title: One window-period donation in two years of individual donor-nucleic acid test screening for hepatitis B, hepatitis C and human immunodeficiency virus.
abstract: OBJECTIVE
  To describe general data on nucleic acid/serology testing and report the first hepatitis B-nucleic acid testing yield case of an immunized donor in Brazil.
  
  
  METHODS
  A total of 24,441 donations collected in 2010 and 2011 were submitted to individual nucleic acid testing for hepatitis B, hepatitis C and human immunodeficiency virus using the TaqMan((r)) MPX kit (Roche) on the Cobas s201 platform, in addition to routine screening for serological markers. Nucleic acid testing-reactive donations were further evaluated by real-time polymerase chain reaction using Cobas AmpliPrep/Cobas TaqMan hepatitis B virus, hepatitis C virus and human immunodeficiency virus tests.
  
  
  RESULTS
  Thirty-two donations were reactive by nucleic acid testing, 31 were also serologically reactive and one first-time donor was identified as having hepatitis B in the window period. Follow-up samples showed increasing titers of anti-HBs rising from 19 UI/mL in the index donation to 109 IU/mL seven months later attributable to his vaccination history. Curiously, this donor was never reactive for HbsAg nor for anti-HBc. In the yield donation, he was concomitantly reactive for syphilis (enzyme immunoassay and fluorescent treponemal antibody-absorption; venereal disease research laboratory non-reactive). Overall, six donors (0.02%) were characterized as occult hepatitis B. A total of 35% of the confirmed (recombinant immunoblot assay positive) hepatitis C donations were nucleic acid testing non-reactive and no human immunodeficiency virus "elite controller" was identified.
  
  
  CONCLUSIONS
  The yield rate (1:24,441; 95% confidence interval: 1:9,537 - 1:89,717) contrasts to the North American rate (1:410,540 donations) and strongly advocates the adoption of nucleic acid testing for hepatitis B in Brazil despite the increasing rate of anti-HBs reactive subjects due to the successful immunization program.
authors.affiliation: Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brazil.
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Levi
authors.forename: Ricardo Antonio D'Almeida
authors.initials: RA
authors.lastname: Pereira
authors.forename: Márcia Bernardino de Carvalho
authors.initials: MB
authors.lastname: Polite
authors.forename: Mariza Aparecida
authors.initials: MA
authors.lastname: Mota
authors.forename: Silvia Patricia
authors.initials: SP
authors.lastname: Nunez
authors.forename: João Renato Rebello
authors.initials: JR
authors.lastname: Pinho
authors.forename: José Mauro
authors.initials: JM
authors.lastname: Kutner
keywords: Blood donors; HIV; Hepatitis B virus; Hepatitis B/diagnosis; Hepatitis C virus; Hepatitis C/diagnosis; Reverse transcriptase polymerase chain reaction
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