Ispitivanje markera krvlju prenosivih bolesti, algoritama testiranja i preventivnih mera

Introduction/Aim The most common blood borne diseases or transfusion transmitted infections (TTI) are hepatitis B, hepatitis C and human immunodeficiency virus (HIV). Numerous tests are used to prove the presence of these viruses indirectly (by detecting antibody presence - ELISA and CLIA) or directly (by detecting the presence of viral genome - NAT-PCR and LCR).To present a two-year analysis of testing for blood borne disease markers in pregnant women, patients preparing for surgery procedures and people with high-risk behavior (HBs Ag, anti-HCV and anti-HIV) at the Belgrade City Institute for Public Health and adopting measures for their prevention. Methodology During the two-year period, 11,983 pregnant women and 934 people with high-risk behavior were tested. Preliminary testing for HBs antigen, anti-HCV antibodies and anti-HIV antibodies was performed with 3rd generation ELISA tests ("Hepanostika HBsAg Uni-Form II", "Vironostika HIV Uni-Form II Ag / Ab" ; "The bioMérieux Clinical Diagnostics," manufactured in France; "Hepanostika HCV Ultra" is manufactured by "Beijing United Biomedical Co.Ltd.", China and the other two are manufactured in France). Primarily positive blood samples were tested again with the same test (in a duplicate procedure) on a new sample which was placed in a "dry" tube with no anticoagulant 10-14 days after being primarily positive for TTI markers. Those samples were also tested with a WB "Western Blot" confirmatory test - WB ("INNO-LIA HCV Ab III"; INNO-LIPA HBV Genotyping "and" INNO-LIA HIV I / II"). "Innogenetics NV ", Belgium is the manufacturer of all three confirmatory tests. Blood samples with positive results on the confirmatory tests for TTI were accepted as positive for HBs Ag, anti-HCV or anti-HIV. Results From 11,983 tested pregnant women, 152 (1.27%) were preliminarily reactive to HBsAg, 38 (0.32%) were confirmed positive for HBsAg and 114 (0.95%) were false reactive to HBsAg; 123 (1.03%) were preliminarily reactive to anti-HCV, 35 (0.29%) pregnant women were confirmed positive for antiHCV and 88 (0.74%) were false reactive for anti-HCV; and 15 (0.13%) pregnant women were preliminarily reactive to anti-HIV, 5 (0.04%) pregnant women were confirmed positive for anti-HIV and 10 (0.09%) were false reactive to anti-HIV. From 934 tested individuals with high-risk behavior 36 (3.85%) were preliminarily reactive to HBs Ag, 28 (2.99%) were confirmed positive for HBsAg and 8 (0.86%) were false reactive to HBsAg; 38 (4.07 %) were preliminarily reactive to anti-HCV, 33 (3.53%) were confirmed positive for anti-HCV and 5 (0.54%) false reactive to anti-HCV and 10 (1.07%) were preliminarily reactive to anti-HIV, 9 (0.96%) were confirmed anti-HIV positive and 1(0.11%) was false reactive to anti-HIV. Conclusion The results of our study showed a higher prevalence of HBsAg, anti-HCV and anti-HIV in people with high-risk behavior than in pregnant women. There are more false reactive results in pregnant women than in people with high-risk behavior. Preventive measures would include broader education on ways blood borne diseases are transmitted, testing blood and blood products with the latest generation of tests and correct execution of medical interventions with special attention on principles of asepsis and antisepsis.Uvod/cilj Najčešće krvlju prenosive bolesti ili transfuzijske transmisivne infekcije (TTI) su hepatitis tipa B i C i virus humane imunodeficijencije (HIV). Brojnim testovima može se dokazati njihovo prisustvo u krvi indirektnim (prisustvo antitela - ELISA i CLIA) ili direktnim putem (prisustvo genoma virusa NAT PCR i LCR). Cilj rada je analiza testiranja na markere krvlju prenosivih bolesti kod trudnica, pacijenata koji se pripremaju za planirane hirurške procdure i osobe sa rizičnim ponašanjem na prisustvo virusa (HBs Ag, anti-HCV i anti-HIV) sprovedenog u Gradskom zavodu za javno zdravlje u Beogradu i upoznavanje sa preventivnim merama za njihovo suzbijanje. Metod rada U dvogodišnjoj studiji testirano je 11.983 trudnica i 934 osoba sa rizičnim ponašanjem. Preliminarno testiranje na HBs Ag, antitela anti-HCV i anti-HIV, vršeno je ELISA testom treće generacije. Preliminarno pozitivni uzorci krvi ponovno su testirani istim testom iz novog uzorka, nakon 10-14 dana od utvrđene preliminarne pozitivnosti na ispitivane markere TTI. Kod ponovno pozitivnih uzoraka krvi rađen je potvrdni "Western Blot" test za određivanje antitela u humanom serumu ili plazmi, na markere TTI. Uzorci krvi pozitivni na potvrdnom testu na ispitivane markere TTI, prihvaćeni su kao potvrdno HBs Ag pozitivni, potvrdno anti-HCV reaktivni i potvrdno anti-HIV reaktivni. Rezultati Od ukupno testiranih trudnica bilo je 152 (1,27%) preliminarno reaktivnih, 38 potvrdno pozitivnih na HBsAg (0,32%) i 114 (0,95%) lažno reaktivnih na HBsAg; 123 (1,03%) preliminarno reaktivnih na anti-HCV, 35 potvrdno pozitivnih trudnica na antitelo antiHCV (0,29%) i 88 (0,74%) lažno pozitivnih na HCV; i 15 (0,13%) preliminarno reaktivnih, 5 trudnica potvrdno pozitivnih na antitelo anti-HIV (0,04%) i 10 (0,09%) lažno reaktivnih antiHIV. Od 934 testirane osobe sa rizičnim ponašanjem detektovano je 36 (3,85%) preliminarno reaktivnih na HBs Ag, 28 (2,99%) potvrdno pozitivnih na HbsAg i 8 (0,86%) lažno reaktivnih HBsAg; 38 (4,07%) preliminarno reaktivnih anti-HCV, 33 (3,53%) potvrdno pozitivnih na anti-HCV i 5 (0,54%) lažno reaktivnih na anti-HCV, kao i 10 (1,07%) preliminarno anti-HIV reaktivnih, 9 (0,96%) anti-HIV potvrdno pozitivnih i jedna (0,11%) osoba lažno-reaktivno na anti-HIV sa rizičnim ponašanjem. Zaključak Naše ispitivanje pokazuje veću prevalencu na HbsAg, anti-HCV i anti-HIV kod osoba sa rizičnim ponašanjem u odnosu na trudnice, ako i veću razliku u nalazu lažno reaktivnih rezultata kod trudnica, u odnosu na osobe rizičnog ponašanja. Preventivne mere sastojale bi se u edukaciji stanovništva o putevima širenja krvlju prenosivih bolesti, njihovoj prevenciji, testiranju krvi i krvnih produkata testovima najnovije generacije i pravilnom izvođenju medicinskih intervencija uz poštovanje principa asepse i antisepse