HBsAg non-reactive HBV infection in blood donors: Transmission and pathogenicity

Abstract

Five blood donors with occult persistent and one donor with an early window phase HBV infection were identified. They were negative in regular HBsAg screening and had low levels of HBV DNA that were probably not detectable by current mini-pool nucleic acid amplification testing. In four donors several mutations were found located in the HBs antigen loop. In three donors the mutations were predominantly outside the ''a'' determinant; one donor had a wild type HBsAg sequence. Fifty-five recipients of donations from the persistently infected donors could be tested for previous or ongoing HBV infection and of them 53% (29/55) were anti-HBc positive. Based on the prevalence of antiHBc in Germany (7%), it was assumed that four of those recipients had already been positive before transfusion. In 22 cases, it was assumed that they acquired infection by the donations, but the infection remained asymptomatic and was resolved. In three cases transmission was proven by the time course of the acute infection and sequence identity The resulting infection was fatal and associated with immunological disorders at the time of transmission: in one case sepsis and in the other two cases immunosuppression. In a further asymptomatic case of proven transmission from the early window phase donation passively administered anti-HBs could not prevent spread of wildtype HBV but antiviral treatment lead to resolution. Surprisingly the typical acute hepatitis B was not observed in a single one of the 26 cases of assumed or proven transmission.

Occult Hepatitis B Virus Infection: Detection and Significance

“…He developed typical acute hepatitis B five months later [12] . A second similar case has also been described [13] . The long early window period leads to the relatively large residual risk of 1: 360,000 for undetected HBV, even in a low-incidence country like Germany [14] .…”

Prevalence of Occult Hepatitis B Infection in Iranian Cancer Patients Before Chemotherapy Treatment

“…In spite of the global HBV vaccination program, hepatitis B is still problematic in blood products. Depending on the point that OBI may be regarded as a crucial risk factor for HBV transmission in blood recipients, several researchers have evaluated the prevalence of OBI in blood donors and have also assessed the hazard of OBI transmission through blood and blood products (14) . It should be mentioned that occult HBV patients may develop HBsAg seroreversion, with subsequent HBV reactivation after chemotherapy, particularly in the cases of serious immunosuppression, such as patients of hematopoietic stemcell transplantation and also, those getting rituximab-based chemotherapy.…”

“…Some patients might experience liver failure and death. Most of these patients are remained in a persistent carrier condition and might cultivate chronic liver disorders, accompanied with its antecedent additional complications (14,18,27) .…”

False interpretation of diagnostic serology tests for patients treated with pooled human immunoglobulin G infusions: a trap for the unwary

“…2 Occult HBV infection detected by HBV DNA testing has been shown in 0.1-2.4% (median 1%) of HBV surface antigennegative, HBV core antibody-positive blood donors in Western countries such as the United States. 3 HBV transmission by blood components negative for HBV surface antigen has occurred historically, [4][5][6] but is highly unlikely with current manufacturing methods. Risk of transmission of hepatitis B from plasma products appears to be negligible when concurrent HBV surface antibody is present in the blood above a certain level (100-200 mIU/ml), and it has been observed that blood containing detectable HBV surface antibody carries no increased risk of transmitting hepatitis B when compared with blood that lacks this antibody.…”