Reversed passive hemagglutination test fails to detect HBsAg in a number of HBeAg positive sera.

In endemic areas of hepatitis B virus (HBV) infection, perinatal transmission from asymptomatic HBsAg carrier mothers to infants plays a major role in the transmission of HBV. HBeAg indicates a high level of viral replication and infectivity. Most of the infants born to HBeAg positive mothers become carriers. Prenatal screening of HBsAg would identify infected mothers and thus allow preventive administration of immunoglobulin and immunization to the newborns. Reversed passive hemagglutination assay (RPHA) is commonly used in Thailand for HBsAg screening. However this method has low sensitivity and gives false negative results. Therefore, infants born to HBsAg false negative mothers would not receive proper immunization. This study reveals the rate of false negative results for HBsAg by RPHA in high infectivity sera. Of 985 sera which were HBsAg positive by ELISA, 70 (7.1%) were negative for HBsAg by RPHA. Of these 70 false negative sera, 7 (10%) were HBeAg positive. Our results indicate that RPHA is a less sensitive method for detection of HBsAg than ELISA. RPHA can give false negative results even in sera with high HBV infectivity. Therefore, RPHA should be replaced by EIA for prenatal HBsAg screening or any other screening for HBV infection whenever possible.