Context: Hepatitis B virus (HBV) is highly infectious and can be transmitted covertly by percutaneous routes and overtly by blood transfusion. Earlier studies among Nepalese blood donors have shown a high seroprevalence of HBV. Regarding this problem Blood Transfusion Service in Nepal has focused seriously for improving its service by various motivation and education programs. Aims: The study was aimed to reveal the seroprevalence of HBV among different category of blood donors, in relation to their sex and age. Settings and Design: Descriptive cross-sectional Study. Materials and Methods: A total of 33,255 blood samples were screened from donors using enzyme-linked immunosorbent assay kits from December 1, 2006 to September 1, 2007 in Central Blood Transfusion Service, Nepal Red Cross Society, Exhibition Road, Kathmandu. Statistical Analysis: Chi-square test was used for significance testing by using the software SPSS ver. 11.5. Results: The seroprevalence of HBsAg among total blood donors was 0.53% (95% confidence interval [CI] = 0.46-0.62%). Significantly, higher seroprevalence was observed among male donors than in females (0.58% vs. 0.18%, respectively) ( P < 0.05). The seroprevalence was significantly higher in the age group 41-50 years (0.88%). Similarly, significantly higher seroprevalence was observed among replacement donors (0.81%) than among volunteer donors (0.5%) ( P < 0.05). Almost similar seroprevalence of HBV was observed among first time and among repeat blood donors (0.53% and 0.54%, respectively) ( P > 0.05). The hepatitis C virus coinfection rate among HBV-infected donors was 1.67%. Conclusions: On the basis of this study, we concluded that the seroprevalence of HBV among Nepalese blood donors in Kathmandu Valley, is decreasing compared to recent past years and is relatively lower than as described for most of the major cities in South Asia. However, similar seroprevalence rate among first time and repeat donors suggests that further improvements are essential.
Keywords: HBsAg, hepatitis B virus, Nepalese blood donors, serosurveillance.
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Karki S, Ghimire P, Tiwari BR, Rajkarnikar M. HBsAg serosurveillance among Nepalese blood donors. Ann Trop Med Public Health 2008;1:15-8
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Karki S, Ghimire P, Tiwari BR, Rajkarnikar M. HBsAg serosurveillance among Nepalese blood donors. Ann Trop Med Public Health [serial online] 2008 [cited 2013 Apr 19];1:15-8. Available from: https://www.atmph.org/text.asp?2008/1/1/15/43072
Hepatitis B virus (HBV) infection is one of the most common infectious disease in the world with significant acute and chronic morbidity and thus has become a global public health problem.  World health organization (WHO) has estimated that more than 2 billion people in the world have been infected with HBV at some time in their lives and about 350 million people worldwide are HBV carriers with the majority in developing world mainly in Asia and Africa.  HBV is highly infectious and can be transmitted covertly by percutaneous routes and overtly by blood transfusion. HBV infection is the leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is estimated that 500,000-1,000,000 deaths annually are related to HBV infection.  The presence of HBsAg in serum indicates active HBV infection, either acute or chronic. Usually, HBsAg is the first serologic marker in acute HBV infection and is detected 2-4 weeks before the alanine aminotransferase (ALT) level becomes abnormal and 3-5 weeks before symptoms or Jaundice. 
In Nepal, seroprevalence of HBsAg has been reported ranging from 0.3 to 4.0% in general population by various studies conducted from 1990 to 2003. ,,,,,, Among the Nepalese blood donors, HBsAg seroprevalence has been reported ranging from 0.88 to 1.26%. ,, In Nepal, screening of blood for HBsAg was started from 1979 in Kathmandu and now it is mandatory for all blood transfusion services within the country. However, it should be emphasized that a nonreactive HBsAg cannot exclude HBV infection due to serological window period. The best way for assuring blood safety is through the selection and recruiting of low-risk populations for blood donation. Currently, HBV has got relatively more public health attention in Nepal and organized mass vaccination programs have been conducted in schools, communities, etc. Such activities might have significant positive impact for reducing the prevalence of HBV in general population and relatively lower seroprevalence of HBsAg among blood donors. Thus, present study was aimed to reveal the current scenario of HBsAg prevalence regarding age, sex, type of donation, and times of donation of blood donors which would be valuable for formulating strategies to improve blood transfusion safety.
This was a descriptive cross-sectional study conducted in Nepal Red Cross Society (NRCS), Central Blood Transfusion Service (CBTS), Exhibition Road, Kathmandu, over a period of 9 months (December 1, 2006 to September 1, 2007). All blood donors, donating blood in Central Blood Transfusion Service or in Mobile camps organized in Kathmandu Valley were considered as study population. A total of 33,255 blood donors were included in the present study. All blood donors selected for donation as fulfilling per criteria of NRCS, CBTS except those who donated previously within the specified time period of study, were included in the study. Sera from blood donors were tested for detection of HBsAg by enzyme linked immunosorbent assay (ELISA) (Enzygnost HBsAg 5.0, Dade Behring, Marbug, Germany) in an automated ELISA processor (Behring ELISA Processor III, Dade Behring). Initial reactive samples were retested for confirmation. Repeatedly reactive results were considered seropositive for HBV infection. HBsAg seropositive samples were also tested for detection of anti-HCV antibodies by third generation ELISA tests (GENEDIA HCV ELISA 3.0, Green Cross Corporation, Kyunggido, Korea). Initially reactive samples for anti-HCV antibodies were confirmed by retesting on rapid anti-HCV spot test (HCV TRI-DOT, J Mitra and Co, New Delhi, India). Repeatedly reactive results were considered seropositive for HCV infection. The data were entered in Microsoft excel spreadsheet collecting the information from Blood Donor’s Form and was analyzed by the statistical software “SPSS ver. 11.5.” “Chi-square” test was used for test of association. All the blood samples were anonymously tested and confidentiality was maintained as per guidelines of “National Guidelines for Blood Transfusion service in Nepal” in NRCS, CBTS, ethically.
Out of 33,255 blood donors studied, 179 had repeatedly reactive serologic test for HBsAg. Thus, the overall seroprevalence of HBV infection among the blood donors was found to be 0.53% (95% CI = 0.46-0.62%). Statistically significant difference in seroprevalence was found between males and females (0.58% vs. 0.18%, respectively) ( P < 0.05) [Table 1]. The overall seroprevalence of HBV was highest in the age group 41-50 ( P < 0.05). The highest seroprevalence rate among males (0.94%) and among females (0.47%) was observed in the same age group of 41-50 years ( P < 0.05) [Table 2]. The seroprevalence of HBV was observed higher in replacement donors than in volunteer donors (0.81% vs. 0.5%, respectively) and the difference was statistically significant ( P < 0.05). Higher seroprevalence rate was observed among male replacement donors than among male volunteer donors (0.84% vs. 0.55%, respectively) and the difference was statistically significant ( P < 0.05) [Table 3]. The seroprevalence of HBV among first time and repeat blood donors was almost the same (0.53% vs. 0.54%, respectively) [Table 4]. Higher seroprevalence rate was observed among first time replacement donors than among first time volunteer donors (0.93% vs. 0.47%, respectively) and the difference observed was highly significant ( P < 0.05); however, the seroprevalence rate was not significantly different among the repeat replacement donors and repeat volunteer donors ( P > 0.05) [Table 5]. The HCV coinfection rate among HBV-infected donors was 1.67% [Table 6].
Among the 33,255 blood donors screened, the overall seroprevalence of HBsAg was observed to be 0.53% (95% CI = 0.46-0.52%). The seroprevalence rate observed in present study was significantly lower than reported by Joshi et al. and Ghimire from Nepalese blood donors. ,, The decrease in the seroprevalence rate might be due to increased awareness to HBV infection including early diagnosis, actual decrease in HBV prevalence in general population due to impact of mass vaccination in different population groups, self-exclusion from donation by those who are at risk of HBV infection, or who practice risk behavior and using of stringent donor selection criteria by the authorities. In contrast to present study, very high seroprevalence of HBV infection among blood donors has been reported from Pakistan by Rahaman et al. , from Thailand by Luksamijarulkul et al. , from India by Garg et al. , from Indonesia by Budihosodo et al. , from Yemen by Haider, and from Ghana by Sarkodie et al . ,,,,
Present study revealed that HBsAg seroprevalence was significantly higher in males than among females in Nepalese blood donors; however, slightly higher seroprevalence of HBsAg in males but not significant, had been reported in similar studies from Nepal. ,
Present study revealed that HBsAg seroprevalence was relatively higher in the age group of 41-50 years and the seroprevalence in this age group is significantly higher than other groups. The finding of present study was similar to the finding of Joshi and Ghimire  who reported a higher seropositivity rate for HBsAg in the age groups of more than 30 years among healthy Nepalese males. Present study revealed that HBV infection was significantly more prevalent among replacement blood donors than among volunteer donors which was in concordance with the study of Nijhawan et al. , Singhivi et al. , Garg et al. , similar study population from the neighboring country India. ,,
In present study, a very similar HBsAg seroprevalence was observed among first time and repeat donors, indicating that repetition of the donation does not ensure more safe blood regarding HBV in our study population. According to present study, first time replacement donors were the category of blood donors that were most unsafe blood donors regarding HBV infection.
In present study, the coinfection (1.67%) of HCV among HBsAg seropositive donors was observed. Since, HCV and HBV share similar mode of transmission, their coinfection is a common event particularly among high-risk groups. The study population in this study was a low-risk group, hence relatively lower coinfection rate has been observed.
So far as concerned, present study is the largest study among blood donors in Nepal consisting representative sample size according to the recommendation of WHO.  We emphasize that the result of present study cannot be directly generalized for healthy looking Nepalese population; however, we conclude that the HBsAg seroprevalence among healthy looking asymptomatic population is more than 0.53%.
We would like to thank all the Blood Donors who donated blood for saving life of the needy patients and Nepal Red Cross Society, Central Blood Transfusion Service for its support to conduct this research.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]