Prevention of Blood-borne Diseases in Bolivia, 1993–2002 Gabriel A. Schmunis,* Gloria Rodriguez, Jan Coenen, Enrique Gil Bellorin, and Alberto Gianella Pan American Health Organization/World Health Organization, Washington, DC; Regional Blood Bank, Santa Cruz, Bolivia; Institute of Tropical Medicine, Antwerp, Belgium; Pan American Health Organization, Guatemala City, Guatemala; National Center for tropical Diseases, Santa Cruz, Bolivia Abstract. This report shows the outcome of a coordinated effort by locals, foreign institutions, and an international agency, from 1996–2002, aimed at preventing transmission of blood-borne diseases in Santa Cruz, Bolivia. From 2001– 2002, testing the donor pool for HIV prevented transfusion of 32 infected units and 29 infections. With 100% screening coverage, 196 hepatitis B virus (HBV)-infected units were discarded, and 177 infections of HBV were prevented between 1999 and 2002. Incomplete screening for hepatitis C virus (HCV) may have tainted nine units of blood and generated eight HCV infections in 1999. On the other hand, 600 units infected with HCV were discarded, and 540 HCV infections were prevented between 1999 and 2002. Screening for Chagas disease prevented transfusion of 10,661 tainted units and 2,133 infections from 1999 to 2002. From 1996–2002, the investment was US$1,108,000. INTRODUCTION In the 1980s and early 1990s, prevention of blood borne diseases in Latin American countries was difficult, even when policies were in place and effective control strategies had been known for years, because resources may not have been available or the capability of countries to enforce compliance with norms, and regulations were weak. In several countries, there were multiple public and private blood banks, each pro- viding limited number of units of whole blood, in which norms of quality assurance were unknown or not followed, thus decreasing the safety of the blood supply. 1 This was es- pecially true in Bolivia, where official data indicated that, of the total pool of blood donors, only 36% were screened for HIV, 15% for hepatitis B virus (HBV), none for hepatitis C virus (HCV), and 29% for Chagas disease in 1993. 2 At that time, country-wide estimated prevalence’s were 0.1 and 2.0 per 1,000 donors for HIV and HBV respectively, and were unknown for HCV. 2 On the other hand, country-wide preva- lence for Chagas disease was 148.0 per 1,000 population, 2 but there were areas of the country, like the department of Santa Cruz, where up to 50% of the population was infected with Trypanosome cruzi. 3–6 We report how coordinated actions carried out by local, foreign institutions, and an international agency from 1996– 2002 prevented transmission of blood-borne diseases in Santa Cruz, Bolivia, which at the time was the second largest city in the country (today it has the largest population); how much investment was needed; and how this investment impacted the outcome: transmission of blood-borne infections in that area from 1999–2002. MATERIALS AND METHODS Sources of information. Information was obtained from the agencies/institutions involved. The percentage of donors screened (screening coverage) for the different infectious dis- eases’ serologic markers, the prevalence of the serologic markers, and estimates of blood transmitted diseases for Santa Cruz in 1993 were compared with those of 1999–2002 in the same city and with the situation in the country as a whole in 1993, 2001, and 2002. Although 1993 data for the country as a whole were official information provided by the Ministry of Health, 2 there were no matching records from the Santa Cruz Blood Bank for that year. Therefore, basic data for Santa Cruz in 1993 were based on several assumptions. Assumptions were also made regard- ing the nationwide prevalence of HCV in 1993 and the preva- lence of all serologic markers in 2002 (Table 1). Assumptions. The number of blood donors in Santa Cruz was reported to be 13,708 for 1993. 7 The number of transfu- sions in Santa Cruz reached at least 10,000 in that year. 6 It was assumed that screening coverage in 1993 was similar to that reported for the whole country in that year: 36% for HIV; 15% for HBV; unknown for HCV; and 29% for T. cruzi. 2 The assumed prevalence rate in Santa Cruz for the different se- rologic markers in 1993 was that reported for 1994: 0 for HIV; 3/1,000 for HBV (HBsAg), the lowest end of the prevalence reported in Santa Cruz at that time; and 471.5/1,000 for T. cruzi (Table 1). 7 The prevalence for the latter is the upper end of the prevalence range found in four general hospitals of Santa Cruz but a lower prevalence than that reported in Santa Cruz blood donors in 1990 (510/1,000), 4 1992 (490/1,000), 5 and 1993 (485/1,000). 6 Screening for HCV was not available in the country in 1993, so we assumed a prevalence rate of 5/1,000 for HCV in Santa Cruz, the lowest prevalence re- ported in a survey of blood donors at Santa Cruz in 1992. 7 The Ministry of Health did not report the nationwide prevalence of HCV in 1993 or the prevalence of all serologic markers in 2002. 2,8 Therefore, it was assumed that the nation- wide prevalence of HCV in 1993 was the same as in Santa Cruz in 1992 (i.e., 5/1,000), 7 whereas the prevalence of infec- tious diseases markers per 1,000 donors in 2002 was similar to that found nationwide in 2003: 1.0 for HIV; 3.8 for HBV; 8.9 for HCV, and 76.5 for T. cruzi. 8 (Table 1) Calculations. Positivity for T. cruzi in Santa Cruz was so high that in 2002 blood donors were screened for T. cruzi infection by indirect hemagglutination (IHA) before with- drawal of blood. Only donors negative for T. cruzi were per- mitted to donate. This strategy prevented waste by saving blood bags and avoiding serology for viral diseases in units of blood that would have been discarded because of T. cruzi * Address correspondence to Gabriel A. Schmunis, 4256 Warren Street NW, Washington, DC 20016. E-mail: gabriel.schmunis@ gmail.com Am. J. Trop. Med. Hyg., 79(5), 2008, pp. 803–808 Copyright © 2008 by The American Society of Tropical Medicine and Hygiene 803