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


METHODS
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.


CONCLUSIONS
Therefore, despite active immunization, sensitive screening assays for occult HBV infection such as nucleic acid amplification test could be considered in endemic areas.
Liu
Chun-Jen
CJ
Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 100, Taiwan.
Lo
Shyh-Chyi
SC
Kao
Jia-Horng
JH
Tseng
Ping-Tsung
PT
Lai
Ming-Yang
MY
Ni
Yen-Hsuan
YH
Yeh
Shiou-Hwei
SH
Chen
Pei-Jer
PJ
Chen
Ding-Shinn
DS
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D018562:Disease Transmission, Infectious; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D006510:Hepatitis B Antibodies / Q000032:analysis; D006513:Hepatitis B e Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D065227:Transfusion Reaction
D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006513:Hepatitis B e Antigens