Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Clin Infect Dis. 2011 Mar 1;52(5):624-32. doi: 10.1093/cid/ciq247. Epub 2011 Jan 18.
Studies of the transmissibility of hepatitis B virus (HBV) in occult hepatitis B (OHB) through blood transfusion are scarce. We aimed to determine the transmissibility of HBV in blood donors with OHB through transfusion in animal and human studies.
Among 217,595 blood donors, 67 donors with OHB were identified. Four chimeric mice populated with human hepatocytes were inoculated with 2 donor serum samples. Serial serum and liver HBV DNA levels were measured. Forty-nine recipients of blood transfusions traced from 10 donors with OHB (9 of whom were positive for antibody to hepatitis B surface antigen [anti-HBs]) were tested for HBV infection. Homology and phylogenetic analyses between the HBV genomic sequences of donors and recipients were performed.
Serum HBV DNA was detectable (10(4) copies/mL) in 1 mouse at weeks 5 and 7 after inoculation. Total HBV DNA and HBV replication template (covalently closed circular DNA) and hepatitis B core antigen were detected in the mouse liver. After transfusion, 45 recipients (91.8%) had no HBV infection (ie, they tested negative for hepatitis B surface antigen and HBV DNA). Four tested positive for HBV DNA. In 3 recipients, 83%-86% homology and distant phylogenetic relatedness with their donor HBV excluded transmission through transfusion. The remaining recipient HBV had 95% sequence homology with her donor HBV, compatible with acquisition of HBV infection from the transfusion. High anti-HBs levels in 7 other recipients suggested recent transfusion-related HBV immune response.
OHB donor blood infectivity was shown in our animal and human studies. However, the risk of HBV transmission in humans was low, especially from blood products obtained from donors with OHB who were anti-HBs positive.
隐匿性乙型肝炎（OBH）患者的乙型肝炎病毒（HBV）经输血传播的研究较为匮乏。我们旨在通过动物和人体研究，确定 OBH 献血者通过输血传播 HBV 的可能性。
在 217595 名献血者中，发现 67 名 OBH 献血者。4 只嵌合小鼠用人肝细胞接种 2 份供者血清样本。连续测量血清和肝 HBV DNA 水平。对 10 名 OBH 供者（其中 9 名抗乙型肝炎表面抗原抗体阳性）追踪的 49 名输血受血者进行 HBV 感染检测。对供者和受者 HBV 基因组序列进行同源性和系统发生分析。
接种后第 5 和第 7 周，1 只小鼠血清 HBV DNA 可检出（104 拷贝/ml）。小鼠肝脏中检测到总 HBV DNA 和 HBV 复制模板（共价闭合环状 DNA）和乙型肝炎核心抗原。输血后，45 名受血者（91.8%）未发生 HBV 感染（即乙型肝炎表面抗原和 HBV DNA 检测均为阴性）。4 名受血者 HBV DNA 检测阳性。其中 3 名受血者 HBV 与供者 HBV 同源性为 83%-86%，且系统发生关系较远，排除了经输血传播的可能性。其余 1 名受血者 HBV 与供者 HBV 具有 95%的序列同源性，提示其 HBV 感染来源于输血。另外 7 名受血者抗-HBs 水平较高，提示近期发生与输血相关的 HBV 免疫反应。
我们的动物和人体研究显示，OBH 供者血液具有感染性。然而，人类 HBV 传播风险较低，尤其是来自抗-HBs 阳性的 OBH 供者的血液制品。
