Donor screening for antibody to hepatitis B core antigen and hepatitis B virus infection in transfusion recipients

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Abstract
BACKGROUND: Testing for antibody to hepatitis B core antigen (anti‐HBc) as a surrogate for hepatitis C viremia is no longer needed for blood donor screening. Currently, the important question is how much its use supplements hepatitis B surface antigen (HBsAg) donor screening in preventing transfusion‐transmitted hepatitis B virus (HBV) infection. STUDY DESIGN AND METHODS: In a study conducted in the 1970s, 64 blood donors were associated with 15 cases of HBV (1.0%) in 1533 transfusion recipients. Sera from 61 donors at donation and 29 follow‐up visits were available for present‐day assays for HBsAg, HBV DNA, anti‐HBc, and antibody to HBsAg (anti‐HBs). RESULTS: HBsAg was found in four previously negative blood donors; HBV DNA was limited to three of these four. Anti‐HBc was detected in six HBsAg‐negative donors. Two other donors were negative in all assays at donation, but positive for anti‐ HBc and anti‐HBs 2 to 4 months later. The remaining donors were negative for all HBV markers, which left five recipient cases unexplained. No HBV transmission was observed when anti‐HBs sample‐to‐ negative control values were > or = 10. CONCLUSION: Some 33 to 50 percent of cases of hepatitis B that could be transmitted by transfusion of blood from HBsAg‐negative donors are prevented by anti‐ HBc screening. Anti‐HBc‐positive donors unequivocally positive for anti‐ HBs should be considered noninfectious for HBV and should be allowed to donate. Anti‐HBc screening of paid plasmapheresis donors, supplemented by anti‐HBs testing, would reduce the amount of HBV to be processed by virus inactivation and increase the content of anti‐HBs in plasma pools.