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mong bloood donors in

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Available online at w

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Journal Scan

Occult hepatitis B infections among blood donors inLao PDR

R.N. Makroo a,*, Vikas Hegde b, Aakanksha Bhatia c

aDirector, Senior Consultant, Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar,

New Delhi, IndiabDNB Resident, Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi,

IndiacSr. Registrar, Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi,

India

a r t i c l e i n f o

Article history:

Received 16 April 2014

Accepted 21 April 2014

Available online 3 June 2014

Occult hepatitis B infections among b

Samountry K, Thammavong T, Keokham

1111/vox.12073. Epub 2013 Aug 12.

Abstract

Background and objectives: In Lao Peo

nations are only screened for HBsAg, l

characterized first-time blood donors to

Materials and methods: Sera were scre

infections (OBIs) were assessed in HBsA

phylogenetically characterized.

Results: 9.6% of the donors were HBsA

markers. More than 40% HBsAg carriers

Furthermore, 10$9% of HBsAg-negative

virus. Thus, at least 3.9% of blood dona

varied between donors.

Conclusion: In Lao People’s Democrati

blood donations are potentially DNA po

* Corresponding author.E-mail address: makroo@apollohospitals

http://dx.doi.org/10.1016/j.apme.2014.04.0010976-0016

lood donors in Lao PDR. Jutavijittum P, Andernach IE, Yousukh A, Samountry B,

phue J, ToriyamaK, Muller CP.Vox Sang. 2014 Jan;106(1):31e37. http://dx.doi.org/10.

ple’s Democratic Republic, hepatitis B virus is highly endemic. However, blood do-

eaving a risk of transmission by HBsAg-negative occult infected donors. Here, we

assess prevalence of hepatitis B virus infections and occult infected donors.

ened for HBsAg, HBeAg and anti-HBs, anti-HBc and anti-HBe antibodies. Occult HBV

g-negative sera by PCR, and sera of HBsAg positive and occult infected donors were

g positive, and 45.5% were positive for at least one of the hepatitis B virus serum

were HBeAg positive, with HBeAg seroconversion occurring around 30 years of age.

, anti-HBc and/or anti-HBs-positive donors were occult infected with hepatitis B

tions would potentially be unsafe, but hepatitis B virus DNA copy numbers greatly

c Republic, a sizable proportion of HBsAg-negative and anti-HBc antibody-positive

sitive and infective for hepatitis B.

.com (R.N. Makroo).

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Comments

Occult hepatitis B infection (OBI) is defined as, the presence of

HBV DNA in the individual with HBsAg being below the

detectable limits. Such individuals can be seropositive or

seronegative depending on whether anti-HBsAg antibody is

present or absent in the individual respectively. They may

have anti-HBc antibody present or absent in them. The rele-

vance of screening for anti-HBc antibody has been debated

contrastingly by different authors. In the western part of the

world where HBV is in low prevalence(<2%) the presence of

anti-HBc antibody prompts the discarding of the particular

unit of blood. In highly HBV endemic countries the prevalence

of anti-HBc antibody can be found in up to 40% of the in-

dividuals. The discarding of such a high proportion of units

can’t be afforded by these countries.

The authors in this study have noted that 10.9% of HBsAg-

negative, anti-HBc and/or anti-HBs-positive donors were

occult infected with hepatitis B virus which can be potentially

dangerous if transfused to the patients. They opine that NAT

testing can be a good strategy to exclude this infective blood

from being transfused. However, the question of doing away

with anti-HBc antibody screening remains unanswered.

Our experience is different from the above article. In our

study, 10.22% (9638/94,247) were positive for anti-HBc, of

which, 9.19% (8660/94,247) of donors were positive for anti-

HBc and negative for HBsAg and only 0.15% of anti-HBc posi-

tive and HBsAg-negative donors showed the presence of HBV

DNA in their sera. Majority i.e. 99.85% of these donors were

anti-HBc positive and negative for HBsAg and HBV DNA.

In countries where there is high prevalence of HBV infec-

tion screening for anti-HBc antibody can cause discarding of a

large proportion of units. Though it is said to cover the second

window period (i.e. around 150e180 days after infection when

both HBsAg and HBV DNA falls to minimum levels) its use-

fulness in detecting OBI is questionable. NAT is very useful in

detecting the OBI. Risk-benefit ratio of doing away with anti-

HBc ab screening and implementation of NAT should be

individualized by countries according to their prevalence of

infection and their resources.

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