Transfusion‐transmitted HBV infection in an endemic area: the necessity of more sensitive screening for HBV carriers

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Abstract
BACKGROUND: By NAT, HBV DNA is occasionally detectable in blood donors with past HBV infection but negative for HBsAg. Whether or not these donors can cause transfusion‐transmitted HBV infections is uncertain.STUDY DESIGN AND METHODS: To determine whether or not donors with past HBV infection but negative for HbsAg can cause HBV transfusion‐transmitted infections, recipients followed for blood transfusion in a university medical center in Taiwan were studied. HBV DNA and serologic markers were tested in donors and recipients.RESULTS: Of 1038 enrolled recipients, 910 completed the 6‐month post‐transfusion follow‐up visit. Of these, only 39 patients (4.3%) tested negative on the pretransfusion sample for HBsAg, anti‐HBs, anti‐HBc, and HBV DNA by PCR. These 39 HBV‐naive recipients had been transfused with blood from 147 donations for which stored samples were available for HBV DNA testing by PCR; 11 of these HBsAg‐negative samples tested positive for HBV DNA and anti‐HBc. Two of the 11 patients who received the HBV‐DNA‐positive donations (18%) became positive for HBV DNA, and one seroconverted to anti‐HBc and finally to anti‐HBs, with a mild transient elevation of serum ALT activities. Based on the one confirmed case of HBV transmission, a projection was made that approximately 200 post‐transfusion HBV infections could occur in one million units of transfused blood in Taiwan.CONCLUSIONS: In HBV‐endemic areas like Taiwan, where blood donors are screened for HBsAg only, the risk of transfusion‐transmitted HBV appears to be substantial. Implementation of NAT for blood screening in these settings warrants consideration.