Transmission of occult hepatitis B virus by transfusion to adult and pediatric recipients in Taiwan

Liu, Chun-Jen; Lo, Shyh-Chyi; Kao, Jia-Horng; Tseng, Ping-Tsung; Lai, Ming-Yang; Ni, Yen-Hsuan; Yeh, Shiou-Hwei; Chen, Pei-Jer; Chen, Ding-Shinn

doi:10.1016/j.jhep.2005.06.016

« Previous Next »Journal of Hepatology
Volume 44, Issue 1 , Pages 39-46, January 2006

Transmission of occult hepatitis B virus by transfusion to adult and pediatric recipients in Taiwan

Chun-Jen Liu
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Shyh-Chyi Lo
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Jia-Horng Kao
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 100, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Ping-Tsung Tseng
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Ming-Yang Lai
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 100, Taiwan
Yen-Hsuan Ni
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Shiou-Hwei Yeh
- Department of Microbiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Pei-Jer Chen
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 100, Taiwan
- Department of Medical Research, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Corresponding author. Address: Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 100, Taiwan. Tel.: 886 2 23123456x7072; fax: 886 2 23317624.
Ding-Shinn Chen
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 100, Taiwan

Received 22 March 2005; received in revised form 6 June 2005; accepted 17 June 2005. published online 13 July 2005.

Background/Aims

The infectivity of occult hepatitis B virus (HBV), defined as HBsAg-negative but HBV DNA-positive, after transfusion has been low but not negligible. To address this, we investigated the incidence of post-transfusion HBV infection after receiving screened blood units in Taiwan.

Methods

Consecutive HBV-naïve (anti-HBc-negative) recipients with normal ALT were followed for HBV DNA and serologic markers before and after transfusion. Among 4448 blood recipients, 467 (10.5%) were anti-HBc-negative. Post-transfusion 6-month follow-up was completed for 327. We identified 5 (1.5%) who developed hepatitis B viremia 1 week after transfusion. Three were children who later seroconverted to anti-HBc but with normal ALT indicating subclinical acute infection, despite all had anti-HBs from previous vaccination. One had transient transfusion-transmitted HBV without seroconversion to anti-HBc and one possibly had occult HBV infection. Our findings suggested the possibility that occult HBV infection was transmissible by transfusion. The incidence of post-transfusion acute HBV infection was 0.9% (100 per million units) in naïve recipients in Taiwan, a figure 7∼40-fold higher than in developed countries. Moreover, some vaccinated children with anti-HBs were still susceptible.

Conclusions

Therefore, despite active immunization, sensitive screening assays for occult HBV infection such as nucleic acid amplification test could be considered in endemic areas.

Keywords: Occult hepatitis B virus, transfusion, HBV DNA, anti-HBc

Abbreviations: ALT, alanine aminotransferase, Anti-HBc, antibody to hepatitis B core antigen, Anti-HBe, antibody to hepatitis B e antigen, Anti-HBs, antibody to hepatitis B surface antigen, HBe, hepatitis B e antigen, HBsAg, hepatitis B surface antigen, HBV, hepatitis B virus, NAT, nucleic acid amplification test, PCR, polymerase chain reaction