Beruflich Dokumente
Kultur Dokumente
TRANSACTIONSOF THE ROYAL SOCIETYOF TROPICAL MEDICINE AND HYGIENE (1995) 89,167-170
Prevalence
of hepatitis
Indonesian
blood donors
Medical
Faculty, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Directorate General, Communicable
Disease Control and Environmental Health Ministry of Health, Jakarta, Indonesia; 3US Naval Medical Research Unit No. 2,
Jakarta, Indonesia; 41ndonesian Blood Bank Service, Jakarta, Indonesia
H. A. Sulaiman, Julitasari2, Annie Sie3, Masri Rustam4, W. Melani4, A. Co&n3 and G. B. Jennings3
Abstract
Blood samples were collected from 7572 healthy volunteer blood donors from 21 of the 27 Indonesian provinces, and tested for antibodies to hepatitis C virus (anti-HCV) using the new second-generationenzyme immunosorbent assay,and also tested for hepatitis B surface antigen (HBsAg). We detected anti-HCV in 2.1% of
the blood donors. No statistically significant difference was found between males and females or between locations, but there was a statistically significant increasing likelihood of anti-HCV prevalence with increasing
age. HBsAg was found in 8.8% of the 3839 tested donors. There was no statistically significant difference
between sexesor age groups, but there was a statistically significant higher prevalence in the islands of Sulawesi and eastern Indonesia. Only 7 individuals, from 5 locations, were both anti-HCV and HBsAg positive. Based on responsesto a questionnaire, a history of surgery, blood transfusion, intravenous medication,
and acupuncture were identified as risk factors for the presenceof anti-HCV. No such risk factor was identified for HBsAg prevalence. The combined data suggest separatemodes of transmission for the 2 viruses,
and indicate the need for continued surveillance for these agentsin Indonesian blood banks.
Keywords: hepatitis B, hepatitis C, prevalence in blood donors, Indonesia
Introduction
Hepatitis B virus (HBV) causesacute and chronic hepatitis and hepatocellular carcinoma (ROBINSON, 1985).
Hepatitis C virus (HCV) has been associatedwith acute
hepatitis and hepatic cirrhosis (CHEN et al., 1990), and
may be a cause of hepatocellular carcinoma (DAZZA et
al., 1993). These agents therefore pose a serious threat to
the safe collection of blood for blood bank systems.
Numerous studies have documented the prevalence of
these viruses in developed countries (KUHNL et al.,
1989; STEVENS et al., 1990), but less is known about developing countries where cost is a major factor in determining which assaysare available for blood bank screening programmes. The obvious value of such testing is a
decreasedprevalence of associateddiseasein blood recipients (ALTER et al., 1986).
A previous assessmentof HBV prevalence in Indonesia, conducted in 1981, was limited to Jakarta, the national capital, and found 10% of the blood donors positive for hepatitis B surface antigen (HBsAg) (MBOI et al.,
1981). A more recent report, limited to the provincial
capital of South Sulawesi, identified 7.1% of the blood
donors as HBsAg seropositive (AMIRUDIN et al., 1991).
The samereport detected HCV antibodies (anti-HCV) in
3.1% of the blood donors, a much higher proportion
than that in other countries (DAWSON et al., 1991;
JANOT et al., 1989). The importance of these agents in
Indonesia was shown recently by SULAIMAN et al. (1991).
Among acute hepatitis cases, 6.4% were associatedwith
HBV and 2.8% had anti-HCV. However, HBsAg was detected in 36.5% of liver cirrhosis cases and anti-HCV
in
NAMRU-2,
procedures were approved by the Naval Medical Research Unit No. 2 Committee for the Protection of
Human Subjects.
Laboratory assays
The proportional hypothesis test was used to determine the statistical significance of differences between 2
proportions from onegroup (overlapping categoriesfrom
a single sample). In addition, 95% confidence intervals
(CI) were calculated for proportions from a single sample
168
Table 1. Age distribution
of hepatitis C virus and
HBsAg positive blood donors screened throughout
Indonesia, November 1992-February
1993
Age group
(years)a
Anti-hepatitis C
positive
HBsAg positive
1l-20
21-30
31-40
41-50
5 l-70
Location
Java/Bali
Sumatra
Kalimantan
Sulawesi
Eastern
Indonesia
Anti-hepatitis C virus
No. positive/
No. of
no. tested
cities
9
5
:
3
No. of
cities
11214487 (25%)
2011186 (1.7%)
3
2
121800 (1.5%)
131700 (1.8%)
41399 (1.0%)
x2=8.2, P=O.O8
3
3
HBsAg
No. positive/
no. tested
9911793
271382
281597
871694
(55%)
(7.0%)
(4.7%)
(12.5%)
97/373 (26%)
3
x2=187.6, P<O,OOOl
Table 3. Risk factors associated with the presence and absence of hepatitis C virus and HBsAg among blood donors
in Indonesia, November 1992-February
1993
Historya
Jaundice
Family member with
jaundice
Surgery
Blood transfusion
Circumcision
Tattoo
Acupuncture
Intravenous
medication
Anti-hepatitis C virus
Pre(e;i posltlveino. tested)
Absent
.I+&
Prei~;i pontlve/no. tested).
Absent
5/158 (9.5%)
62416949(9.0%)
261313(8.3%)
30513285(9.3%)
5/157 (3.2%)
36/161 (224%))::
141158(8.9%)
138068 (86.2%)
9061 (5.6%)
21/161 (13%)
315/7178 (4.4%)
940/7311 (12.8%)
23417284(3.2%)
6050/7200 (83.8%)
319/7321 (5.8%)
42317238(5.8%)
151328(4.5%)
30/333 (9*0%)**
1l/330 (3.3%)
2391329(72.6%)
16/334 (4.7%)
23/238 (7.0%)
159/3398 (4.7%)
501/3444 (14.5%)
loo/3417 (2.9%)
2704/3405 (79.4%)
15613456(4.5%)
23313426(6.8%)
211158(13.3%)
491/7138 (6.9%)
18/333 (5.4%)
246/3454 (7.1%)
Respondents answering not known were not included in calculations. Statistically significant results are indicated thus:
lzJ<o*o1, l *P<o*ool, **P<o*ooo1.
HBsAg prevalences when the archipelago was divided
Analysis of age and sex data was restricted to 7415
into East and West Indonesia. There were, however, sigcases; 157 cases (2.1% of total samples) were excluded
nificant differences when locations were grouped by size,
becauseof incomplete demographic data.
regardless of age of the subjects. Anti-HCV was detected
in 1.6% (4912984) of subjects living in locations with
Results
populations < 1 million and in 2.4% (11214588)of subThe overall prevalences of HCV antibody and HBsAg
jects living in locations with populations 21 million
antigen were 2.1% (95% CI 1.8-2.5%) (16117572)and
(x2=4.82, PcO.05). In contrast, prevalence of HBsAg
8.8% (95% CI 7+-9.7%) (338/3839), respectively (Table
was significantly higher (x2=44.86, P<O.OOOl) in cities
1). The mean age of donors positive for anti-HCV (42.0
or provinces with smaller populations (13.3%) than in
years) was significantly higher (P<O.OOl) than that of
those with 21 million (6.6%).
those without this antibody (32.7 years) (the 95% CI for
Risk factors associatedwith HCV and HBsAg positivthe difference between the means was -10.9 to 7.8
ity differed overall (Table 3). HCV reactors were more
years). However, there was no statistically significant diflikely to have reported a medical history of blood transfuference (P>O.O5) between the mean ages of those who
were HBsAg antibody positive (32.5 years) and those
sions, surgery, acupuncture and intravenous medication.
who were negative (32.9 years) (the 95% CI for the difHowever, surgery and circumcision were significantly asference between the meanswas -0.7 to 1.6 years).
sociated with absenceof HBsAg. There was no apparent
association (P>O+OS)between the presence or absenceof
No significant difference (P>O.O5) was found between
169
HBsAg and the risk of HCV infection.
Discussion
antibody response detectable by the EIA. HBsAg prevalence, on the other hand, was constant throughout the
5 age groups. This may indicate that the prevalence of
HBsAg is due to exposure early in life, i.e. through vertical transmission. These conclusions are consistent with
there being different means of transmission of the 2
viruses.
The prevalence of HBsAg in the blood donors, though
lower than previously reported for Jakarta (MBOI et al.,
sian archipelago.
A significantly
higher prevalence of
170
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Health, 22,133-134.
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j Announcement
Yap, I., Guan, R., Kang, J. Y., Tay, H. H., Lee, E., Choong,
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1
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