The seroprevalence of hepatitis C virus (HCV) among 559,890 first-time volunteer blood donors in China reflects regional heterogeneity in HCV prevalence and changes in blood donor recruitment models

Chronic infection with hepatitis C virus (HCV) is a major and growing public health problem. Globally, approximately 170 million people are infected with HCV; however, the prevalence varies greatly among countries, from 0.2% to 26%.1-6 The rapid global spread of HCV is believed to have occurred primarily because of efficient transmission through blood transfusion and parenteral exposures with contaminated equipment.7 In countries where HCV antibody screening and nucleic acid amplification testing (NAT) are mandatory for all blood donors, new HCV-infected donors often have a history of injecting illicit drugs, contaminated medical procedures, or other parenteral exposures. Risk factors also include tattooing, ear and body piercing, household or sexual contact, and unknown sources of infection.8 One of the most consistent characteristics of HCV is its ability to cause chronic infection in a high percentage of individuals. Chronic HCV infection often leads to liver cirrhosis and hepatocellular carcinoma.9,10 As blood-borne pathogens, both HCV and the human immunodeficiency virus (HIV) were frequently detected among paid blood donors in China during the early 1990s.11-14 To improve the safety of blood supply and reduce the risk of transfusion-transmitted diseases, the Chinese government has, since 1998, outlawed the use of paid blood donors. As a result, Chinese blood banks now rely on various other methods to recruit blood donors; these include employer-organized donor recruitment and the use of student donors, replacement donors, and in the recent past, only volunteer donors. This transition in the blood donor recruitment methods in China has been associated with a gradual decrease in the seroprevalence of anti-HCV among donors.13 The HCV seroprevalence among the general population of China has been estimated to be about 3.2%, while among paid blood donors the prevalence has been 5.7% or higher.15-17 However, among employer-organized donors and volunteer donors, the prevalence has ranged between 1.1, 2.3, and 0.46%, respectively13,18,19 Although a progressive decrease in the overall prevalence of anti-HCV has been observed among donors in some regions, the HCV prevalence among first-time volunteer blood donors in China has not been reported. From January 2004 to December 2007, a total of 559,890 first-time volunteer blood donors were evaluated at the Guangzhou Blood Center, in Guangdong Province. In this study, we report the prevalence of anti-HCV in this cohort of donor population.