title: Transfusion-transmitted HBV infection in an endemic area: the necessity of more sensitive screening for HBV carriers.
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.
  
  
  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 1,038 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.
authors.affiliation: Department of Microbiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Jin-Town
authors.initials: JT
authors.lastname: Wang
authors.forename: Cha-Ze
authors.initials: CZ
authors.lastname: Lee
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
authors.forename: Teh-Hong
authors.initials: TH
authors.lastname: Wang
authors.forename: Ding-Shinn
authors.initials: DS
authors.lastname: Chen
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D000956:Antigens, Viral / Q000097:blood; D001782:Blood Donors; D004279:DNA, Viral / Q000097:blood; D019353:Endemic Diseases; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000175:diagnosis / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000276:immunology*; D006801:Humans; D008969:Molecular Sequence Data; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D013624:Taiwan; D065227:Transfusion Reaction
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens