Hepatitis B virus screening in contacts of blood donors with antibodies against core protein (anti-HBc), but without surface antigen (HBsAg)

Abstract

To increase blood safety Brazil introduced screening for anti-HBc among blood donors in 1993. There was a decrease in the hepatitis B virus (HBV) transmission, but this measure identified a great number of HBsAg-negative, anti-HBc-positive Studies have shown an increasing chance of finding HBV-positive subjects among household contacts of hepatitis B virus (HBV) carriers as compared with contacts of HBV-negative individuals (Berris et al. 1973, Kashiwagi et al. 1984, Milas et al. 2000. HBV spread inside families can take place by vertical or horizontal route (Dumpis et al. 2001, Ono-Nita et al. 2004. A surveillance approach recommended by the Center for Disease Control and Prevention (US) and the Brazilian Health Ministry is to screen contacts of HBV carriers in order to identify other carriers and susceptible individuals who could benefit from prophylaxis (CDC 1991). One of the most common ways of identifying HBV carriers takes place during blood donation screening (Hadler et al. 1987.In Brazil, HBV blood donors screening was extended to include analysis of antibodies against the core antigen (anti-HBc) in 1993 (Brasil, Ministério da Saúde). While improving safety, the addition of anti-HBc testing has increased the rejection of donated blood and has uncovered a large number of HBsAg-negative, anti-HBc-positive individuals considered to be unsuitable for blood donation. This serologic profile is quite common in en- demic areas and usually indicates a resolved HBV infection, although HBV DNA can be detected in serum from some of these individuals (Hennig et al. 2002).These HBsAg-negative, anti-HBc-positive blood donors require counseling regarding the implications of these results and whether their relatives and sexual contacts are at increased risk for HBV infection. However there is no such policy in Brazil and it has not yet been determined if the contacts of HBsAg-negative, anti-HBc-positive individuals are at increased risk of HBV exposure (Brasil 2000). It is also not know how long these blood donors remained infective in the past or when they stopped carrying HBV. This raises the question: should the surveillance policy for contacts of HBsAg-positive individuals be broadened to include contacts of HBsAg-negative, anti-HBc-positive individuals? The aim of the present study was to clarify whether contacts of HBsAg-negative, anti-HBc-positive blood donor are at increased risk for HBV infection. MATERIALS AND METHODSA cross-sectional study was designed to compare HBV infection prevalence in contacts of subjects with one of two profiles of HBV markers (HBsAg-positive or only antibodies positive: HBsAg-negative, anti-HBc-positive) identified during blood donation. The study was conducted in Cuiabá, (the largest city of the state of Mato Grosso, Central Brazil) at two institutions: the local public blood bank and the main private one. Both collect blood in Cuiabá and also in other cities of the region.

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Anti‐HBc screening in Egyptian blood donors reduces the risk of hepatitis B virus transmission

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