Transmission of hepatitis C virus by blood transfusions and other medical procedures: A global review

doi:10.1016/j.jhep.2006.07.003

Journal of Hepatology

Volume 45, Issue 4, October 2006, Pages 607-616

https://doi.org/10.1016/j.jhep.2006.07.003 Get rights and content

Hepatitis C virus (HCV) is a leading cause of chronic blood-borne infection and chronic liver disease. The global epidemic of HCV infection emerged in the second half of the 20th century, and several lines of evidence indicate that it was primarily triggered and fed iatrogenically by the increasing use of parenteral therapies and blood transfusion. In developed countries, the rapid improvement of healthcare conditions and the introduction of anti-HCV screening for blood donors have led to a sharp decrease in the incidence of iatrogenic hepatitis C, but the epidemic continues to spread in developing countries, where the virus is still transmitted through unscreened blood transfusions and non-sterile injections.

This article reviews the published literature concerning HCV transmission through blood transfusions and other unsafe medical procedures. Given the substantial difference in current disease transmission patterns between the northern and southern hemispheres, the situation in developed and developing countries is separately analysed.

Section snippets

Search methods

The information in this report is primarily based on peer-reviewed medical articles published up to 15 April 2006. A PubMed search for appropriate articles was made using the terms “hepatitis C” or “HCV” in combination with the roots “iatrogen*, “nosocom*, and “transfus*”. The search was not restricted by language. Up-to-date reviews and highly regarded older papers were also selected. The bibliographies of the articles on hand were used to find other references.

Social and historical background

As pointed out by Stephen S. Morse, the history of infectious diseases has largely been a history of microbes that have taken advantage of the rich opportunities we offered them to thrive, prosper and proliferate [1]. The global epidemic of HCV illustrates this very well: the rapid spread and worldwide dissemination of HCV arises from its efficient transmission through transfusions of blood and blood products, parenteral therapies, and the other invasive medical procedures that became

Developed countries

Clinicians in developed countries are now facing the long-term effects of the past epidemics of transfusion-associated hepatitis C. Adult cohort studies have shown that, an average of 15 years after blood transfusion, approximately 75% of the patients are positive for HCV RNA and the frequency of liver cirrhosis is 15–20%, although more favorable outcomes have been observed in children and young women [15], [20], [21], [22], [23], [24], [25], [26].

However, blood supplies are now very safe. As

Developed countries

The healthcare environment is far from being free of risk. Even in countries who have adopted high sanitary standards, patients may still acquire HCV infection from other patients or infected healthcare providers.

The transmission of HCV in the setting of hemodialysis deserves special emphasis. Cases of viral hepatitis due to breaks in infection control techniques have been described among dialysed patients since the late 1960s [76]. When anti-HCV testing became available, it was observed that

Conclusions

In resource-rich countries, the use of blood transfusions has reached an unprecedented level of safety with regard to HCV transmission. The risk of acquiring transfusion-transmitted hepatitis C is now below 1 case per million blood units in most countries. However, there are still reports of associations with other medical practices, and residual cases and clusters of iatrogenic HCV transmission, mainly due to breaches of infection-control standards.

The situation is completely different in the

Acknowledgements

I thank Dr José Ramiro Cruz (Pan American Health Organization) and Ms Jan Fordham (World Health Organization) for helpful suggestions and discussions, and professor Jean-Pierre Allain (University of Cambridge, UK) for his critical review of the manuscript.

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ReviewTransmission of hepatitis C virus by blood transfusions and other medical procedures: A global review

Section snippets

Search methods

Social and historical background

Developed countries

Developed countries

Conclusions

Acknowledgements

Lancet

Gastroenterology

J Hepatol

Lancet

Dig Liver Dis

Lancet Infect Dis

Dig Liver Dis

J Hepatol

Hepatology

Blood

Blood

Transf Clin Biol

Lancet

Lancet

Lancet

Lancet.

Lancet

Lancet

Lancet Infect Dis

J Clin Virol

Kidney Int

J Hepatol

Lancet

Factors in the emergence of infectious diseases

Emerg Infect Dis

The history of blood transfusion

Br J Haematol

The epidemiology and iatrogenic transmission of hepatitis C virus in Egypt: a Bayesian coalescent approach

Mol Biol Evol

Spread times of hepatitis C virus estimated by the molecular clock differ among Japan, the United States and Egypt in reflection of their distinct socioeconomic backgrounds

Intervirology

Viral gene sequences reveal the variable history of hepatitis C virus infection among countries

J Infect Dis

Modeling the hepatitis C virus epidemic in France

Hepatology

Population genetic history of hepatitis C virus 1b infection in China

J Gen Virol

A multicenter, prospective study of posttransfusion hepatitis in Milan

Hepatology

Donor transaminase and recipient hepatitis. Impact on blood transfusion services

J Am Med Assoc

Benefits and complications of regular blood transfusion in patients with beta-thalassemia major

Vox Sang

The Hemophilias – from royal genes to gene therapy

N Engl J Med

Epidemiology of hepatitis C

Hepatology

Long-term clinical and histopathological follow up of chronic post-transfusion hepatitis C

Hepatology

Non-A, non-B post-transfusion hepatitis. Looking back in the second decade

Ann Intern Med

Prevalence and clinical outcome of hepatitis C infection in children who underwent cardiac surgery before the implementation of blood-donor screening

N Engl J Med

The epidemiology of virus transmission by plasma derivatives: clinical studies verifying the lack of transmission of hepatitis B and C viruses and HIV type 1

Transfusion

Infection in Endoscopy Study Group. The significance of transfusion in the past as a risk for current hepatitis B and hepatitis C infection: a study in endoscopy patients

Transfusion

Closing the windows on viral transmission by blood transfusion

Risks of blood transfusion

Crit Care Med

Liver biopsy

N Engl J Med

Catastrophic football injuries: 1977–1998

Neurosurgery

Legal, financial, and public health consequences of HIV contamination of blood and blood products in the 1980s and 1990s

Ann Intern Med

International Forum: implementation of donor screening for infectious agents transmitted by blood by nucleic acid technology

Vox Sang

Implementation of donor screening for infectious agents transmitted by blood by nucleic acid technology: update to 2003

Vox Sang

Review
Transmission of hepatitis C virus by blood transfusions and other medical procedures: A global review