Feasibility and usefulness of an efficient anti‐HBc screening programme in blood donors

Abstract

Post-transfusion hepatitis B remains a risk for recipients of hepatitis B surface antigen (HBsAg) screened blood. Anti-hepatitis B core antibody (anti-HBc) screening may help reduce this risk. To evaluate its usefulness, 9,238 East Anglian blood donors were screened for anti-HBc. Those with isolated anti-HBc were identified with two confirmatory anti-HBc and anti-HB surface antibody (anti-HBs) assays. The prevalence of anti-HBc reactions in screening and confirmatory assays was 1.29% and 0.35%, respectively. The level of reactivity was significantly higher when two anti-HBc assays gave concordant results or, being concordant, were anti-HBs positive. All isolated anti-HBc-positive units (0.04%) were negative for additional HBV markers including DNA tested with nested polymerase chain reaction (PCR). A 0.31% prevalence of past HBV infection was found in this population, all carrying both anti-HBc and anti-HBs antibody, most above the protective level (0.1 IU/ml). The proposed screening schemes would limit the number of deferred donors and discarded units and keep the testing time within the remit of routine blood banking practices for an additional cost of approximately 1 pound per unit. However, no evidence was found in this donor population to suggest that anti-HBc screening would significantly reduce the incidence of post-transfusion hepatitis B.

Hepatitis B core antibodies in Danish blood donors: a surrogate marker of risk behaviour

“…The prevalence of HBV infectious donations in Denmark has recently been estimated to be one per 250 000 donations, and this prevalence was unlikely to be detected by a study of this size [18]. The zero prevalence of HBV DNA among anti‐HBc‐positive donors is in accordance with the literature from countries where anti‐HBc is of low endemicity [19,20]. In a lookback study of recipients from anti‐HBc‐positive donors, the incidence was estimated to be one per 52 000 donations [21].…”

Prospective investigation of transfusion transmitted infection in recipients of over 20 000 units of blood

“…In the United States, testing for antibody to hepatitis B core antigen may prevent 33% to 50% of cases of hepatitis B potentially transmissible from donors who test negative for hepatitis B surface antigen 10. In the United Kingdom, the potential benefits of routine testing for antibodies to hepatitis B core antigen are considered not to outweigh the disadvantages (such as uncertainties in confirmation of infection and wastage of falsely positive units11). …”

Frequency of HBV DNA detection in US blood donors testing positive for the presence of anti‐HBc: implications for transfusion transmission and donor screening

“…The same principle of lack of HBV transmission by units with high levels of anti‐HBs has been referred to by many authors, although there does not appear to be agreement on the definition of low and high anti‐HBs levels 4,12,14,16 . When designing this study, our review of unpublished data from HBV seroconverters and from chronic HBV patients who lost HBsAg spontaneously or in response to IFN therapy had not identified cases in which HBV DNA was detected in patients whose anti‐HBs levels were greater than 100 IU per L. Previous authors have also adopted this 100 IU per L criteria 14,17 . It should be noted, however, that we are not aware of any large‐scale population studies directly comparing the HBV DNA detection rate in persons with low and high levels of anti‐HBs.…”