Hepatitis-Associated Markers in the American Red Cross Volunteer Blood Donor Population

Abstract. The present study was undertaken to determine whether there were any differences in the distribution of hepatitis B virus-(HBV) associated serologic markers among hepatitis B surface antigen-(HBsAg) positive first-time and repeat blood donors. The markers examined in samples from 412 newly identified HBsAg-positive donors (254 first-time and 158 repeat) included HBsAg titer and subtype, HBeAgIanti-HBe, and anti-HBc. Repeat donors were more frequently HBeAg-positive (25.9%) than were first-time donors (17.7%). Anti-HBc and anti-HBe were observed more often among first-time (99.6 and 76%) than repeat (91.8 and 60.8%) donors. No differences were found in the mean HBsAg titer nor in the subtype distribution in the two populations. The frequency of HBeAg positivity and the mean HBsAg titer in blood were significantly lower among first-time donors aged 30 or older as compared to those younger than 30. Such age-related tendencies did not occur among the repeat donors. The profiles of HBV markers suggest that the HBsAg-positive first-time donor group consists predominantly of long-term HBsAg carriers who may have acquired HBV at an early age, while the HBsAg-positive repeat donors have newly acquired infections.     

Seroprevalence of hepatitis B and C virus infections among Lao blood donors

There have been no previous reports of the prevalence of hepatatis B virus (HBV) and hepatitis C virus (HCV) infections in Lao PDR. From 2003 to 2005, 13,897 first-time blood donors were screened for the presence of hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV). The seroprevalence of HBsAg positive blood donors was 8.7%. The prevalence among males (9.7%) was higher than in females (6.2%). The prevalence of anti-HCV positive blood donors was 1.1%, with no significant differences between males (1.1%) and females (1.0%). Annual positive rates for HBsAg and anti-HCV during the years 2003 to 2005 did not differ significantly. Lao PDR has a high endemicity of HBV carriers (8.7%). Dual infection with HBV and HCV was 0.12%. For preventing HBV infection, the country introduced DPT-Hepatitis B vaccines into the National Immunization Program in 2001. The large reservoir of HBV and HCV infections will cause an enormous burden of patients with cirrhosis and hepatocellular carcinoma in the future.     

Follow-Up of Blood Donors Positive for Hepatitis B Surface Antigen

From 1973 to 1977 in Amsterdam the incidence of hepatitis B surface antigen (HBsAg) in blood donations from new donors was 0.224 and from known donors 0.034%. 65 donors, previously found positive for HBsAg, were re-examined. Persistence of HBsAg in new donors (28 of 31) occurred significantly (p less than 0.0005) more often than in known donors (15 of 34). All carriers were classified into HBeAg (21%) or anti-HBe (79%) by a sensitive Elisa technique. Abnormal liver function tests (LFTs) were observed in 30% of the carriers and were significantly (p less than 0.005) more often found in HBeAg than in anti-HBe-positive carriers. When the LFTs remained abnormal, in almost all (8 of 9) carriers moderate to severe histological liver disease was diagnosed.     

Hepatitis-Associated Markers in the American Red Cross Volunteer Blood Donor Population

Abstract: From January 1975 to December 1978, 19,140,169 units of blood were collected by the American Red Cross at 57 regional locations. Each unit was tested for hepatitis B surface antigen (HBsAg) by a single commercial radioimmunoassay test system. A total of 15,954 donations were reported reactive, representing a rate of HBsAg reactivity of 0.83/ 1,000 units tested. The rate during 1975 was 0.94/1,000 units tested, decreasing to 0.71/1,000 units tested in 1978 (p<0.005). The prevalence of HBsAg among first-time donors was 2.08/ 1,000 during 1977 and 1978, 2.7 times higher than that calculated for repeat donors (0.77/ 1,000 donors). Substantial geographic variation in the prevalence and rate of detection of HBsAg was observed.     

Prevalence of hepatitis B and C markers in volunteer blood donors in Crete. A 5-year study

Greece is a country with an intermediate prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Crete, the third-largest island of the Mediterranean sea, has a different prevalence of viral hepatitis. One-eighth of the total island population, of 550000, was included in a 5-year study of blood donors from three out of four blood banks, serving three out of four prefectures of the island. Markers for HBV and HCV were studied and evaluated according to geographical area, gender and age of donor. A total of 65219 blood donors were studied. A greater number of males than females were hepatitis B surface antigen (HBsAg) positive (0.41% vs 0.28%, respectively) with a peak at a younger age for males and older age for females. Males are more frequently exposed to HBV and become carriers more often than females. For HCV, an opposite gender trend was found, females being infected more frequently (0.49%) than males (0.37%). Statistical differences were found among geographical areas of the island. Hence, Crete is an area of low endemicity for HBsAg in blood donors. The HCV infectivity is more similar to Northern Europe than to other neighbouring countries. Differences in geographical distribution within the island and during different years indicate the need for extended epidemiological surveys for valid results.     

Intrafamilial spread of hepatitis B virus infection in Greece

OBJECTIVE: No study has investigated the intrafamilial spread of hepatitis B virus (HBV) in Greece. We conducted a 9-year prospective study to determine the rate of HBV spread in family members when a member is identified as an HBV carrier, the possible routes and risk factors for transmission of HBV and the family members with the highest risk of infection according to kinship degrees. METHODS: A total of 387 family members of 166 hepatitis B surface antigen (HBsAg) carriers were investigated for the detection of HBV infection markers using standard enzyme immunoassays; 6.696 blood donors from the same area were used as controls. RESULTS: Serological markers of past or current HBV infection were detected significantly more frequently among family members of HBsAg carriers (23.2 and 15.8%, respectively) compared with blood donors (14.1 and 0.85%, respectively). The prevalence of the above markers was higher among siblings, husbands and parents of the carriers. Offspring of the female index cases had higher rates of current or past infection. HBV infection markers were significantly increased in family members who reported common use of syringes (P<0.001), birth in rural areas (P<0.001) and a low level of education (P<0.001). CONCLUSIONS: We demonstrated a high risk of HBV transmission among family members of HBsAg carriers, which was associated with special risk factors for contracting HBV. Our findings indicate the need for strict adherence to the universal guidelines of vaccination against HBV and also the need for an immediate investigation of other potentially infected relatives among family members of HBsAg carriers.     

Concomitant carriage of hepatitis B virus and human T-lymphotropic virus type I among blood donors in Kitakyushu, Japan

The seroprevalence of hepatitis B surface antigen (HBsAg) by gender and age and of human T-lymphotropic virus type I (HTLV-I), and their concomitant carriage was examined among blood donors at the Kitakyushu Red Cross Blood Centre in the fiscal year of 1988. The positive rates of HBsAg among males were consistently higher than those of females; the peaks were detected in male donors aged 30-39 years and in females aged 40-49 years. Declining seropositive rates in individuals aged 50 years or over were observed for both genders. Self-selection due to chronic HBV infection may partly account for such tendencies. On the other hand, the prevalence rates of anti-HTLV-I antibodies among males were uniformly lower than those of females, which must be attributable to male-to-female transmission of HTLV-I via sexual contact. Elevated positive rates in proportion to age were noted for both genders, which may be explained in part by birth cohort effect. The seropositive rates of HBsAg among HTLV-1 carriers were not statistically different from those of non-HTLV-I carriers. Conversely, the prevalence of antibodies to HTLV-I was unrelated to the status of seropositivity of HBsAg.     

Persistence of HBsAg, HBeAg and Anti-HBe in Healthy Blood Donors

Abstract. The persistence of hepatitis B surface antigen (HBsAg), e antigen (HBeAg) and antibodies to e antigen (anti-HBe) was studied retrospectively in 197 Finnish voluntary blood donors, who had been found positive for HBsAg by routine screening in 1970 or 1971. Two samples were available from each donor: the first was taken in 1970 or 1971 and the second in 1978; the average interval between the specimens was 7.6 years. All except one (99.5%) of the donors remained HBsAg carriers during the whole study period. HBeAg was detected initially in 3 (2%) cases, all of whom lost HBeAg after the follow-up, and 2 converted to anti-HBe-positive. Anti-HBe was found in the first samples of 158 (80%) HBsAg carriers, 154 (97%) of whom were still positive for anti-HBe in the second samples. These results suggest that the HBsAg carrier stage is stable as for the presence of HBsAg and anti-HBe.     

Hepatitis B virus markers in the population of Dar es Salaam, Tanzania

A total of 542 serum samples from healthy adults (medical students and medical staff, blood donors and pregnant women) residing in or near the city of Dar es Salaam, Tanzania were examined for markers of hepatitis B virus (HBV) infection. Of these samples, 95 (17.5%) were not found to contain any HBV marker when examined by enzyme-linked immunoassay for hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs) and antibody to hepatitis B core antigen (anti-HBc). HBsAg was demonstrated in 52 (9.6%) samples of which 7 (13.5%) were positive for hepatitis Be antigen (HBeAg) and 17 (32.7%) were positive for anti-HBc IgM. None of 9 HBsAg positive pregnant women were carriers of HBeAg. These results show that hepatitis B infection is very common in this country. The relatively low prevalence of HBeAg among HBsAg carriers may indicate that transmission of hepatitis B at birth is not of major importance.     

Prevalence of hepatitis B surface and e antigens, risk factors for viral acquisition and serum transaminase among blood donors in Ibadan, Nigeria.

The objective of this study was to determine the prevalence of hepatitis B e antigen (HBeAg) in blood donors with hepatitis B surface antigen (HBsAg), and alaninine transaminases (ALT) levels and possible risk factors for the transmission of hepatitis B virus (HBV). Over a 6-month period, consecutive blood donors were screened for HBsAg, HBeAg, ALT and risk factors for HBV transmission. One hundred seventy-five adults (158 males, 17 females) were screened. Thirty-seven (21.3%) were HBsAg positive, 4 (2.3%) were HBeAg Positive and 17 (9.7%) had a raised ALT level, which ranged between 42-126 IU/L. All the HBeAg-positive subjects had raised ALT levels. The main risk factors among others, were scarification and indiscriminate injections. Twenty of the 37 HBsAg-positive subjects (54%) had no identifiable risk factor. The present study revealed that, HBeAg positivity among HBsAg positive blood donors was infrequent and whenever present was associated with active liver disease indicated by raised ALT value.     

Seroprevalence and risk factors for hepatitis B virus infection among general population in Northern India

BACKGROUND: Infection with hepatitis-B virus has been a significant cause of morbidity claiming more than a million lives every year. Epidemiological data reveals that there are 360 million carriers of hepatitis-B virus throughout the globe and 78% of the world populations' hail from Asia. Though several studies from Indian sub-continent have provided an estimate of the prevalence of this viral infection, there exist only few studies, which reflect the status in the general population. AIM: The present study was designed to investigate the prevalence of hepatitis-B infection in North Indian general population. METHODS: The study population comprised of 20,000 healthy blood donors who were screened for hepatitis-B surface antigen (HBsAg) status using third generation ELISA kit. Seroprevalence rate of seropositive donors was calculated and stratified by age, sex and blood groups. Statistical analysis was performed using tests of proportions, chi-square and confidence interval. RESULTS: The study showed that out of 20,000 donors, 450 (2.25%) were HBsAg positive (95% confidence interval (CI), 2.0445-2.4554). Higher prevalence of HbsAg was found among males (440/19235) than females (10/765). The age specific prevalence rose from 1.78% (108/6058) in donors aged 19-25 years to a maximum of 3.03% (96/3161) in donors aged 35-45 years and decreased in older age groups. The peaks were detected in male donors aged 35-45 years and in females aged 25-35 years. Rh-negative blood group donors (21/873) and Rh-positive group donors (429/19127) had almost equivalent prevalence rates of HBsAg. HBsAg was more prevalent in blood group B donors (174/7426) and less prevalent in AB blood group donors (38/2032). CONCLUSION: It was found that variables including gender and age were significantly associated with HBsAg positivity. HBsAg positivity in our population was statistically not associated with ABO blood groups.     

Genotype screening for hereditary hemochromatosis among voluntary blood donors in Hungary

Hereditary hemochromatosis (HH) is a common genetic disorder. Although it is inherited in an autosomal recessive manner, heterozygous individuals are believed to be protected against iron deficiency. Screening to estimate the prevalence of HH was frequently performed among blood donors, not considering that carriers of the HH gene mutations may be present in higher proportion in this population. To examine the allele frequencies of the HH gene (HFE) point mutations, C282Y and H63D genotyping was carried out in 996 consecutive, first-time, and regular Hungarian blood donors by PCR-RFLP techniques. Iron parameters of the first-time donors and the identified C282Y heterozygotes and age, gender, and number of previous blood donation-matched wild-type donors were also determined. We were not able to demonstrate a significant increase in the frequency of C282Y and H63D alleles among regular blood donors, compared to first-time blood donors. However, there was a trend of higher C282Y allele frequency among women with higher number of previous blood donations (2.2 +/- 1.5% in female blood donors with 0-8 previous blood donations compared to 4.8 +/- 2.3% in women with more than 8 previous blood donations, P = 0.06). No detectable phenotypic differences were observed in serum iron, ferritin, and transferrin saturation values between C282Y wild-type and heterozygous groups. However, the single identified C282Y homozygous male (age 21) showed definite signs of iron overload. Our observations suggest that the protective effect of C282Y heterozygosity against iron deficiency may be less significant than other environmental (e.g., iron-rich diet) or genetic factors.     

Significant increase in HBV, HCV, HIV and syphilis infections among blood donors in West Bengal, Eastern India 2004-2005： Exploratory screening reveals high frequency of occult HBV infection

AIM： To evaluate the prevalence of markers of hepatitis B virus （HBV） and hepatitis C virus （HCV） and human immunodeficiency virus （HIV） among blood donors in Kolkata, Eastern India for two consecutive years and to conduct a pilot study to explore the presence of HBV DNA among hepatitis B surface antigen （HBsAg） negative but anti-HBc positive blood donors.
METHODS： Seroprevalence of HBsAg, anti-HCV and anti-HIV was studied among 113051 and 106695 voluntary blood donors screened in 2004 and 2005, respectively. Moreover, a pilot study on 1027 HBsAg negative donors was carried out for evaluating the presence of HBV DNA by PCR on HBsAg negative/anti- HBc positive donors.
RESULTS： A statistically significant increase in the prevalence of HBV （1448 vs 1768, P 〈 0.001）, HIV （262 vs 374, P 〈 0.001）, HCV （314 vs 372, P = 0.003） and syphilis （772 vs 853, P = 0.001） infections was noted among blood donors of Kolkata West Bengal in 2005 as compared to 2004. Moreover, the exploratory study on 1027 HBsAg negative donors revealed that 188 （18.3%）of them were anti-HBc positive out of which 21% were positive for HBV DNA.
CONCLUSION： The findings of this study underscore the significantly increasing endemicity of hepatitis viruses, syphilis and HIV among the voluntary blood donors of our community. The pilot study indicates a high rate of prevalence of HBV DNA among HBsAg negative/anti-HBc positive donors and thus emphasizes the need for a more sensitive and stringent screening algorithm for blood donations.     

Prevalence of HIV-positives and hepatitis B surface antigen-positives among donors in the University of Benin Teaching Hospital, Nigeria

The purpose of this study is to determine the rate of human immunodeficiency virus (HIV) and hepatitis B surface antigen (HBsAg) among commercial blood donors in the University of Benin Teaching Hospital. Five thousand seven hundred and thirty-seven prospective commercial blood donors were screened for both HIVand HBsAg. Three hundred and eighty-three (7%) donors were positive for HIV while 609 donors (11%) were positive for HBsAg. Thirty-seven donors were positive for both HIV and HBsAg. The need to make the screening of blood donors for HIV and HBsAg compulsory in all hospitals is crucial so that the spread of HIV and HBsAg can be prevented.     

Blood donor screening: how to decrease the risk of transfusion-transmitted hepatitis B virus?

QUESTIONS UNDER STUDY: The risk of transfusion-transmitted HBV remains significant in Switzerland, where routine screening for hepatitis B virus (HBV) in blood donations relies solely on serological hepatitis B surface antigen (HBsAg) testing. This study was designed to determine the prevalence of anti-hepatitis B core (anti-HBc) and HBV nucleic acid testing (NAT) positive donations in two different Swiss donor populations, to help in deciding whether supplemental testing may bring additional safety to blood products. METHODS: In a first population of donors, 18143 consecutive donations were screened initially for HBsAg, anti-HBc (with one EIA assay) and with HBV NAT in minipools of 24 donations. The screening repeatedly reactive anti-HBc donations were then "confirmed" with two supplemental anti-HBc assays, an anti-hepatitis B surface assay (anti-HBs) and with single donation HBV NAT. In a second population of donors, 4186 consecutive donations were screened initially with two different anti-HBc assays in addition to the mandatory HBsAg screening test. The screening repeatedly reactive donations with at least one anti-HBc assay were tested for anti-HBs. RESULTS: In the first subset of 18143 donations, 17593 (97.0%) were negative for HBsAg, anti-HBc and HBV NAT in minipools. 549 (3.0%) were HBsAg and HBV NAT negative, but repeatedly reactive for anti-HBc. Of these 549 donations, 287 could not be "confirmed" with two additional anti-HBc assays and were negative with an anti-HBs assay, as well as with single donation HBV NAT. Only 211 (1.2% of the total screened donations) were "confirmed" positive with at least one of two supplemental anti-HBc assays. One repeatedly reactive HBsAg donation, from a first-time donor, was confirmed positive for HBsAg and anti-HBc, as well as with single donation HBV NAT. In the second subset of 4186 donations, 4014 (95.9%) were screened negative for HBsAg and for anti-HBc, tested with two independent anti-HBc assays. 172 donations (4.1%) were HBsAg negative but repeatedly reactive with at least one of the two anti-HBc assays. Of these 172 samples, 86 were reactive with the first anti-HBc assay only, 13 were reactive with the second anti-HBc assay only and 73 (1.7% of the total screened donations) were "confirmed" positive with both anti-HBc assays. CONCLUSION: The prevalence of anti-HBc "confirmed" positive donations in the two Swiss blood donor populations studied was low (<2%) and we found only one HBV NAT positive (HBsAg positive) donation among more than 18000. Concerning blood product safety, an increase in the deferral rate of less than 2% of anti-HBc positive, potentially infectious donors, would in our opinion make routine anti-HBc testing of blood donations cost-effective. There is however still a need for more specific assays to avoid an unacceptably high deferral rate of "false" positive donors. In contrast, the introduction of HBV NAT in minipools gives minimal benefit due to the inadequate sensitivity of the assay. It remains to evaluate more extensively the value of individual donation NAT, alone or in addition to anti-HBc, as supplemental testing in the context of several Swiss blood donor populations.     

Relationship of HBsAg Subtypes with HBeAg/anti-HBe Status and Chronic Liver Disease. Part I: Analysis of 1744 HBsAg Carriers

A total of 1744 HBsAg carriers were investigated to determine whether there are clinical differences among HBsAg subtypes or not. Although adr was more predominant than adw in 1078 asymptomatic carriers as well as in 666 carriers with liver dysfunction, the adr carriers had liver dysfunction more frequently than the adw carriers (p = 0.005). In addition, the adr carriers were more often positive for HBeAg and less often positive for anti-HBe than the adw carriers (p less than 0.001). Multivariate analyses indicated that the HBsAg subtypes were associated with liver dysfunction not directly but through the relationship between the HBsAg subtypes and HBeAg/anti-HBe status. HBeAg/anti-HBe status of each age bracket in the adr carriers and in the adw carriers suggested that adr carriers are seroconverted later than adw carriers. In conclusion, HBsAg subtypes may affect the development of chronic liver disease, through their association with HBeAg/anti-HBe status.     

Ethnic differences in the prevalence of anti-hepatitis C antibodies and hepatitis B surface antigen in Israeli blood donors by age, sex, country of birth and origin

Summary. The presence of anti-hepatitis C virus (HCV) antibodies frequently indicates both persistent infection and infectivity. Consequently, blood donors found to be anti-HCV positive, are excluded from the donor pool. The aim of this study was to compare age, sex and ethnic differences in the prevalence of anti-HCV antibodies with that of hepatitis B surface antigen (HBsAg) among immigrant and Israeli-born blood donors. Anti-HCV antibodies were assayed by a second-generation enzyme-immunoassay (EIA) and HBsAg by a standard EIA in a sample of 136 977 blood donors in Israel during 1992. The overall age-adjusted prevalence of anti-HCV antibodies was 0.66% in men and 0.55% in women, and for HBsAg, 0.85% and 0.44%, respectively. There was a significant increase in the prevalence of anti-HCV antibody with age, and significant differences by country of birth, with the highest prevalence found among those born in the former USSR and eastern Europe. This contrasted with the findings for the prevalence of HBsAg, where the highest rates were among those born in northern Africa. Among Israeli-born donors, differences in the prevalence of anti-HCV antibodies by parental country of origin were minimal and much less than for HBsAg. Hence the prevalence of anti-HCV antibodies in Israel is strongly associated with age and country of birth but not with country of origin. There is little evidence of substantial vertical or intra familial transmission of HCV infection in Israel.     

Anti-HBe and Subtypes of HBsAg among Asymptomatic HBsAg Carriers

Finnish HBsAg positive blood donors were analyzed for the HBsAg subtype distribution and the presence of e antigen (HBeAg) and antibody to e (anti-HBe). 88% (159 of 180) of the donors had subtype and ad and 12% (21 of 180) had ay. HBeAg was found in 1% (2 of 180) and anti-HBe in 74% (133 of 180) of the donors. Anti-HBe was significantly (p less than 0.0001) more common among donors with subtype ad than with ay: 80 and 29% respectively. The mean age of donors with both subtype ad and anti-HBe was significantly (p less than 0.001) lower than that of the other donor categories.     

The Prevalence of Hepatitis B Surface Antigen and Its Antibody in Blood Donors and High Risk Groups in Iran

The prevalence of HBsAg and anti-HBs among voluntary blood donors, professional blood donors, INBTS laboratory staff, haemophiliacs and the patients and medical personnel of three haemodialysis centres was compared. The 3.4% incidence of HBsAg found among 168,890 voluntary donors was significantly less than the 8.4% found among 378 professional blood donors. The prevalence of HBsAg was higher in male than in female donors, and also higher in single than in married donors. Prevalence of HBsAg was unrelated to ABO-Rh blood group but was related to age. Anti-HBs was found in 30% of voluntary blood donors, 67% of professional donors, 68% of haemodialysis patients, 39% of haemodialysis staff, 86% of haemophiliacs and in only 4.8% of HBsAg carriers. Subtyping of HBsAg found in 100 voluntary donors showed 65 were ay; 5 ad; 10 ad + ay and 20 were untypable.     

金标法初筛试剂与诊断试剂检测乙肝表面抗原的结果分析

目的:分析金标法初筛试剂与诊断试剂检测无偿献血者乙肝表面抗原的阳性率、假阳性率及假阴性率的结果。方法:金标法初筛试纸条检测68 326例,诊断试纸条检测55 637例,乙肝表面抗原初检阴性者与初检阳性者均用ELISA法做复检。结果:初筛试剂检测68 326例的HBsAg阳性率为5.96%、假阳性率5.8%、假阴性率2.84%,诊断试剂检测55 637例的阳性率为2.77%、假阳性率2.6%、假阴性率0.47%。结论:金标法初筛试剂检测无偿献血者乙肝表面抗原的阳性率、假阳性率及假阴性率均高于诊断试剂。