The persistence of hepatitis C virus transmission risk in China despite serologic screening of blood donations

Authors

  • Jingxing Wang,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Jing Liu,

    Corresponding author
    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
    • Address reprint requests to: Jing Liu, PhD, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287; e-mail: jliu84@jhmi.edu.

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  • Yi Huang,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • David J. Wright,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Julin Li,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Zhongmin Zhou,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Weilan He,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Tonghan Yang,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Fuzhu Yao,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Xiangming Zhu,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Guoxin Wen,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Xinhong Bi,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Mei-hei-li Tiemuer,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Xiuqiong Wen,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Mei Huang,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Ru'an Cao,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Zhongqiao Yun,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Yunlai Lü,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Hongli Ma,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Nan Guo,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Qilu Yu,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Paul Ness,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • Hua Shan,

    1. Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China
    2. Johns Hopkins School of Medicine, Baltimore, Maryland
    3. Westat, Inc., Rockville, Maryland
    4. Guangxi Blood Center, Liuzhou, Guangxi, P.R. China
    5. Kunming Blood Center, Kunming, Yunnan, P.R. China
    6. Urumqi Blood Center, Urumqi, Xinjiang, P.R. China
    7. Mianyang Blood Center, Mianyang, Sichuan, P.R. China
    8. Luoyang Blood Center, Luoyang, Henan, P.R. China
    9. Johns Hopkins School of Public Health, Baltimore, Maryland
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  • and for the NHLBI Retrovirus Epidemiology Donor Study-II (REDS-II) International Component


Abstract

Background

A total of 2%-2.9% of the population in China is infected with hepatitis C virus (HCV). This study estimated the prevalence and incidence of HCV among Chinese blood donors.

Study Design and Methods

We examined whole blood and apheresis platelet donations at five Chinese blood centers in 2008 to 2010. All donations were screened using two rounds of testing for alanine aminotransferase, antibody to human immunodeficiency virus Types 1 and 2, hepatitis B surface antigen, anti-HCV, and syphilis. Screening reactivity is defined by a reactive result in one or both rounds of screening tests. Confirmatory tests (Ortho third-generation HCV enzyme immunoassay, Johnson & Johnson) were performed on anti-HCV screening–reactive samples. Confirmatory positive rates among first-time donors (prevalence) and repeat donors (incidence) were calculated by blood center and demographic categories. Donor characteristics associated with HCV confirmatory status among first-time donors were examined using trend test and multivariable logistic regression analysis.

Results

Among 821,314 donations, 40% came from repeat donors. The overall anti-HCV screening–reactive rate was 0.48%. Estimated HCV prevalence was 235 per 100,000 first-time donors; incidence was 10 per 100,000 person-years in repeat donors. In multivariable logistic regression analysis, first-time donors older than 25 years displayed higher HCV prevalence than the younger donors. Less education is associated with higher HCV prevalence. Donors 26 to 35 years old and those above 45 years displayed the highest incidence rate.

Conclusion

High prevalence and incidence in donors indicate high residual risks for transfusion-transmitted HCV in Chinese patients. Implementation of minipool nucleic acid testing in routine donation screening may prevent a substantial number of transfusion-transmitted HCV infections.

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