title: Performance evaluation of 70 hepatitis B virus (HBV) surface antigen (HBsAg) assays from around the world by a geographically diverse panel with an array of HBV genotypes and HBsAg subtypes.
abstract: OBJECTIVE
  This study was conducted by the International Consortium for Blood Safety (ICBS) to identify high-quality test kits for detection of hepatitis B virus (HBV) surface antigen (HBsAg) for the benefit of developing countries.
  
  
  METHODS
  The 70 HBsAg test kits from around the world were evaluated comparatively for their clinical sensitivity, analytical sensitivity, sensitivity to HBV genotypes and HBsAg subtypes, and specificity using 394 (146 clinical, 48 analytical and 200 negative) ICBS Master Panel members of diverse geographical origin comprising the major HBV genotypes A-F and the HBsAg subtypes adw2,4, adr and ayw1-4.
  
  
  RESULTS
  Seventeen HBsAg enzyme immunoassay (EIA) kits had high analytical sensitivity <0.13 IU/ml, showed 100% diagnostic sensitivity, and were even sensitive for the various HBV variants tested. An additional six test kits had high sensitivity (<0.13 IU/ml) but missed HBsAg mutants and/or showed reduced sensitivity to certain HBV genotypes. Twenty HBsAg EIA kits were in the sensitivity range of 0.13-1 IU/ml. The other eight EIAs and the 19 rapid assays had analytical sensitivities of 1 to >4 IU/ml. These assays were falsely negative for 1-4 clinical samples and 17 of these test kits showed genotype dependent sensitivity reduction. Analytical sensitivities for HBsAg of >1 IU/ml significantly reduce the length of the HBsAg positive period which renders them less reliable for detecting HBsAg in asymptomatic HBV infections. Reduced sensitivity for HBsAg with genetic diversity of HBV occurred with genotypes/subtypes D/ayw3, E/ayw4, F/adw4 and by S gene mutants. Specificity of the HBsAg assays was >or=99.5% in 57 test kits and 96.4-99.0% in the remaining test kits.
  
  
  CONCLUSIONS
  Diagnostic efficacy of the evaluated HBsAg test kits differed substantially. Laboratories should therefore be aware of the analytical sensitivity for HBsAg and check for the relevant HBV variants circulating in the relevant population.
authors.affiliation: Paul-Ehrlich-Institut, Langen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Scheiblauer
authors.forename: M
authors.initials: M
authors.lastname: El-Nageh
authors.forename: S
authors.initials: S
authors.lastname: Diaz
authors.forename: S
authors.initials: S
authors.lastname: Nick
authors.forename: H
authors.initials: H
authors.lastname: Zeichhardt
authors.forename: H-P
authors.initials: HP
authors.lastname: Grunert
authors.forename: A
authors.initials: A
authors.lastname: Prince
mesh_terms: D000349:Africa / Q000453:epidemiology; D000595:Amino Acid Sequence; D001208:Asia / Q000453:epidemiology; D003906:Developing Countries; D005188:False Negative Reactions; D005814:Genes, Viral; D005838:Genotype; D014943:Global Health; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood* / Q000145:classification / Q000235:genetics; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000276:immunology; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D008969:Molecular Sequence Data; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D016415:Sequence Alignment; D017386:Sequence Homology, Amino Acid; D013020:South America / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D006514:Hepatitis B Surface Antigens; D011933:Reagent Kits, Diagnostic
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