title: The risk of hepatitis B virus infection by transfusion in Kumasi, Ghana.
abstract: The risk of hepatitis B virus (HBV) transmission by transfusion in sub-Saharan Africa is considered to be relatively low, and testing of blood donors is often not done or is done relatively poorly. To re-examine this attitude, we identified HBV chronically infected blood donors from a major hospital in Ghana with a range of hepatitis B surface antigen (HBsAg) assays. Test efficacy was estimated using HBV DNA as a gold standard, and the risk of HBV infection in blood recipients was estimated for different testing strategies. Particle agglutination, dipstick, and enzyme immunoassay (EIA) HBsAg screening detected 54%, 71%, and 97% of HBV infectious donors, respectively. The risk of HBV transmission to recipients less than 10 years old ranged between 1:11 and 1:326 with blood unscreened and screened by EIA, respectively. For older recipients, the risk decreased a further 4-fold because of the high frequency of natural exposure to HBV. A total of 98% of HBsAg-confirmed positive samples contained HBV DNA. HBV DNA load was less than 1 x 10(4) IU/mL in 75% of HBsAg-reactive samples, most of them anti-HBe reactive. Approximately 0.5% of HBsAg-negative but anti-HBc-positive samples contained HBV DNA. The use of sensitive HBsAg tests is critical to prevent transfusion transmission of HBV infection to young children in a population with a 15% prevalence of chronic HBV infection in blood donors. However, this will not have much effect on the prevalence of this infection unless other strategies to protect children from infection are also advanced in parallel.
authors.affiliation: Division of Transfusion Medicine, Department of Haematology, University of Cambridge, United Kingdom. jpa1000@cam.ac.uk
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Allain
authors.forename: Daniel
authors.initials: D
authors.lastname: Candotti
authors.forename: Kate
authors.initials: K
authors.lastname: Soldan
authors.forename: Francis
authors.initials: F
authors.lastname: Sarkodie
authors.forename: Bruce
authors.initials: B
authors.lastname: Phelps
authors.forename: Cristina
authors.initials: C
authors.lastname: Giachetti
authors.forename: Venkatakrishna
authors.initials: V
authors.lastname: Shyamala
authors.forename: Francis
authors.initials: F
authors.lastname: Yeboah
authors.forename: Margaret
authors.initials: M
authors.lastname: Anokwa
authors.forename: Shirley
authors.initials: S
authors.lastname: Owusu-Ofori
authors.forename: Ohene
authors.initials: O
authors.lastname: Opare-Sem
mesh_terms: D001782:Blood Donors; D002648:Child; D004279:DNA, Viral / Q000097:blood; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005869:Ghana; D006509:Hepatitis B / Q000175:diagnosis / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000453:epidemiology; D006801:Humans; D007124:Immunoenzyme Techniques; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D065227:Transfusion Reaction; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens