Two cases of transfusion-transmitted hepatitis B virus (HBV) infection in a low-endemic country before implementation of HBV nucleic acid testing.
BACKGROUND
The risk of hepatitis B virus (HBV) transmission by transfusion is higher than that of other blood-borne viruses. In France, before the introduction of HBV nucleic acid testing (NAT) in 2010, blood donations were tested for hepatitis B surface antigen (HBsAg) and antibodies against hepatitis B core antigen, and the residual risk of HBV transfusion related to preseroconversion acute phase was estimated at 0.54 per million donations. The additional value of the implementation of a highly sensitive HBV NAT to prevent such transmissions is discussed.


METHODS
Two lookback investigations based on HBV seroconversion of repeat donors were performed. Donors and recipients were followed up in multiple samples that were tested for HBV serologic and molecular markers.


RESULTS
The recipients have shown posttransfusion HBsAg seroconversion. The archived samples from the implicated donations were positive for HBV DNA at extremely low viral load in both cases. HBV isolates from donors and recipients of each case were organized in the same cluster with 100% identities into Genotypes A2 and B4, respectively. One recipient spontaneously recovered from infection while the second was successfully treated.


CONCLUSIONS
The present cases highlight the importance of introducing highly sensitive HBV NAT to prevent transmission. Moreover, the lookback studies based on appropriate molecular and serologic investigations of patients transfused with previous donations from newly identified HBV-infected repeat donors offer the opportunity to treat a recently infected recipient.
Laboratoire d'Expertise en Virologie, Centre National de Référence des Hépatites Virales B et C et du VIH en Transfusion, Institut National de la Transfusion Sanguine, Paris, France.
Annabelle
A
Servant-Delmas
Claude
C
Chuteau
Caroline
C
Lefort
Yves
Y
Piquet
Sylvie
S
Chevaleyre
Véronique
V
Betbeze
Martine
M
Delhoume
Sébastien
S
Hantz
Sophie
S
Alain
Syria
S
Laperche
D000328:Adult; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D019353:Endemic Diseases; D005260:Female; D006284:Health Plan Implementation; D006509:Hepatitis B / Q000453:epidemiology / Q000635:transmission*; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D021141:Nucleic Acid Amplification Techniques; D012698:Serologic Tests; D065227:Transfusion Reaction
D004279:DNA, Viral