 80, N-9038, University Hospital North Norway, Tromsoe, Norway
Source of Support: None, Conflict of Interest: None
Background & objectives: Safe blood and blood products should be offered to all patients in need for blood transfusion. The objectives of the present study were to establish prevalence estimates for hepatitis B and hepatitis C virus infections as a foundation for safe blood transfusion in rural Vietnam, and to check the accuracy of the laboratory analysis used for hepatitis testing of blood donors in Vietnam.
Methods: A cross-sectional study was conducted in two rural communities in Quang Tri, Vietnam. A total of 1,200 blood samples collected from potential blood donors were tested by an enzyme immunoassay technique (EIA) for detection of hepatitis surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), and antibodies to hepatitis C antigen (anti-HCV). The EIA test outcome was validated by a chemiluminescent micro particle immunoassay technique (CMIA).
Results: The prevalence of HBsAg and anti-HBc in the study population was 11.4 per cent (95% CI 9.6 - 13.2) and 51.7 per cent (95% CI 48.8 - 54.5), respectively, the prevalences being higher in males than females. The prevalence of anti-HCV was 0.17 per cent. The test agreement between the EIA and CMIA techniques was high both for HBsAg detection (κ = 0.91; 95% CI: 0.83 - 0.99) and for anti-HBc detection (κ = 0.89; 95% CI 0.81 - 0.97). Compared to CMIA results, the positive and negative predictive values of the EIA tests were found to be 94.9 per cent (95% CI 87.5 - 98.6) and 97.5 per cent (95% CI 86.8 - 99.9) for HBsAg, and 92.4 per cent (95% CI 84.2 - 97.2) and 100 per cent (95% CI 91.2 - 100) for anti-HBc.
Interpretation & conclusions: The study shows that hepatitis B virus infection is endemic in rural areas of Vietnam and that almost half of the population is or has been infected. Hepatitis C infection is rare, but false negative test results cannot be ruled out. Also, the results indicate that the EIA performance in blood donor screening in Vietnam may be sub-optimal, missing 2.5 per cent of hepatitis B virus carriers and falsely excluding more than 7 per cent of blood donors. As the prevalence of hepatitis B infection is high, occult hepatitis B infection may represent a threat to safe blood transfusion. Therefore, nucleic acid amplification testing for HBV should be considered for blood donor screening in Vietnam.