Nuffield Department of Medicine, University of Oxford, Oxford, UK.
School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia.
Transfusion. 2024 Nov;64(11):2144-2156. doi: 10.1111/trf.18018. Epub 2024 Oct 2.
Hepatitis B core antibody (anti-HBc) screening has been implemented in many blood establishments to help prevent transmission of hepatitis B virus (HBV), including from donors with occult HBV infection (OBI). We review HBV screening algorithms across blood establishments globally and their potential effectiveness in reducing transmission risk.
A questionnaire on HBV screening and follow-up strategies was distributed to members of the International Society of Blood Transfusion working party on transfusion-transmitted infectious diseases. Screening data from 2022 were assimilated and analyzed.
A total of 30 unique responses were received from 25 countries. Sixteen respondents screened all donations for anti-HBc, with 14 also screening all donations for HBV DNA. Anti-HBc prevalence was 0.42% in all blood donors and 1.19% in new donors in low-endemic countries; however, only 44% of respondents performed additional anti-HBc testing to exclude false reactivity. 0.68% of anti-HBc positive, HBsAg-negative donors had detectable HBV DNA. Ten respondents did universal HBV DNA screening without anti-HBc, whereas four respondents did not screen for either. Deferral strategies for anti-HBc positive donors were highly variable. One transfusion-transmission from an anti-HBc negative donor was reported.
Anti-HBc screening identifies donors with OBI but also results in the unnecessary deferral of a significant number of donors with resolved HBV infection and donors with false-reactive anti-HBc results. Whilst confirmation of anti-HBc results could be improved to reduce donor deferral, transmission risks associated with anti-HBc negative OBI donors must be considered. In high-endemic areas, highly sensitive HBV DNA testing is required to identify infectious donors.
乙型肝炎核心抗体（抗-HBc）筛查已在许多血液机构实施，以帮助预防乙型肝炎病毒（HBV）的传播，包括来自隐匿性 HBV 感染（OBI）的供体。我们审查了全球血液机构的 HBV 筛查算法及其在降低传播风险方面的潜在效果。
向国际输血协会传染病工作组的成员分发了一份关于 HBV 筛查和随访策略的问卷。综合分析了 2022 年的筛查数据。
共收到来自 25 个国家的 30 份独特的回复。16 名受访者对所有献血者进行抗-HBc 筛查，其中 14 名受访者还对所有献血者进行 HBV DNA 筛查。在低流行国家，所有献血者的抗-HBc 流行率为 0.42%，新献血者为 1.19%；然而，只有 44%的受访者进行了额外的抗-HBc 检测以排除假阳性反应。68%的抗-HBc 阳性、HBsAg 阴性供体可检测到 HBV DNA。10 名受访者进行了普遍的 HBV DNA 筛查而不进行抗-HBc 筛查，而 4 名受访者则两者都不筛查。对抗-HBc 阳性供体的延期策略差异很大。报告了一例由抗-HBc 阴性供体传播的输血传播事件。
抗-HBc 筛查可识别 OBI 供体，但也导致大量已解决的 HBV 感染供体和具有假阳性抗-HBc 结果的供体被不必要地延期。虽然可以通过确认抗-HBc 结果来减少供体延期，但必须考虑与抗-HBc 阴性 OBI 供体相关的传播风险。在高流行地区，需要进行高度敏感的 HBV DNA 检测以识别感染供体。
