Screening Donated Blood for Transfusion-Transmissible Cytomegalovirus Infection among Libyans

Human cytomegalovirus (HCMV) is a ubiquitous DNA-containing herpesvirus causes severe and fatal diseases in immunocompromised patients and a prevalent cause of virus-associated birth defects. Blood transfusion donated for neonates, pregnant women, and immunocompromised patients should be adequately screened for evidences of CMV infection prior to use in clinical management. The effective national programmes for quality-assured screening of donated blood have not yet been fully established, hence this study was undertaken to assess whether any bloodborne-CMV infections pose a significant threat to the safety of the blood supplies. A total of 200 voluntary blood donor subjects admitted to the Blood Bank of Benghazi/Libya were screened for transfusion-transmissible CMV (TT-CMV) using a highly sensitive CMV total IgG and IgM antibody enzyme immunoassay as well as CMV pp65 antigenemia assays. We determined that the overall seropositivity for IgG antibodies (80.50%) was higher than that of IgM antibodies (39.00%), but only 2 (1.00%) individuals out of these donors were seropositive for the CMV-antigenic protein pp65. The frequency of CMV infection based on gender was incomparable due to the small population number of blood-donated females. According to age, there was not influence of various age groups on prevalence of anti-CMV IgG antibodies, while a progressive increase in seropositivity of CMV-IgM antibodies with age was detected. The age groups were not significantly associated with CMV prevalence. In contrast, only 2 (1.00%) patients were shown to be positive for all three performed assays indicating a recurrent infection. How to cite this paper: Bleiblo, F., Eljaki, A., Bumadian, M., Elwaheishi, K., Almismary, E., Aljlale, M., Alghazal, R. and Abraheem, M. (2020) Screening Donated Blood for Transfusion-Transmissible Cytomegalovirus Infection among Libyans. Journal of Biosciences and Medicines, 8, 5-12. https://doi.org/10.4236/jbm.2020.81002 Received: October 27, 2019 Accepted: December 21, 2019 Published: December 24, 2019 Copyright © 2020 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/


Introduction
Human cytomegalovirus (HCMV) is a ubiquitous virus infection distributed worldwide. This virus is the most common infectious cause of birth defects and congenital diseases, the most significant and difficult opportunistic pathogen affecting immunocompromised patients [1] [2]. HCMV infects an overwhelming majority of the population, transmitted efficiently throughout life and universally through contacts with bodily secretions. After the initial acquisition of HCMV, the virus replicates and causes a systemic infection, sometimes detected as a leukocyte-associated viremia, and disseminates to secretory organs such as salivary glands and kidney where replication produces virus found in secretions [3].Viruses may be shed in any body fluids, including urine, saliva, tears, semen, and cervical secretions, and persistent shedding may continue for months to years, depending on age and immune status of the host [3] [4]. Like other human herpesviruses, HCMV is never completely cleared and remains latent for the life of the host. Persistently and sporadically shed virus is an important recurrent source of virus for transmission. Susceptibility to HCMV disease is associated with a compromised immune system, particularly related to defects in cell-mediated CD4 and CD8 T-cell functions [2]. Despite potential antiviral drugs aimed to control the overall disease burden, the HCMV remains an important etiologic agent of opportunistic infections and disease in immunocompromised individuals following organ transplantation and hematopoietic cell allografting, immunosuppressive therapies, and genetic or acquired immunodeficiency [1] [2] [5].
During active infection, the HCMV circulates in leukocytes and plasma and subsequently persists latent in leucocytes and other body cells. Following reactivation, the virus released again in blood stream and readily transmitted by transfusion of contaminated blood. In population where CMV is highly prevalent, there is a higher risk for blood transfused by viremic donors. Thus, for the majority of countries, anti-CMV screening is still central to the prevention of posttransfusion CMV [6] [7]. Safe and effective blood transfusion requires several processes including testing donated blood samples for transfusion-transmissible infections (TTIs) to minimize the risk of transmitting infections to seronegative recipients. Therefore, this study aimed to screen donated blood for evidence of CMV infection prior to the release of blood for clinical use to establish an effec-

Patient Population
Two hundred subjects admitted to the Blood Bank of Benghazi/Libya were recruited in this study. Informed consent was obtained from all patients and the protocol was approved by the Blood Services Ethics Committee. Demographic information including age, sex, marital status, literacy status, residential status, socioeconomic status were obtained by means of referring to medical records and personal interviews. Throughout their tenure on the Blood Unit, a 5 ml of blood was drawn from donors by vein puncture and placed in plastic disposable tubes; it was left to stand at room temperature (20˚C -25˚C) to allow for clotting, then the sera was separated by centrifugation 10,000 rpm for 5 minutes.
Sera samples were stored at-20˚C and later tested for cytomegalovirus antibodies by serological investigation.

Detection of CMV IgG
Microplate-based enzyme-linked immunoassay (ELISA) was used for the qualit-

Detection of CMV IgM
To determine if the blood donors have acute or primary infection, serum samples were assayed for CMV-specific IgM using a CMV IgM ELISA (Autobio Diagnostics Co., Ltd.) and the results were interpreted according to the manufacturer's instructions. Samples giving an absorbance less than the cut-off value were considered negative for the presence of CMV-specific IgM antibodies whe-

Detection of CMV Antigenemia
To quantitate the viral antigenemia, we performed Sandwich-ELISA to assay

Results and Discussion
Two hundred subjects of blood donors were followed during the course of the study. Our results revealed that 161 (80.50%) out of these subjects were seropositive for CMV-IgG indicating a past exposure to infection, while 78 (39.00%) individuals were seropositive for CMV-IgM indicating a recent or primary in-  [12]. In Nigeria, prevalence of anti-CMV IgG antibodies was 96.2% and that of IgM was 2.6% [13]. In a German study, the seroprevalence of CMV among blood donors ranged from 30% and increased up to about 80% in donors older than 65 years [14]. However, young donors already had a distinctly higher seroprevalence (about 70%) in Australia than was reported for Europe or North America [15]. Ethnicity has been suggested also to be an important factor for CMV seroprevalence. Low rates are reported for non-Hispanic Whites (about 50%) and very high rates for South Asians (∼89% of South Asian UK-born women and 98% among women born in South Asia and living in the UK) [16]. IgM appears first in response to a CMV primary infection CMV or reactivations. In general, IgM antibodies might be detectable both prior to IgG antibodies or shortly after IgG seroconversion and remain positive for several months [17]. Studies on the IgM seroprevalence in blood donors are less frequent than those about IgG seroprevalence. Most studies reported that IgM seroprevalence is much lower comparing to that of IgG [12]. In this study, we could not compare the overall seropositivity of CMV

Conclusion
Based on these findings, we highly recommend a quality-assured screening of all donated blood for transfusion transmissible infections, including CMV to establish effective national programmes to easily prevent the unacceptable risk of acquiring life-threatening diseases.