1Institute of Biochemistry, University of Baluchistan Quetta, Quetta, Pakistan.
2Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Am J Trop Med Hyg. 2021 Feb 1;104(4):1569-1576. doi: 10.4269/ajtmh.20-0740.
There are an estimated 2,000 children with β-thalassemia in the province Baluchistan of Pakistan. These children are at high risk of acquiring transfusion-transmitted infections (TTIs) due to their need of regular blood transfusions for survival. Therefore, we investigated the frequencies of TTIs among these multi-transfused patients in a region where the WHO guidelines for blood safety are not always followed. Sera from 400 children (mean age 7.7 ± 4.70 years) treated at two thalassemia centers in Baluchistan were investigated for TTIs. Eleven (2.8%) were hepatitis B surface antigen positive, and 72 (18.3%) had anti-hepatitis C virus (HCV), two of which were infected with both viruses. Only 22% of the children had been reached by the program for universal hepatitis B virus (HBV) vaccination which started in 2004. Half (51%) of the HCV infected had also been HBV infected. The HBV- and HCV-infected patients were older and had received more blood transfusions than the uninfected patients (P < 0.001). Molecular characterization of the viral strains revealed the presence of several genetically different strains in at least three HBV- and seven HCV-infected children. This is the first study to demonstrate infections with multiple HBV or HCV strains simultaneously infecting thalassemia patients. These may become the source for new emerging recombinant viruses of unknown virulence. The high prevalence of anti-HCV-positive children, and the presence of HBV infections among children who should have been vaccinated, highlights an urgent need for improvements of blood safety in this region of Pakistan.
巴基斯坦俾路支省估计有 2000 名β-地中海贫血症患儿。由于这些儿童需要定期输血才能生存，因此他们感染输血传播感染（TTIs）的风险很高。因此，我们在一个并不总是遵循世界卫生组织（WHO）血液安全指南的地区，调查了这些多次输血患者的 TTIs 频率。对俾路支省两个地中海贫血症中心治疗的 400 名儿童（平均年龄 7.7 ± 4.70 岁）的血清进行了 TTIs 调查。11 名（2.8%）乙型肝炎表面抗原阳性，72 名（18.3%）抗丙型肝炎病毒（HCV），其中 2 名同时感染了这两种病毒。只有 22%的儿童接受了 2004 年开始的乙型肝炎病毒（HBV）疫苗普种计划。感染 HCV 的儿童中有一半（51%）也感染了 HBV。HBV 和 HCV 感染患者比未感染患者年龄更大，接受的输血更多（P < 0.001）。病毒株的分子特征表明，至少有 3 名 HBV 感染和 7 名 HCV 感染的儿童同时存在几种遗传上不同的病毒株。这是第一项同时感染多种 HBV 或 HCV 株的地中海贫血症患者感染的研究。这些可能成为未知毒力的新出现重组病毒的来源。高比例的抗 HCV 阳性儿童，以及本应接种疫苗的儿童中存在 HBV 感染，突显了巴基斯坦该地区急需改进血液安全。
