Transmissibility of hepatitis B virus (HBV) infection through blood transfusion from blood donors with occult HBV infection.
BACKGROUND
Studies of the transmissibility of hepatitis B virus (HBV) in occult hepatitis B (OHB) through blood transfusion are scarce. We aimed to determine the transmissibility of HBV in blood donors with OHB through transfusion in animal and human studies.


METHODS
Among 217,595 blood donors, 67 donors with OHB were identified. Four chimeric mice populated with human hepatocytes were inoculated with 2 donor serum samples. Serial serum and liver HBV DNA levels were measured. Forty-nine recipients of blood transfusions traced from 10 donors with OHB (9 of whom were positive for antibody to hepatitis B surface antigen [anti-HBs]) were tested for HBV infection. Homology and phylogenetic analyses between the HBV genomic sequences of donors and recipients were performed.


RESULTS
Serum HBV DNA was detectable (10(4) copies/mL) in 1 mouse at weeks 5 and 7 after inoculation. Total HBV DNA and HBV replication template (covalently closed circular DNA) and hepatitis B core antigen were detected in the mouse liver. After transfusion, 45 recipients (91.8%) had no HBV infection (ie, they tested negative for hepatitis B surface antigen and HBV DNA). Four tested positive for HBV DNA. In 3 recipients, 83%-86% homology and distant phylogenetic relatedness with their donor HBV excluded transmission through transfusion. The remaining recipient HBV had 95% sequence homology with her donor HBV, compatible with acquisition of HBV infection from the transfusion. High anti-HBs levels in 7 other recipients suggested recent transfusion-related HBV immune response.


CONCLUSIONS
OHB donor blood infectivity was shown in our animal and human studies. However, the risk of HBV transmission in humans was low, especially from blood products obtained from donors with OHB who were anti-HBs positive.
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong. mfyuen@hkucc.hku.hk
Man-Fung
MF
Yuen
Danny Ka-Ho
DK
Wong
Cheuk-Kwong
CK
Lee
Yasuhito
Y
Tanaka
Jean-Pierre
JP
Allain
James
J
Fung
Jennifer
J
Leung
Che-Kit
CK
Lin
Masaya
M
Sugiyama
Fuminaka
F
Sugauchi
Masashi
M
Mizokami
Ching-Lung
CL
Lai
D000293:Adolescent; D000328:Adult; D000818:Animals; D001769:Blood / Q000821:virology*; D001782:Blood Donors; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D004195:Disease Models, Animal; D005260:Female; D006509:Hepatitis B / Q000635:transmission*; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008099:Liver / Q000821:virology; D008297:Male; D051379:Mice; D008875:Middle Aged; D010802:Phylogeny; D018570:Risk Assessment; D017422:Sequence Analysis, DNA; D065227:Transfusion Reaction; D055815:Young Adult
D004279:DNA, Viral