Screening for hepatitis B virus markers is not justified in West African transfusion centres.

62 severely anaemic Gambian children who were transfused with whole blood not screened for hepatitis B surface antigen (HBsAg) were followed for evidence of hepatitis B virus (HBV) infection over six months. 89% of donors and 44% of recipients before their transfusion had at least one HBV marker. Of the 54 recipient children surviving for the follow-up period, only 1 had a transient rise in liver enzymes. In 13 (37%) of 35 previously uninfected children HBV infection developed within twelve weeks of transfusion. Only 1 of these 13 children followed up at one year had become a persistent HBsAg carrier. The rate at which this cohort acquired persistent HBV infection or clinically important hepatitis was no greater than that in a cohort of similarly aged, nontransfused, children not admitted to hospital. In sub-Saharan Black Africa, where 15% of children have persistent HBV infection by the age of 10 years, HBV screening programmes in transfusion centres cannot at present be justified.