Infectivity of blood products from donors with occult hepatitis B virus infection

被引:157
作者
Allain, Jean-Pierre
Mihaljevic, Ivanka
Gonzalez-Fraile, Maria Isabel
Gubbe, Knut
Holm-Harritshoj, Lene
Garcia, Jose Maria
Brojer, Ewa
Erikstrup, Christian
Saniewski, Mona
Wernish, Lorenz
Bianco, Lydia
Ullum, Henrik
Candotti, Daniel
Lelie, Nico
Gerlich, Wolfram H.
Chudy, Michael
机构
[1] Univ Cambridge, Dept Haematol, Cambridge, England
[2] Croatian Inst Transfus Med, Zagreb, Croatia
[3] Ctr Hemoterapia Castilla & Leon, Valladolid, Spain
[4] German Red Cross, Inst Transfus Med, Plauen, Germany
[5] Rigshosp, Dept Clin Immunol, DK-2100 Copenhagen, Denmark
[6] Reg Blood Ctr, Oviedo, Spain
[7] Inst Hematol & Transfus Med, Warsaw, Poland
[8] Arhus Univ Hosp, Dept Clin Immunol, Aarhus, Denmark
[9] Univ Giessen, Inst Med Virol, D-35390 Giessen, Germany
[10] Inst Publ Hlth, MRC, Biostat Unit, Cambridge, England
[11] Natl Hlth Serv Blood & Transplant England, Cambridge, England
[12] Sci Affairs Consultant, Paris, France
[13] Paul Ehrlich Inst, Langen, Germany
关键词
HBV INFECTION; MOLECULAR CHARACTERIZATION; TRANSFUSION RECIPIENTS; LOOK-BACK; REACTIVATION; TRANSMISSION; CHEMOTHERAPY; POPULATION; COMPONENTS; DONATIONS;
D O I
10.1111/trf.12096
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundOccult hepatitis B virus (HBV) infection (OBI) is identified in 1:1000 to 1:50,000 European blood donations. This study intended to determine the infectivity of blood products from OBI donors. Study Design and MethodsRecipients of previous donations from OBI donors were investigated through lookback (systematic retrieval of recipients) or traceback (triggered by clinical cases). Serologic and genomic studies were undertaken on consenting donors and recipients. Multiple variables potentially affecting infectivity were examined. ResultsA total of 45 of 105 (42.9%) donor-recipients pairs carried antibodies to HBV core (anti-HBc) as evidence of previous HBV infection. Subtracting 15% of anti-HBc population background, the adjusted transmission rate was 28%. Anti-HBc prevalence increased to 28 of 44 (63.8%) in unvaccinated recipients receiving anti-HBs-negative OBI blood products. In contrast, four of 26 (15.4%) recipients of anti-HBs-positive products were anti-HBc positive. Transmission with anti-HBs-negative products depended on volume of plasma transfused (85%-100% with 200mL of fresh frozen plasma [FFP], 51% with 50mL in platelet concentrates [PCs], and 24% with 20mL in red blood cells [RBCs], p<0.0001 FFP vs. RBCs). The 50% minimum infectious dose of OBI HBV DNA was estimated at 1049 (117-3441) copies. Donor and recipient strains sequence homology of at least 99% confirmed transfusion-transmitted infection in 10 cases and excluded it in one case. ConclusionBlood products from donors with OBI carry a high risk of HBV transmission by transfusion. This risk is dependent on presence of anti-HBs and viral dose. This may justify safety measures such as anti-HBc and HBV nucleic acid test screening depending on epidemiology.
引用
收藏
页码:1405 / 1415
页数:11
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