Department of Haematology, University of Cambridge, Cambridge, UK.
Transfusion. 2013 Jul;53(7):1405-15. doi: 10.1111/trf.12096. Epub 2013 Jan 30.
Occult hepatitis B virus (HBV) infection (OBI) is identified in 1:1000 to 1:50,000 European blood donations. This study intended to determine the infectivity of blood products from OBI donors.
Recipients of previous donations from OBI donors were investigated through lookback (systematic retrieval of recipients) or traceback (triggered by clinical cases). Serologic and genomic studies were undertaken on consenting donors and recipients. Multiple variables potentially affecting infectivity were examined.
A total of 45 of 105 (42.9%) donor-recipients pairs carried antibodies to HBV core (anti-HBc) as evidence of previous HBV infection. Subtracting 15% of anti-HBc population background, the adjusted transmission rate was 28%. Anti-HBc prevalence increased to 28 of 44 (63.8%) in unvaccinated recipients receiving anti-HBs-negative OBI blood products. In contrast, four of 26 (15.4%) recipients of anti-HBs-positive products were anti-HBc positive. Transmission with anti-HBs-negative products depended on volume of plasma transfused (85%-100% with 200 mL of fresh frozen plasma [FFP], 51% with 50 mL in platelet concentrates [PCs], and 24% with 20 mL in red blood cells [RBCs], p < 0.0001 FFP vs. RBCs). The 50% minimum infectious dose of OBI HBV DNA was estimated at 1049 (117-3441) copies. Donor and recipient strains sequence homology of at least 99% confirmed transfusion-transmitted infection in 10 cases and excluded it in one case.
Blood products from donors with OBI carry a high risk of HBV transmission by transfusion. This risk is dependent on presence of anti-HBs and viral dose. This may justify safety measures such as anti-HBc and HBV nucleic acid test screening depending on epidemiology.
在 1000 至 50000 份欧洲献血者中，可发现 1 例至 1 例隐匿性乙型肝炎病毒（HBV）感染（OBI）。本研究旨在确定 OBI 供体血液制品的传染性。
通过追溯（系统检索受血者）或回溯（由临床病例触发）调查 OBI 供体既往献血的受血者。对有意愿的供体和受血者进行血清学和基因研究。检查了多个可能影响传染性的变量。
在 105 对供-受者中，共有 45 对（42.9%）携带乙型肝炎核心抗体（抗-HBc），表明以前有 HBV 感染。扣除 15%的抗-HBc 人群背景，调整后的传播率为 28%。在未接种疫苗的接受抗-HBs 阴性 OBI 血液制品的受血者中，抗-HBc 阳性率上升至 28 例（63.8%）。相比之下，26 例接受抗-HBs 阳性产品的受血者中，仅有 4 例抗-HBc 阳性。抗-HBs 阴性产品的传播取决于输血浆量（100%的新鲜冰冻血浆[FFP]为 200 毫升，血小板浓缩物[PC]为 50 毫升，红细胞[RBC]为 20 毫升，51%和 24%，p < 0.0001 FFP 与 RBC）。OBI HBV DNA 的 50%最小感染剂量估计为 1049（117-3441）拷贝。至少 99%的供体和受者株序列同源性证实了 10 例输血传播感染，1 例除外。
来自 OBI 供体的血液制品具有通过输血传播 HBV 的高风险。这种风险取决于抗-HBs 和病毒剂量的存在。这可能证明了根据流行病学情况进行抗-HBc 和 HBV 核酸检测筛查等安全措施是合理的。
