Hepatitis C virus infection in polytransfused thalassemic children in Pakistan.

INDIAN PEDIATRICS 1072 VOLUME 41OCTOBER 17, 2004 In developing countries including Pakistan, due to lack of resources for universal and effective screening of blood donors for antibodies to hepatitis C virus (anti-HCV), blood transfusion is still a major source of HCV transmission. Therefore, in addition to other potential recipients of blood transfusion, the thalassemic patients on a long-term transfusion therapy continue to be at high risk of acquiring HCV infection(1). In this study we assessed HCV seroprevalence among poly transfused thalassemic children registered at a charity clinic and blood bank of a nongovernmental organization (NGO) at Karachi for regular blood transfusion therapy. Between November 1998 and January 1999, consecutive 256 registered children were included and a serum sample for evaluation of anti-HCV from each participating child was obtained. Anti-HCV was detected by HCV microparticle enzyme immunoassay 3rd generation kit according to the manufacturer’s instructions (Abbott, Chicago, USA). HCV ribonucleic acid (RNA) was tested in sera of a subset of anti-HCV positive patients using amplicor HCV RNA assay as suggested by the manufacturer (Roche Diagnostic System, USA). Eighty nine of 256 (34.8%) thalassemic children were anti-HCV positive. HCV RNA was detected in 15 of 38 (39.5%) anti-HCV positive children who were tested for HCV RNA. The mean (± SD) age of HCV seropositive children was 11.9 ± 4.6 years. Fifty eight (67%) HCV infected children were male, 44 (51%) belonged to Urdu speaking families, remaining children were distributed in nearly equal proportions of Sindhi, Punjabi, Pushto, Balouchi speaking families. Of HCV seropositive children, majority (73%) of them tended to live in families having monthly income less than 10000 rupees and 83% lived in households of size of 5 or more. Despite mandatory screening of blood donors at study blood bank, we found 35% HCV seroprevalence among poly ‘transfused thalassaemic children, which is relatively lower than 61% reported from Italy(2). This may be because of difference in assay systems used to test for anti-HCV. Other risk factors on the study subjects from both the studies were not available for evaluation. The incidence of thalassemias in developing countries continues to be very high(3). Therefore, high HCV seroprevalence in thalassemic patients renders the familial contacts at high risk of contacting HCV infection. Family members of such patients have been reported to be at elevated risk of acquiring HCV infection(4,5). It is therefore imperative that highly sensitive sero-assays be used universally in screening donors in Pakistan and other developing countries in the region.