title: Impact of pooling on accuracy of hepatitis B virus surface antigen screening of blood donations.
abstract: Expenditure on screening blood donations in developing countries can be reduced by testing donations in pools. This study evaluated serological screening in pools for hepatitis B virus (HBV) at the Israeli national blood bank and a hospital blood bank in Gaza, the Palestinian Authority. The accuracy of HBV surface antigen (HBsAg) enzyme immunoassay performed on pools of 3-24 samples was compared with individual tests. Delay in detecting positive samples due to dilution in pools and the possibility of antibody-antigen neutralization were analyzed. The sensitivity of pooled testing for HBsAg was 93-99%, prolonging the window period by 5 days (8.3%). Neutralization of HBsAg by hepatitis B surface antibodies (anti-HBs) could be minimized by testing immediately after pooling. Serological testing for HBsAg in pools may be performed using manually created pools of up to six samples, with 5% loss in sensitivity and a risk of neutralization by anti-HBs present in the donor population. Pooling can therefore be considered as an option only in countries with a low prevalence of HBV.
authors.affiliation: Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel. lena.novack@hcri.harvard.edu
authors.forename: L
authors.initials: L
authors.lastname: Novack
authors.forename: B
authors.initials: B
authors.lastname: Sarov
authors.forename: R
authors.initials: R
authors.lastname: Goldman-Levi
authors.forename: V
authors.initials: V
authors.lastname: Yahalom
authors.forename: J
authors.initials: J
authors.lastname: Safi
authors.forename: H
authors.initials: H
authors.lastname: Soliman
authors.forename: M
authors.initials: M
authors.lastname: Orgel
authors.forename: A
authors.initials: A
authors.lastname: Yaari
authors.forename: N
authors.initials: N
authors.lastname: Galai
authors.forename: J S
authors.initials: JS
authors.lastname: Pliskin
authors.forename: E
authors.initials: E
authors.lastname: Shinar
mesh_terms: D000936:Antigen-Antibody Complex / Q000097:blood / Q000302:isolation & purification*; D001771:Blood Banks; D001782:Blood Donors; D003362:Cost-Benefit Analysis; D046148:Donor Selection; D005240:Feasibility Studies; D006510:Hepatitis B Antibodies / Q000097:blood / Q000302:isolation & purification*; D006512:Hepatitis B Core Antigens / Q000097:blood / Q000302:isolation & purification*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007118:Immunoassay / Q000379:methods; D012680:Sensitivity and Specificity; D019562:Viral Load
chemical_list: D000936:Antigen-Antibody Complex; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens