Transmission of occult hepatitis B virus by transfusion to adult and pediatric recipients in Taiwan
Received 22 March 2005; received in revised form 6 June 2005; accepted 17 June 2005. published online 13 July 2005.
Background/Aims
The infectivity of occult hepatitis B virus (HBV), defined as HBsAg-negative but HBV DNA-positive, after transfusion has been low but not negligible. To address this, we investigated the incidence of post-transfusion HBV infection after receiving screened blood units in Taiwan.
Methods
Consecutive HBV-naïve (anti-HBc-negative) recipients with normal ALT were followed for HBV DNA and serologic markers before and after transfusion. Among 4448 blood recipients, 467 (10.5%) were anti-HBc-negative. Post-transfusion 6-month follow-up was completed for 327. We identified 5 (1.5%) who developed hepatitis B viremia 1 week after transfusion. Three were children who later seroconverted to anti-HBc but with normal ALT indicating subclinical acute infection, despite all had anti-HBs from previous vaccination. One had transient transfusion-transmitted HBV without seroconversion to anti-HBc and one possibly had occult HBV infection. Our findings suggested the possibility that occult HBV infection was transmissible by transfusion. The incidence of post-transfusion acute HBV infection was 0.9% (100 per million units) in naïve recipients in Taiwan, a figure 7∼40-fold higher than in developed countries. Moreover, some vaccinated children with anti-HBs were still susceptible.
Conclusions
Therefore, despite active immunization, sensitive screening assays for occult HBV infection such as nucleic acid amplification test could be considered in endemic areas.
aDivision of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
bDepartment of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
cGraduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 100, Taiwan
dHepatitis Research Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
eDepartment of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
fDepartment of Microbiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
gDepartment of Medical Research, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Corresponding author. Address: Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 100, Taiwan. Tel.: 886 2 23123456x7072; fax: 886 2 23317624.
ABSTRACT