Thalassemia Patients from Baluchistan in Pakistan Are Infected with Multiple Hepatitis B or C Virus Strains

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  • 1 Institute of Biochemistry, University of Baluchistan Quetta, Quetta, Pakistan;
  • 2 Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
  • 3 BUMHS Bolan University of Medical and Health Sciences Quetta, Quetta, Pakistan;
  • 4 MSPH Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Karachi, Pakistan;
  • 5 Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
  • 6 Baluchistan University of Information Technology, Engineering Management Science, Baluchistan, Pakistan;
  • 7 Ulf Lundahls Foundation, Stockholm, Sweden;
  • 8 Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden

There are an estimated 2,000 children with β-thalassemia in the province Baluchistan of Pakistan. These children are at high risk of acquiring transfusion-transmitted infections (TTIs) due to their need of regular blood transfusions for survival. Therefore, we investigated the frequencies of TTIs among these multi-transfused patients in a region where the WHO guidelines for blood safety are not always followed. Sera from 400 children (mean age 7.7 ± 4.70 years) treated at two thalassemia centers in Baluchistan were investigated for TTIs. Eleven (2.8%) were hepatitis B surface antigen positive, and 72 (18.3%) had anti-hepatitis C virus (HCV), two of which were infected with both viruses. Only 22% of the children had been reached by the program for universal hepatitis B virus (HBV) vaccination which started in 2004. Half (51%) of the HCV infected had also been HBV infected. The HBV- and HCV-infected patients were older and had received more blood transfusions than the uninfected patients (P < 0.001). Molecular characterization of the viral strains revealed the presence of several genetically different strains in at least three HBV- and seven HCV-infected children. This is the first study to demonstrate infections with multiple HBV or HCV strains simultaneously infecting thalassemia patients. These may become the source for new emerging recombinant viruses of unknown virulence. The high prevalence of anti–HCV-positive children, and the presence of HBV infections among children who should have been vaccinated, highlights an urgent need for improvements of blood safety in this region of Pakistan.

Author Notes

Address correspondence to Heléne Norder, Gothenburg, Sweden. E-mail: helene.norder@gu.se

Financial support: The Higher Education Commission in Pakistan funded the subsidence of Sheikh Ahmed in Sweden and awarded him a scholarship for bench fee and education in molecular epidemiology at the University of Gothenburg.

Authors’ addresses: Sheikh Ahmed, Muhammad Ayub, and Ashif Sajjad, Institute of Biochemistry, University of Baluchistan Quetta, Quetta, Pakistan, E-mails: sheikhzahid2001@gmail.com, ayub_2004@hotmail.com, and ashifsajjad@hotmail.com. Muhammad Naeem, MSPH Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Karachi, Pakistan, E-mail: z.naeem105835@gmail.com. Faisal Hayat Nazir, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, E-mail: faysalkhan86@yahoo.com. Abrar Hussain, Baluchistan University of Information Technology, Engineering Management Science, Baluchistan, Pakistan, E-mail: abrarhussain857@yahoo.com. Daud Ghilzai, BUMHS Bolan University of Medical & Health Sciences Quetta, Pakistan, E-mail: daudghilzai@gmail.com. Lars O. Magnius, Ulf Lundahls Foundation, Stockholm, Sweden, E-mail: lars.magnius@gmail.com. Heléne Norder, Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, E-mail: helene.norder@gu.se.

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