High Frequency Occult Hepatitis B Virus Infection Detected in Non-Resolved Donations Suggests the Requirement of Anti-HBc Test in Blood Donors in Southern China

Xianlin Ye; Yu Zhao; Ran Li; Tong Li; Xin Zheng; Wen Xiong; Jinfeng Zeng; Min Xu; Limin Chen

doi:10.3389/fimmu.2021.699217

High Frequency Occult Hepatitis B Virus Infection Detected in Non-Resolved Donations Suggests the Requirement of Anti-HBc Test in Blood Donors in Southern China

Front Immunol. 2021 Jul 28:12:699217. doi: 10.3389/fimmu.2021.699217. eCollection 2021.

Authors

Xianlin Ye¹, Yu Zhao¹, Ran Li¹, Tong Li¹, Xin Zheng¹, Wen Xiong¹, Jinfeng Zeng¹, Min Xu², Limin Chen^{2

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Affiliations

¹ Department of Laboratory, Shenzhen Blood Center, Shenzhen, China.
² Provincial Key Laboratory for Transfusion-Transmitted Infectious Diseases, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Chengdu, China.
³ The Joint Laboratory on Transfusion-Transmitted Diseases (TTD) Between Institute of Blood Transfusion, Nanning Blood Center, Chinese Academy of Medical Sciences and Nanning Blood Center, Nanning, China.
⁴ Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada.

Abstract

Background: Most Chinese Blood Centers adopted mini pool (MP) nucleic acid testing (NAT) for HBV screening due to high cost of Individual donation (ID) NAT, and different proportions of MP-reactive but ID-non-reactive donations (MP+/ID-, defined as non-resolved donations) have been observed during daily donor screening process. Some of these non-resolved donations are occult HBV infections (OBIs), which pose potential risk of HBV transmission if they are not deferred. This study is aimed to further analyze these non-resolved donations.

Methods: The non-resolved plasma samples were further analyzed by serological tests and various HBV DNA amplification assays including quantitative PCR (qPCR) and nested PCR amplifying the basic core and pre-core promoter regions (BCP/PC; 295 base pairs) and HBsAg (S) region (496 base pairs). Molecular characterizations of HBV DNA+ non-resolved samples were determined by sequencing analysis.

Results: Of 17,226 MPs from 103,356 seronegative blood donations, 98 MPs were detected reactive for HBV. Fifty-six out of these 98 (57.1%) reactive MPs were resolved as HBV DNA+, but the remaining 42 pools (42.9%, 252 donations) were left non-resolved with a high rate (53.2%) of anti-HBc+. Surprisingly, among 42 non-resolved MPs, 17 contained one donation identified as OBIs by alternative NAT assays. Sequence analysis on HBV DNAs extracted from these OBI donations showed some key mutations in the S region that may lead to failure in HBsAg detection and vaccine escape.

Conclusion: A total of 53.2% of the non-resolved donations were anti-HBc+, and OBIs were identified in 40.5% of these non-resolved pools. Therefore, non-resolved donations with anti-HBc+ might pose potential risk for HBV transmission. Our present analysis indicates that anti-HBc testing in non-resolved donations should be used to identify OBIs in order to further increase blood safety in China.

Keywords: anti-HBc; blood safety; minipool; nucleic acid testing; occult hepatitis B infection.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Blood Donors*
China
DNA, Viral / analysis*
Donor Selection / methods*
Female
Hepatitis B Core Antigens / analysis*
Hepatitis B virus
Hepatitis B* / diagnosis
Hepatitis B* / epidemiology
Humans
Male
Middle Aged
Nucleic Acid Amplification Techniques / methods
Young Adult

Substances

DNA, Viral
Hepatitis B Core Antigens