International review of blood donation screening for anti-HBc and occult hepatitis B virus infection.
Fu MX., Faddy HM., Candotti D., Groves J., Saa P., Styles C., Adesina O., Carrillo JP., Seltsam A., Weber-Schehl M., O'Brien SF., Drews SJ., Aidoo NB., Pajares ÁL., Perez LN., Deng X., van de Laar T., Laperche S., Lehtisalo R., Yilmaz S., Tsoi W-C., Juhl D., Niederhauser C., Chenarsabz N., O'Flaherty N., Goto N., Satake M., Renaud C., Lewin A., Cloutier M., Sawadogo S., Reynolds C., Zhiburt E., Muylaert A., Van Gaever V., Garcia-Otalora M-A., Jarvis L., Vermeulen M., Busch M., Blackmore S., Jones A., Brailsford S., Irving WL., Andersson M., Simmonds P., Harvala H., Virology subgroup of the ISBT WP‐TTID None.
BACKGROUND: Hepatitis B core antibody (anti-HBc) screening has been implemented in many blood establishments to help prevent transmission of hepatitis B virus (HBV), including from donors with occult HBV infection (OBI). We review HBV screening algorithms across blood establishments globally and their potential effectiveness in reducing transmission risk. MATERIALS AND METHODS: A questionnaire on HBV screening and follow-up strategies was distributed to members of the International Society of Blood Transfusion working party on transfusion-transmitted infectious diseases. Screening data from 2022 were assimilated and analyzed. RESULTS: A total of 30 unique responses were received from 25 countries. Sixteen respondents screened all donations for anti-HBc, with 14 also screening all donations for HBV DNA. Anti-HBc prevalence was 0.42% in all blood donors and 1.19% in new donors in low-endemic countries; however, only 44% of respondents performed additional anti-HBc testing to exclude false reactivity. 0.68% of anti-HBc positive, HBsAg-negative donors had detectable HBV DNA. Ten respondents did universal HBV DNA screening without anti-HBc, whereas four respondents did not screen for either. Deferral strategies for anti-HBc positive donors were highly variable. One transfusion-transmission from an anti-HBc negative donor was reported. DISCUSSION: Anti-HBc screening identifies donors with OBI but also results in the unnecessary deferral of a significant number of donors with resolved HBV infection and donors with false-reactive anti-HBc results. Whilst confirmation of anti-HBc results could be improved to reduce donor deferral, transmission risks associated with anti-HBc negative OBI donors must be considered. In high-endemic areas, highly sensitive HBV DNA testing is required to identify infectious donors.