Transmissibility of Hepatitis B Virus (HBV) Infection through Blood Transfusion from Blood Donors with Occult HBV Infection

• Published in: Clinical infectious diseases Vol. 52; no. 5; pp. 624 - 632
• Main Authors: Yuen, Man-Fung, Wong, Danny Ka-Ho, Lee, Cheuk-Kwong, Tanaka, Yasuhito, Allain, Jean-Pierre, Fung, James, Leung, Jennifer, Lin, Che-Kit, Sugiyama, Masaya, Sugauchi, Fuminaka, Mizokami, Masashi, Lai, Ching-Lung
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2011
• Subjects: Adolescent; Adult; Animals; ARTICLES AND COMMENTARIES; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Blood; Blood & organ donations; Blood - virology; Blood donation; Blood Donors; Blood transfusion; Blood transfusions; Deoxyribonucleic acid; Disease Models, Animal; Disease transmission; DNA; DNA, Viral - genetics; DNA, Viral - isolation & purification; Female; Genotypes; Hepatitis; Hepatitis antigens; Hepatitis B; Hepatitis B - transmission; Hepatitis B virus; Hepatitis B virus - classification; Hepatitis B virus - genetics; Hepatitis B virus - isolation & purification; Human bacterial diseases; Human viral diseases; Humans; Infections; Infectious diseases; Liver; Liver - virology; Male; Medical sciences; Mice; Middle Aged; Phylogenetics; Phylogeny; Risk Assessment; Risk factors; Rodents; Sequence Analysis, DNA; Transfusion Reaction; Viral diseases; Viral hepatitis; Young Adult; Transfusion; Orthohepadnavirus; Hepatic disease; Bacteremia; Infection; Virus; Viral hepatitis B; Hepadnaviridae; Viral disease; Bacteriosis; Digestive diseases; Hepatitis B virus; Blood donor
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/ciq247

Background. 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. Methods. 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. Results. Serum HBV DNA was detectable (10⁴ 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. Conclusions. 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.