Transmission of occult hepatitis B virus by transfusion to adult and pediatric recipients in Taiwan

National Taiwan University, T’ai-pei, Taipei, Taiwan
Journal of Hepatology (Impact Factor: 11.34). 02/2006; 44(1):39-46. DOI: 10.1016/j.jhep.2005.06.016
Source: PubMed


The infectivity of occult hepatitis B virus (HBV), defined as HBsAg-negative but HBV DNA-positive, after transfusion has been low but not negligible. To address this, we investigated the incidence of post-transfusion HBV infection after receiving screened blood units in Taiwan.
Consecutive HBV-naïve (anti-HBc-negative) recipients with normal ALT were followed for HBV DNA and serologic markers before and after transfusion. Among 4448 blood recipients, 467 (10.5%) were anti-HBc-negative. Post-transfusion 6-month follow-up was completed for 327. We identified 5 (1.5%) who developed hepatitis B viremia 1 week after transfusion. Three were children who later seroconverted to anti-HBc but with normal ALT indicating subclinical acute infection, despite all had anti-HBs from previous vaccination. One had transient transfusion-transmitted HBV without seroconversion to anti-HBc and one possibly had occult HBV infection. Our findings suggested the possibility that occult HBV infection was transmissible by transfusion. The incidence of post-transfusion acute HBV infection was 0.9% (100 per million units) in naïve recipients in Taiwan, a figure 7 approximately 40-fold higher than in developed countries. Moreover, some vaccinated children with anti-HBs were still susceptible.
Therefore, despite active immunization, sensitive screening assays for occult HBV infection such as nucleic acid amplification test could be considered in endemic areas.

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    • "OBI is the major cause of posttransfusion hepatitis B in western countries and in countries like India and Taiwan, with higher risk of transmission than for HCV or HIV [30–32]. "
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    ABSTRACT: Occult HBV infection (OBI) is defined as HBV DNA detection in serum or in the liver by sensitive diagnostic tests in HBsAg-negative patients with or without serologic markers of previous viral exposure. OBI seems to be higher among subjects at high risk for HBV infection and with liver disease. OBI can be both a source of virus contamination in blood and organ donations and the reservoir for full blown hepatitis after reactivation. HBV reactivation depends on viral and host factors but these associations have not been analyzed thoroughly. In OBI, it would be best to prevent HBV reactivation which inhibits the development of hepatitis and subsequent mortality. In diverse cases with insufficient data to recommend routine prophylaxis, early identification of virologic reactivation is essential to start antiviral therapy. For retrieving articles regarding OBI, various databases, including OVID, PubMed, Scopus, and ScienceDirect, were used.
    Hepatitis research and treatment 03/2013; 2013:259148. DOI:10.1155/2013/259148
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    • "Interestingly, only transient viraemia and subclinical hepatitis were observed, and none of the vaccinated subjects became HBsAg carriers. Similarly, Liu et al.26 evaluated 327 HBV-naïve blood transfusion recipients and found that four vaccinated children developed transient HBV viraemia (3.4×104 – 3.3×105 HBV DNA copies/ml) within 1 month of receiving blood transfusions contaminated with HBV. These children exhibited only subclinical HBV infection, with minimal alanine aminotransferase (ALT) level elevation, after transfusion. "
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    ABSTRACT: Hepatitis B infection, especially by perinatal transmission, is endemic in Asian countries. After the first successful universal hepatitis B virus (HBV) vaccination programme for newborns in Taiwan, it became feasible to prevent HBV transmission and the resultant hepatocellular carcinoma in endemic countries. However, a small subset of vaccinated people have a suboptimal immunological response to vaccination, and the immunity of some young adults who were vaccinated as infants seems to have waned over time. Despite this loss, recent studies suggest that anamnestic anti-HBs antibody responses rapidly resume and eliminate acute HBV infection acquired through sexual contact or blood transfusion, even though the anti-HBs antibody titre has decreased below a protective level. These observations indicate prolonged protection by the HBV vaccine. Therefore, for people with a low infection risk, a universal booster vaccination is not currently recommended, but it should be considered for high-risk groups. However, we still advocate close monitoring of acute hepatitis B among patients who lack a protective level of anti-HBs antibody and suggest a wait-and-see policy to determine the necessity for booster vaccines.
    Emerging Microbes and Infections 09/2012; 1(9). DOI:10.1038/emi.2012.28 · 2.26 Impact Factor
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    • "There has been an increased focus on OBI lately, with several studies published both on the clinical significance of anti-HBc and OBI, and as a starting point for discussing the matter of safe blood transfusion. The infectiousness of OBI cases is not clear although several studies report that exclusion of anti-HBc positive blood probably decreases the rate of HBV transmission by blood transfusion589. The nucleic acid amplification (NAT) technology has greatly enhanced accuracy in identification of OBI cases, and NAT negative individuals are considered safe blood donors10. However, NAT testing is expensive, the NAT tests may not pick up mutated virus, cost-effectiveness may be low, and the technology may not be feasible in blood transfusion services where resources are scarce4. "
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    ABSTRACT: Safe blood and blood products should be offered to all patients in need for blood transfusion. The objectives of the present study were to establish prevalence estimates for hepatitis B and hepatitis C virus infections as a foundation for safe blood transfusion in rural Vietnam, and to check the accuracy of the laboratory analysis used for hepatitis testing of blood donors in Vietnam. A cross-sectional study was conducted in two rural communities in Quang Tri, Vietnam. A total of 1,200 blood samples collected from potential blood donors were tested by an enzyme immunoassay technique (EIA) for detection of hepatitis surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), and antibodies to hepatitis C antigen (anti-HCV). The EIA test outcome was validated by a chemiluminescent micro particle immunoassay technique (CMIA). The prevalence of HBsAg and anti-HBc in the study population was 11.4 per cent (95% CI 9.6 - 13.2) and 51.7 per cent (95% CI 48.8 - 54.5), respectively, the prevalences being higher in males than females. The prevalence of anti-HCV was 0.17 per cent. The test agreement between the EIA and CMIA techniques was high both for HBsAg detection (κ = 0.91; 95% CI: 0.83 - 0.99) and for anti-HBc detection (κ = 0.89; 95% CI 0.81 - 0.97). Compared to CMIA results, the positive and negative predictive values of the EIA tests were found to be 94.9 per cent (95% CI 87.5 - 98.6) and 97.5 per cent (95% CI 86.8 - 99.9) for HBsAg, and 92.4 per cent (95% CI 84.2 - 97.2) and 100 per cent (95% CI 91.2 - 100) for anti-HBc. The study shows that hepatitis B virus infection is endemic in rural areas of Vietnam and that almost half of the population is or has been infected. Hepatitis C infection is rare, but false negative test results cannot be ruled out. Also, the results indicate that the EIA performance in blood donor screening in Vietnam may be sub-optimal, missing 2.5 per cent of hepatitis B virus carriers and falsely excluding more than 7 per cent of blood donors. As the prevalence of hepatitis B infection is high, occult hepatitis B infection may represent a threat to safe blood transfusion. Therefore, nucleic acid amplification testing for HBV should be considered for blood donor screening in Vietnam.
    The Indian Journal of Medical Research 07/2012; 136(1):74-81. · 1.40 Impact Factor
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