|Year : 2014 | Volume
| Issue : 1 | Page : 20-25
Seroprevalence of hepatitis C virus antibody and its associated risk factors in children with sickle cell anaemia
Baba Jibrin, Nma M Jiya, Hamidu Ahmed
Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
|Date of Submission||14-Jul-2013|
|Date of Acceptance||24-Nov-2013|
|Date of Web Publication||24-Mar-2014|
Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Source of Support: None, Conflict of Interest: None
Background: Hepatitis C virus (HCV) is an important hepatotrophic virus known to be transmitted percutaneouly through contaminated sharp objects, blood and blood products. Blood transfusion is a major risk factor for the acquisition of HCV in sub-Saharan Africa and it is attributable to the absence of consistent screening of blood donors. Children and adults are all at risk of being infected especially those with sickle cell disease. Objective: To determine the seroprevalence of hepatitis C viral antibodies among transfused sickle cell anemia (SCA) children. Materials and Methods: Three hundred (300) SCA children aged 6 months-15 years attending the SCA clinic and on admission in emergency pediatric unit (EPU) and pediatric medical ward (PMW), (both in steady state and in crises) of Usmanu Danfodiyo University Teaching Hospital, Sokoto, were screened for hepatitis C infection using anti-HCV as marker of infection and the sensitive enzyme-linked immunosorbent assay method was used for detection of the marker. Three hundred (300) children with minor illness attending pediatric outpatient department and on admission in for various treatment of the same hospital served as gender- and age-marched controls. Results: The result showed that the prevalence of anti-HCV seropositivity for HCV infection among SCA children was 12.7% (38/300) compared with 10.3% (31/300) of the control (P = 0.958). The prevalence of HCV infection increases significantly with increase in frequencies of blood transfusions both in SCA children (P = 0.0001) and the controls (P = 0.0001). Other risk factors for HCV infection such as traditional scarification (SCA 4 out 12, controls 4 out 16) and injections (SCA 38 out of 168, controls 27 out 172) significantly affect the prevalence of HCV infection in both SCA children and controls, (P = 0.0001). Conclusion: The prevalence of HCV infection in both SCA children and controls is high and the higher the frequency of blood transfusions the greater the rate of HCV infections.
Keywords: Hepatitis C, risk factors, sickle cell anaemia
|How to cite this article:|
Jibrin B, Jiya NM, Ahmed H. Seroprevalence of hepatitis C virus antibody and its associated risk factors in children with sickle cell anaemia. Sub-Saharan Afr J Med 2014;1:20-5
|How to cite this URL:|
Jibrin B, Jiya NM, Ahmed H. Seroprevalence of hepatitis C virus antibody and its associated risk factors in children with sickle cell anaemia. Sub-Saharan Afr J Med [serial online] 2014 [cited 2023 May 31];1:20-5. Available from: https://www.ssajm.org/text.asp?2014/1/1/20/129304
| Introduction|| |
Hepatitis C virus (HCV) is an important hepatotrophic virus known to be transmitted percutaneously through blood and blood products.  The prevalence of HCV infection is increasing and currently, it is estimated that about 170 million people are chronically infected and majority are in developing countries. , HCV is a chronic life-long infection in the majority of patients who are infected with the virus.  The clinical importance of HCV infection is due to viral persistence in approximately 85% of those infected and the significant risk of subsequent development of chronic irreversible liver damage.  Children and adults are all at risk of being infected especially those with sickle cell disease. 
The specific serological test to identify HCV infection is the hepatitis C viral antibodies (anti-HCV).  Blood transfusion is a major risk factor for the acquisition of HCV in sub-Saharan Africa and it is attributable to the absence of consistent screening of blood donors.  In sub-Saharan Africa including Nigeria, anti-HCV screening of blood donors was not a standard requirement and the role of blood transfusion in HCV epidemiology is less clearly documented.  Other potential risks factors for HCV in developing countries include reusage of syringes and needles, tattooing, body piercing, accidental needle-stick injury, and sharing of tooth brushes, razors, nail, and hair clippers. 
The HCV is of high interest in sickle cell anaemia (SCA) patients because they are chronic blood recipients as a result of frequent anaemia and are, therefore, exposed to this virus through transfusion of blood and blood products.  Infection with this virus pose additional threat to the health of SCA patients because of the progression in a proportion of hepatitis C-infected patients to chronic liver diseases such as cirrhosis and hepatocellular carcinoma (HCC). Most of the studies on hepatitis C done in Nigeria were not community-based with the majority of reported studies among blood donors.  Therefore, the available data significantly underrepresents the actual burden of the condition.  However, studies have suggested that blood transfusion increases the risks of HCV infection in patients with SCA and also that the seroprevalence of anti-HCV antibodies in these patients is higher than in controls. , This study was conducted to determine the seroprevalence of HCV antibody (anti-HCV), the relationship between the frequency of blood transfusion, sources of blood transfusion and other risk factors of HCV infection, and the prevalence of anti-HCV among paediatric patients with sickle cell anaemia (SCA) (both in steady state and in crisis) and controls.
| Materials and Methods|| |
The study was conducted at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Sokoto state, Nigeria, between July 2010 and January 2011. Approval for the study was obtained from the Ethical Committee of UDUTH, Sokoto. Informed written consent was obtained from parents/care givers and clinical data collected for each subject. Clinical data collected were age, gender of the subjects, risks factors of HCV infection like history of blood transfusion and traditional scarification/circumcision/tattooing. Other clinical parameters included were jaundice, palor, hepatomegaly/splenomegaly, and evidence of traditional scarification marks/tattooing/circumcision.
Three hundred children with SCA confirmed by hemoglobin electrophoresis using cellulate acetate media, aged 6 months-15 years both in steady state and in crisis who were attending sickle cell clinic or on admission in emergency pediatric unit (EPU)/pediatric medical ward (PMW) of UDUTH, Sokoto, had their blood samples collected. The controls were children aged 6 months-15 years with hemoglobin AA, who were attending pediatric outpatient department with minor illness or on admission in EPU/PMW on various treatment for severe malaria, urinary tract infection, acute respiratory tract infection, and protein energy malnutrition rather than SCA.
The blood samples were centrifuged within 2 h of collection and the serum obtained was used to assay for anti-HCV by enzyme-linked immunosorbent assay method using Clinotech diagnostic and Pharmaceuticals Inc, Canada 2010 kits.
Statistical analysis was done using SPSS statistical version 17.0. Chi-square and student's t-test were used to assess the significant difference. A P-value of <0.05 was considered significant.
| Results|| |
A total of 300 SCA children both in crisis and in steady state were recruited. A total of 200 (66.7%) were males and 100 (33.3%) were females with males-females ratio of 2:1. Aged range 6 months-15 years and the mean age was 6.8 years ± 4.1. A total of 300 children with minor illness and on admission in children's ward (EPU/PMW) for various treatments of the same hospital served as aged and gender-marched controls, 196 (65.3%) were males and 104 (34.7%) females giving a ratio of 1.8:1. The mean age for the controls was 6.6 years ± 4.3. No statistical significant difference between the mean ages of SCA children and that of the controls, (P = 0.577) [Table 1].
|Table 1: Age and gender distribution of sickle cell anemia children and controls|
Click here to view
A total of 38 (12.7%) SCA children were seropositive for anti-HCV, 26 were males and 12 were females. There was no statistically significant difference between male and female seropositivity (P value = 0.875). A total of 31 (10.3%) controls were seropositive for anti-HCV, 20 were males and 11 were females and there was no statistically significant difference between male and female seropositivity (P value = 0.813). There was no significant difference in the prevalence of anti-HCV between SCA children and controls (P = 0.958) [Table 2].
|Table 2: Prevalence of antihepatitis C virus among sickle cell anemia children and controls|
Click here to view
The highest prevalence (8.7%) of anti-HCV among SCA children was in the age group of 5.1-10.0 years and that of the control (5%) was recorded in age group 10.1-15.0 years. In this study, there was an increase in number of anti-HCV seropositivity with increase in age among SCA children with respect to age-specific prevalence rates of anti-HCV (except for age group 10.1-15.0 with zero seropositivity). But no clear cut pattern in the control, that is the age-specific prevalence rate increases in age group ≤5 years, (except for age ≤1 with 0 seropositivity), decreases in age group 5.1-10.0 and the rises again above 10 years. The difference in seropositivity within both SCA children (P = 0.201) and the control (P = 0.101) was not statistically significant. The difference in seropositivity between SCA children and control was also not statistically significant, (P = 0.557) [Figure 1].
A total of 144 (48%) of the SCA children were transfused, while 65 (21.7%) of the controls had transfusion. The rate of blood transfusion was significantly higher among the SCA children compared with the controls (144/300 vs. 65/300, P = 0.0001). Among the SCA children, the rate of blood transfusion was observed to be highest in the age group 5.1-10.0 years.
|Figure 1: Age-specific prevalence rates of antihepatitis C virus among sickle cell anemia children and controls|
Click here to view
Of the 38 SCA children that were anti-HCV positive, three (7.9%) were from the 156 non transfused SCA children, seven (18.4%) from 44 previously transfused once, and the remaining 28 (73.8%) were from the 100 SCA children previously transfused twice or more. There was an increasing number of anti-HCV seropositivity with increase in frequency of blood transfusion though the difference was not statistically significant (P value = 0.244). Of the 31 anti-HCV positive in the controls, 2 (6.5%) were from 235 nontransfused controls, 9 (29%) from the 24 previously transfused once, and 20 (64.5%) from previously transfused twice or more. There was an increasing number of anti-HCV seropositivity with increase in frequency of blood transfusion though the difference was not statistically significant (P value = 0.187). But the difference between SCA children and the controls in relation to the frequency of blood transfusion and prevalence of anti-HCV was statistically significant (P = 0.016) [Table 3].
|Table 3: Frequency of blood transfusion and prevalence of antihepatitis C virus among sickle cell anemia children and controls|
Click here to view
Of the 144 transfused SCA children, 116 (80.6%) were transfused in the tertiary health facility, while 28 (19.4%) were transfused outside tertiary health facility (19 in general hospital, 4 in private hospitals, and 5 in rural hospitals). Among the controls, 34 (52.3%) were transfused in the tertiary health facility, while 31 (47.7%) were transfused outside tertiary health facility (15 in general hospitals, 12 in private hospitals, and 4 in rural hospitals).
Of the 35 SCA children that were transfused once, twice or more and were anti-HCV seropositive, the highest degree of anti-HCV seropositivity in relation to sources of blood transfusion among SCA children was recorded in private hospitals (75%) the difference was statistically significant (P = 0.0001) [Table 4].
|Table 4: Sources of blood transfusion and antihepatitis C virus seropositivity among sickle cell anemia children and controls|
Click here to view
Among the controls, of the 29 anti-HCV seropositive control that were transfused once, twice or more, the highest anti-HCV seropositive in relation to source of transfusion was recorded in the rural hospitals (100%), and difference was statistically significant (P = 0.0001). The difference between SCA children and controls in relation to the sources of blood transfusions and anti-HCV seropositivity was not significant (P = 0.670) [Table 4].
The minimal time interval between history of blood transfusion and the time of present study was 30 days which differs in each individual patient [some ≥ 30 days, months or year(s)]. The mean number of blood transfusions received by anti-HCV seropositive SCA children (2.9 ± 2.5) was more than that received by SCA children who were seronegative for anti-HCV (1.0 ± 1.2), P value = < 0.05 [Table 5].
|Table 5: The relationship between the mean frequency of blood transfusion and the prevalence of antihepatitis C virus among sickle cell anemia children|
Click here to view
| Discussion|| |
High prevalences of anti-HCV for HCV infection was found in both SCA children (12.7%) and control (10.3%) in this study. Studies done in some other parts of Nigeria reported prevalence range of 5%-6.6%. These include Lagos 5%,  Ilorin 5%,  and Enugu 6.6%  among SCA patients. Another study done in Benin,  recorded a prevalence of 20%, while in Ibadan  a seroprevalence of 19.4% was obtained among sickle cell disease patients and 21.1% in the controls. The high prevalence obtained in this present study may be attributable to local factors causing intercenter variation such as use of blood especially if sources of blood transfusion were from rural, private, or general hospital, where standard screening facilities for hepatitis (B and C) are not guaranteed. It may also be due to some cultural or behavioral risk factors which may include traditional circumcision or the use of sharp contaminated material such as razor blade in the treatment of convulsion in children by way of scarification marks and may be as a result of sexual assaults in children that are not reported or identified.
There was no statistically significant difference between males and females in this present study. This was the similar findings observed in some of the earlier published series. ,, The similar findings in this study and other studies reported earlier may be due the documented role of blood transfusion in the transmission rates of HCV infection and blood transfusion has no gender predilection. The highest prevalence of 8.7% of anti-HCV positivity among SCA children was in the age group 5.1-10.0 years in this study but this was not statistically significant. This probably may be due to highest number of previous blood transfusions recorded in this age group. Other studies ,, done did not review the relationship between paediatric age-specific group and the prevalence of anti-HCV seropositivity in those studies making comparison limited.
The transfusion rate was 48% among SCA children compared with 21.7% in the controls in this study. A similar trend among SCA patients was reported in Benin (72%) by Multimer et al., and Fasola et al., (80%) in Ibadan. Other studies reviewed , also reported higher transfusion rates among SCA patients. The explanation for high transfusion rate among SCA children in this study and perhaps other studies could be due to the fact that SCA children are prone to chronic hemolysis and anemic crises. They are also prone to infection especially malaria which may worsen or exacerbates hemolysis causing severe anemia. All these culminate to make the SCA children chronic blood recipients and hence repeated or increase rate of blood transfusion in them. Transmission of HCV infection has been characteristically associated with blood transfusion. In this study, 35 out of 38 anti-HCV positive SCA children had a history of blood transfusion although the difference in the prevalence of anti-HCV in transfused and non transfused SCA patients was not statistically significant (P = 0.244).
There was a statistically significant trend between the seroprevalence of anti-HCV and increasing number of units of blood transfusion in this study. This is the similar trend observed in other studies reviewed. , In this study, the magnitude of the increase of blood transfusion in relation to anti-HCV positivity appeared higher, because 73.7% of those SCA children who received two or more units of blood transfusion were seropositive for anti-HCV compared with studies in U.S, , where those that received more than 10 units of blood transfusion recorded seropositivity of 23% and 30%. The higher magnitude of risk of positivity with each transfusion in this study and other Nigerian studies is not surprising considering that blood was not routinely screened for anti-HCV until recently and hence contaminated blood were being transfused.
The highest degree of anti-HCV seropositivity was recorded in private hospital (75%) among SCA children but for the control the highest was in rural hospital (100%). The least of all for anti-HCV seropositivity was recorded in tertiary hospital among SCA children and control. All other studies reviewed did not document sources of blood transfusion in relation to the degree of anti-HCV seropositivity. However, the reason for the finding in this present study may be attributed to the availability of well organised standard blood transfusion services (including screening process for anti-HCV) in our tertiary health facility compared to outside tertiary health facilities (general, private, and rural), where there is reduce or limited blood transfusion services that involves lack of adequate screening of donors for viral hepatitis in those centres.
There was significant association between blood transfusion/circumcision/injections and anti-HCV seropositivity for HCV infection among SCA children and controls in this study. This result support the findings from Benin  and Lagos  in which there was statistically significant anti-HCV seropositivity and increasing number of blood transfusion. The explanation to these findings in this study could be as a result of the exposure of sicklers and nonsicklers to the multiple parenteral risk factors such as blood transfusion, recurrent unsafe injections (in which the syringe, needle, or both have been reused without adequate sterilization) and other poorly covert parenteral exposures. It is possible that the HCV infection that is due to circumcision were those done by the traditional healers who used and reuse contaminated, unsterilized instrument, a practice that is common in this environment.
| Conclusion|| |
The seroprevalence of HCV infection in both SCA children and controls is high and the higher the frequency of blood transfusions the greater the rate of HCV infections in children with SCA and the controls. In view of the high seroprevalence of anti-HCV recorded in this study, screening for viral hepatitis of blood and blood products for donation should not be limited to hepatitis B surface antigen (HBsAg) but should encompasses screening for anti-HCV.
[Table 6] shows various risk factors associated with anti-HCV in SCA children and controls. There was statistically significant difference between SCA children and controls in blood transfusions, scarifications and injections (P-values = < 0.05).
|Table 6: Risk factors associated with antihepatitis C virus in sickle cell anemia children and controls|
Click here to view
| References|| |
|1.||Fasola FA, Odaibo GN, Aken'Ova YA, Olaeye OD. Hepatitis B and C viral markers in patients with Sickle Cell disease in Ibadan, Nigeria. Afr J Med Sci 2003;32:293-5. |
|2.||World Health Organisation. Hepatitis C. WHO Fact Sheet No.164 Available from: http:/www.who.int/inffs/en/fact 164.html [Last accessed on 2002 Jan 3]. |
|3.||Jan-Christian W. Hepatitis C, Epidemiology, Transmission and Natural History. In: Mauss, Berg, Rockstroh, Sarrazin, Wedemeyer, editors. Hepatology. Flying Publishers: Germany; 2009. p. 37-48. |
|4.||Ejiofor OS, Emechebe GO, Igwe WC, Ifeadike CO, Ubajaka CF. Hepatitis C virus infection in Nigerians. Niger Med J 2010;51:173-6. |
|5.||Kesson AM. Diagnosis and management of paeiatric hepatitis C virus infection. J Paediatr Child Health 2002;38:213-8. |
|6.||Madhava V, Burgress C, Drucker E. Epidemiology of chronic hepatitis C virus infection in sub-saharan Africa. Lancet Infect Dis 2002;2:293-302. Available from: http://infection.thelancet.com [Last accessed on 2010 June 2]. |
|7.||Lesi OA, Kehinde MO. Hepatitis C virus infection in patients with sickle cell anaemia at the Lagos University Hospital. Niger Postgrad Med J 2003;10:79-83. |
|8.||Center for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV related chronic diseases. MMWR Recomm Rep 1988;47:1-39. |
|9.||Society for Gastroenterology and Hepatology in Nigeria. SOGHIN. Hepatitis B and C Treatment Guidelines for Nigeria compiled by SOGHIN, the 2 nd scientific & AGM. Benin 2009. Available from: www.soghin.org/images/s37 [Last accessed on 2010 Jun 13]. |
|10.||DeVault KR, Friedman LS, Westerberg S, Martin P, Hosein B, Ballas SK. Hepatitis C in sickle cell anemia. J Clin Gastroenterol 1994;18:206-9. |
|11.||Hassan MF, Marsh F, Posner G, Bellevue R, Dosik H, Suatengco R, et al. Chronic hepatitis C in patients with sickle cell disease. Am J Gastroenterol 1996;91:1204-6. |
|12.||Adewuyi JO. Prevalence of antibodies to hepatitis C virus among normal blood donors and multi-transfused sickle cell anaemic patients in Nigeria. Trop Doct 1996;26:29-30. |
|13.||Ejiofor OS, Ibe BC, Emodi IJ, Ikefuna AN, Ilechukwu GC, Emechebe G, et al. The role of blood transfusion on the prevalence of hepatitis C virus antibodies in children with sickle cell anaemia in Enugu, South East Nigeria. Niger J Clin Pract 2009;12:355-8. |
|14.||Multimer DJ, Olomi A, Skidmore S, Olomu N, Ratcliffe D, Rodgers B, et al. Viral hepatitis in Nigeria-sickle cell disease and commercial blood donors. QJM 1994;87:407-11. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]