Evidence of occult hepatitis B virus infection among Omani blood donors: a preliminary study

Prevalence and trends of transfusion transmissible infections among blood donors in Basra, Iraq

BACKGROUND

Despite saving millions of lives through blood transfusion, transfusion-transmissible infections (TTIs) still threaten the lives of patients requiring blood transfusion. Hence, screening blood donors and studying the prevalence of TTIs among blood donors may display the burden of these diseases among our population. The aim of this study was to assess the seroprevalence rates of transfusion transmitted infections among blood donors in Basra, Iraq from 2019 to 2021 as groundwork for providing safe blood transfusion in Iraq.

METHODS

A cross-sectional study was carried out in the blood banks in Basra, Iraq from 1 January 2019 to 31 December 2021. A total of 197 898 samples were collected and screened for hepatitis B surface antigen (HBsAg), anti-hepatitis B core (HBc), anti-hepatitis C virus (HCV) and syphilis immunologically.

RESULTS

The prevalence rates of seropositive of viral hepatitis for the year 2019, 2020, 2021 were as following: hepatitis B virus (HBV) rates 1.54%, 1.45% and 1.14% with significant declined trend by 26%; anti-HCV rates were 0.14, 0.12 and 0.11% with significant declined trend by 21.4%; and the syphilis rates were 0.38, 0.47, 0.36 with marked declined trend 5.3%, respectively.Of those donors showed HBV positive, 2503 (1.26%) had positive anti-HBc results, while only 173 (0.0874) showed positive test results for both anti-HBc and HBsAg.

CONCLUSION

Prevalence rates of viral hepatitis and syphilis showed a steady decline between 2019 and 2021, and these rates were much lower in Basra than in other parts of Iraq and neighbouring countries. The importance of using the anti-HBc test in the screening of blood donors was indicated in this study. These findings would contribute in improving the understanding of TTIs epidemiology and supporting health authorities controlling bloodborne diseases.

Prevalence of Hepatitis B Virus infection in the Gulf Cooperation Council: a systematic review and meta-analysis

Background

Hepatitis B virus (HBV) infection is a global public-health problem. Since the introduction of an effective vaccine, the epidemiology of HBV infection is changing. We aimed to estimate the prevalence of HBV infection in the Gulf Cooperation Council (GCC) region and delineate any variation in member-countries, special sub-groups, and over time.

Methods

This is a systematic review and meta-analysis to review studies of HBV prevalence in the GCC region. Databases were searched and all studies from inception to July 31st, 2021, were considered for inclusion. The pooled HBV prevalence was analyzed using the random-effect model after assessment for heterogeneity. True prevalence was adjusted using the Rogan-Gladen estimator. Pre-defined subgroup analysis was performed, and publication bias was assessed.

Results

Overall, 99 studies (n = 1,944,200 participants) met the inclusion criteria. The overall HBV apparent prevalence was 3.05% (95% CI 2.60, 3.52) and the true prevalence was 1.67% (95% CI 1.66, 1.68). The apparent prevalence varied between subgroups. Over time, the apparent prevalence of HBV infection has declined from 9.38% (95% CI 7.26, 11.74) before 1990 to 1.56% (95% CI 1.07, 2.12) during the period 2010 to 2020.

Conclusion

Over the last four decades the overall prevalence of HBV infection in the GCC region has decreased from high- to low-endemicity level. However, due to poor methodology of the included studies, further high-quality community-based studies are needed to obtain more precise estimate of HBV infection in this region.

Viral safety of recovered plasma for contract fractionation; an Iranian experience, 2006-2015

OBJECTIVE

The current study analysed the viral safety among Iranian blood donors.

BACKGROUND

Plasma products demand is increasing in the world. With contract plasma fractionation, the plasma wastage decreases and the access of patients to plasma-derived medicines (PDM) improves.

STUDY AND DESIGN METHOD

Screening results including hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), and human immunodeficiency virus (HIV) Ag/Ab of 19 054 036 donations from 2006 to 2015 were analysed. The plasma for fractionation was tested for HBV DNA, HCV RNA, HIV RNA, HAV RNA, and Parvovirus B19 DNA by fractionators. New samples were collected from the positive donors and retested. The prevalence of serological and nucleic acid testing (NAT) markers per 10⁵ donations, 95% confidential interval (CI), and p-values were calculated.

RESULTS

The prevalence of markers was as follows: 250/10⁵ donations for HBsAg from 516 in 2006 to 116/10⁵ donations in 2015; 74/10⁵ donations for HCV, decreasing from 127 to 41/10⁵ and 3.6/10⁵ for HIV during current study. During 10 years, 5 713 641 units of recovered plasma were shipped for contract fractionation to produce PDM; 0.26/10⁵ donations for HBV DNA and 0.14/10⁵ for HCV RNA were reported positive. The results of five retested samples for HBV and one sample for HCV were negative.

CONCLUSION

The prevalence of HBV, HCV, and HIV in blood donations was extremely low. Thanks to the availability, high quality and safety of recovered plasma as a result of the improvements in the quality system at IBTO, this plasma could be used for the production of PDMPs.

Prevalence of Hepatitis B Virus (HBV) Among Blood Donors in Eastern Saudi Arabia: Results From a Five-Year Retrospective Study of HBV Seromarkers

Background

Transfusion-transmissible hepatitis B virus (HBV) infection is a major problem worldwide. Recently, confirmatory nucleic acid tests (NATs) for HBV DNA have been employed in several countries. We assessed the prevalence and yearly trends of HBV infection in blood donors in the Eastern Province of Saudi Arabia, screening for HBV surface antigen (HBsAg), antibody against HBV core antigen (anti-HBc), and HBV DNA.

Methods

Between 2011 and 2015, a total of 22,842 donors were screenedfor HBsAg, anti-HBc, and HBV DNA using the HBsAg Qualitative II kit (Abbott, Ireland Diagnostics Division, Sligo, Ireland), ARCHITECT Anti-hepatitis B core antigen antibody (HBc) II Assay kit (Abbott GmbH & Co. KG, Wiesbaden, Germany), and NAT Procleix Ultrio Elite Assay kit (Grifols Diagnostic Solutions Inc., Los Angeles, CA, USA), respectively.

Results

A total of 739 (3.24%) donors were HbsAg(+), anti-HBc(+), or HBV DNA(+); 63 (0.28%) were HbsAg(+), anti-HBc(+), and HBV DNA(+). Twelve (0.05%) were anti-HBc(+) and HBV DNA(+) but HBsAg(−); they were considered to have occult infection. Further, 664 (2.91%) were HBsAg(−) but anti-HBc(+), indicating chronic or resolving infection. HBV prevalence increased significantly from 2011 to 2012, increased marginally till 2013, and showed a decreasing trend from 2013 (P>0.05).

Conclusions

The five-year prevalence of HBV infection among blood donors in the Eastern Province of Saudi Arabia (3.24%) is lower than that reported for other regions in the country. The occult HBV infection rate of 0.05% emphasizes the importance of NATs in isolating potential infectious blood units.

Epidemiological and Clinical Characteristics of HIV Infected Patients at a Tertiary Care Hospital in Oman

Objectives

In 2015, the Joint United Nations Program on HIV/AIDS (UNAIDS) set a target that 90% of all people living with HIV will know their HIV status, 90% of those diagnosed will receive antiretroviral therapy, and 90% of those receiving antiretroviral therapy will have viral suppression by 2020. We sought to elucidate the epidemiological and clinical characteristics of HIV infected patients at the Infectious Diseases Clinic at Royal Hospital, Oman, with a focus on the UNAIDS 90-90-90 achieved rates.

Methods

We conducted a retrospective analysis of the medical records of 326 HIV infected patients from 1989 to 2016. Data collected included demographics, Word Health Organization (WHO) staging, laboratory analyses, and treatment outcomes.

Results

The overall mean age of the cohort was 36.0±15.0 years, and 60.4% (n = 197) were males. The majority of patients acquired HIV through heterosexual transmission (58.9%; n = 192). At the time of the first clinic visit, 26.1% (n = 85) of patients had WHO stage 4 HIV infection. The rates of HIV/HBV and HIV/HCV coinfections were 2.7% and 5.8%, respectively. The baseline CD4+ cells count was < 200 cells/mm³ in 38.0% (n = 124) of patients, 201-500 cells/mm³ in 30.1% (n = 99) of patients, and > 500 cells/mm³ in 27.0% (n = 88) of patients. The baseline HIV RNA titer was greater than 1000 copies/mL³ in 74.5% (n = 243) of the cohort. A total of 96.3% (n = 314) of patients received antiretroviral therapy, most commonly non-nucleoside reverse transcriptase inhibitor-based regimens. HIV genotype resistance testing was performed in 165 patients (50.6%) either at baseline in treatment naïve patients or following treatment failure. Among the 326 patients included, 22 patients (6.7%) died, and 29 patients (8.9%) were lost to follow-up.

Conclusions

Regarding the UNAIDs 90-90-90 target, over a quarter of the patients presented late with WHO stage 4 HIV disease, 96.3% of cohort patients received antiretroviral treatment, and 71.5% achieved virological suppression.

Impact of "a" determinant mutations on detection of hepatitis B surface antigen (HBsAg) in HBV strains from Chinese patients with occult hepatitis B

This study was designed to detect mutations that occur within the "a" determinant in the S gene of the hepatitis B virus (HBV) in patients with occult hepatitis B (OHB), and to analyze the influence of these mutations on expression and reactivity of the hepatitis B surface antigen (HBsAg). Twenty-three certified OHB samples were compared to 32 HBsAg positive samples from patients with chronic hepatitis B. The median HBV DNA levels in the OHB group were significantly lower than those in the control group (P < 0.0001). Mutations within the "a" determinant were analyzed by gene amplification and sequencing. This revealed mixed infections in which clones within a sample displayed either different mutations or mutations in association with clones that exhibited wild type amino acid patterns. Sequencing analysis also showed a significant difference between the proportions of amino acid mutations observed in the OHB and control groups. Seven recombinant S (rS) proteins with corresponding OHB mutations and three wild type alleles were expressed and purified in the Pichia pastoris expression system to preserve conformational attributes, and their reactivity analyzed using six commercial HBsAg assays. The OHB sera were HBsAg nonreactive while the rS proteins with corresponding OHB mutations were universally reactive. Thus, we postulate that the reduced binding affinity between mutated HBsAg and its antibody may not be as important in defining OHB as is the effect of specific mutations in the preS/S region of the genome that affect the synthesis and secretion of the S protein and/or the virion.

Prevalence of hepatitis B seromarkers and hepatitis C antibodies in blood donors in Basra, Iraq

BACKGROUND

Transfusion-caused hepatitis remains a major problem in Iraq. Therefore, testing for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc) and antibodies to hepatitis C antigen (anti-HCV) is a very important preventative measure. The objective of this study was to establish the prevalence of hepatitis B and C virus seromarkers among blood donors as a foundation for safe blood transfusion in Iraq.

METHODS

A cross-sectional observational study was conducted in the blood banks in Basra, Iraq from 1 January to 31 December 2013. Blood samples were collected and were tested for HBsAg, anti-HBc and anti-HCV using standard laboratory techniques.

RESULTS

A total of 69 915 blood donors were enrolled for the study. A total of 1625 (2.3%) donors have shown serological evidence for hepatitis B virus infection; of those donors, 125 (0.2%) showed a positive test result for both anti-HBc and HBsAg while 1475 (2.1%) had positive anti-HBc results as the only positive test for HBV infection. There was no significant difference between males and females (p=0.28). The prevalence of anti-HCV was 0.1%.

CONCLUSIONS

This is the first large population study of its kind in Basra, Iraq. The prevalence of hepatitis B and C among blood donors is very low in Basra. Around 2% of blood donors had anti-HBc as the only serological evidence of HBV infection. Inclusion of anti-HBc in routine screening of blood donors in Iraq should be encouraged.

Are current screening protocols for chronic hepatitis B virus infection adequate?

Chronic hepatitis B virus (HBV) infection screening usually includes only HBV surface antigen (HBsAg) testing; HBV core and surface antibody (anti-HBc, anti-HBs) assays, indicating resolved infection and immunity, are not routinely performed. Yet, serum HBV DNA is measurable in approximately 10% of HBsAg-negative/anti-HBc-positive cases, representing occult HBV infection (OBI). Patient blood samples from 2 Veterans Affairs medical center look-back investigations were screened for HBV infection using HBsAg enzyme immunoassays. Supplementary testing included anti-HBc and anti-HBs enzyme immunoassays. For anti-HBc-positive samples, HBV DNA testing was performed. Background OBI prevalence was further estimated at these 2 facilities based on HBV serology testing results from 1999-2012. Finally, a literature review was performed to determine OBI prevalence in the published literature. Of 1887 HBsAg-negative cohort patients, 98 (5.2%) were anti-HBc positive/anti-HBs negative; and 175 (9.3%), anti-HBc positive/anti-HBs positive. Six of 273 were HBV DNA positive, representing 0.3% of the total tested and 2.2% who were anti-HBc positive/anti-HBs negative or anti-HBc positive/anti-HBs positive. Among 32,229 general population veterans at these 2 sites who had any HBV testing, 4/108 (3.7%) were HBV DNA positive, none of whom were part of the cohort. In 129 publications with HBsAg-negative patients, 1817/1,209,426 (0.15%) had OBI. However, excluding blood bank studies with greater than 1000 patients, the OBI rate increased to 1800/17,893 (10%). OBI is not rare and has implications for transmission and disease detection. HBsAg testing alone is insufficient for detecting all chronic HBV infections. These findings may impact blood donation, patient HBV screening, follow-up protocols for patients assumed to have cleared the infection, and initiation of immunosuppression in patients with distant or undetected HBV.

Molecular epidemiology and genotyping of hepatitis B virus of HBsAg-positive patients in Oman

Background

Hepatitis B virus (HBV) infection is a major global health burden with distinct geographic public health significance. Oman is a country with intermediate HBV carrier prevalence; however, little is known about the incidence of HBV variants in circulation. We investigated the HBV genotype distribution, the occurrence of antiviral resistance, and HBV surface antigen (HBsAg) escape mutations in HBsAg-positive patients in Oman.

Methods

Serum samples were collected from 179 chronically HBV-infected patients enrolled in various gastroenterology clinics in Oman. HBV genotypes were determined by sequencing and phylogenetic analysis. Mutations in the HBV polymerase and the HBsAg gene were characterized by mutational analysis.

Results

HBV genotypes D (130/170; 76.47%) and A (32/170; 18.28%) are predominant in Oman. The HBV genotypes C and E were less frequent (each 1.18%), while the HBV genotypes B, G, F, and H were not detected. Four patients revealed HBV genotype mixtures (HBV-A/D and D/C). The analyses of vaccine escape mutations yield that 148/170 (87.06%) HBV sequences were wild type. 22/170 (12.94%) HBV sequences showed mutations in the “a” determinant of the HBsAg domain. Two patients showed the described HBV vaccine escape mutation sP120T. 8/146 (5.48%) HBV isolates harbored mutations in the HBV polymerase known to confer resistance against antiviral therapy. Especially the lamivudine resistance mutations rtL180M/rtM204V and rtM204I were detected.

Conclusion

This study shows the distribution of HBV genotypes, therapy resistance, and vaccine escape mutations in HBV-infected patients in Oman. Our findings will have a major impact on therapy management and diagnostics of chronic HBV infections in Oman to control HBV infection in this intermediate HBV-endemic country.

Right upper-quadrant pain in a patient with drug abuse, secondary syphilis and occult hepatitis B virus

OBJECTIVE

To describe the etiology of hepatitis and identify occult hepatitis B virus (HBV) infection.

CLINICAL PRESENTATION AND INTERVENTION

A 40-year-old man presented with severe abdominal pain and jaundice, a history of acute HBV infection that had cleared as well as the use of acetaminophen, methamphetamine, buprenorphine and marijuana. He admitted to having had unprotected sex with multiple partners of both genders. A thorough skin examination revealed papulosquamous lesions on his penis, scrotum, upper and lower extremities and feet. Transaminases and bilirubin were elevated. His rapid plasma reagin was reactive, and hepatitis serologies showed occult HBV. Liver biopsy showed severe hepatitis, but the stains for hepatitis B surface antigen and hepatitis B core antigen were negative. The pathological findings were highly indicative of drug-induced hepatitis without evidence of chronic hepatitis, reactivation of HBV or syphilitic hepatitis. With supportive management and abstinence from drugs, his condition improved.

CONCLUSION

This case describes a patient with multiple potential causes for hepatitis and highlights the importance of obtaining a detailed social history. Further, one should consider the presence of occult HBV and recognize the serologic pattern.

Prevalence of HBc-Ab among HBs-Ag negative healthy blood donors in south of Iran

Background:

The risk of infection with transfusion-transmitted viruses, such as Hepatitis B virus (HBV), has been reduced markedly. However, a zero-risk blood supply remains a popular goal. Anti-hepatitis B core antigen (anti-HBc) is considered to be an effective marker for occult HBV infection, and it has served a significant role in improving blood safety. The purpose of this study was to determine the seroprevalence of anti-HBc antibodies among blood donors.

Methods:

During a period of six months in 2012, 1000 blood donors in Bandar Abbas were investigated for the presence of HBV infection markers. We used ELISA for the detection of HBsAg and chemiluminescence for the detection of HBsAb and anti-HBc antibodies.

Results:

The prevalence of positive anti-HBc among the 1000 donors was 8.3%. Almost 2.3% of the donors were reactive for anti-HBc and negative for HBsAg.

Conclusions:

The study showed that more than 2% of healthy blood donors in Bandar Abbas already have been exposed to HBV, although their HBsAg tests were negative. We suggest screening for anti-HBc to improve the safety of the blood supply.

Characteristics of hepatitis B infection in a sample of omani patients

OBJECTIVES

This study aimed to describe the demographic and virological characteristics of chronic hepatitis B virus (HBV) infection in a sample of Omani patients, and indirectly assess the efficacy of hepatitis B vaccination programmes and catch-up strategies.

METHODS

A retrospective study was undertaken of all patients with chronic HBV infections evaluated and followed-up at the Hepatology Clinic of the Armed Forces Hospital (AFH), Muscat, Oman, between January 2009 and April 2011.

RESULTS

A total of 154 patients met the inclusion criteria. The mean age of infected patients was 33 years with 72.7% being over 27 years. Females constituted 47.7% of the patients. Half of the cohort was referred either from the AFH's Obstetric Clinic (29.2%) or its Blood Bank (22.1%). A family history of chronic HBV infection was present in 70% of patients. A total of 95% had positive hepatitis B surface antigens, while only 5% had isolated total hepatitis B core antibodies. Most patients (96%) were hepatitis B e-antigen-negative. The majority (77.9%) had low HBV dioribonucleic acid levels of <2,000 IU/ml. Radiological features of liver cirrhosis were observed in 5%. Patients requiring treatment were in the minority (9%).

CONCLUSION

Almost 50% of the infected patients were female, the majority being of childbearing age. Medical authorities in Oman should consider enforcing a screening policy for all pregnant women using complete hepatitis B serological testing.

Hepatitis B virus in transfusion medicine: still a problem?

Hepatitis B virus (HBV) has probably evolved with humans for nearly 35,000 years. HBV diversified into 9 genotypes (A-I) presenting specific features directing epidemiology, clinical expression and testing. Genotypes E and C are more infectious and carry higher risk of chronicity and cancer. HBsAg blood screening implemented 40 years ago enormously decreased the risk of transfusion transmission but the remaining risk requires extremely sensitive nucleic acid testing (NAT) to be removed. Limitations of the host immune system, the impact of immunodeficiency and the mechanisms utilised for viral persistence were recently identified. HBV replication produces excess HBsAg and infectious and defective viral particles but screening assays for HBsAg or viral particles alone do not allow fully efficient detection, making necessary screening for both. The host immune system fails to completely control the virus that escapes and persists unrecognized at very low levels or as immuno-selected variants. Variants may not be identified by assays, explaining false negative results. Specific mutations may affect post-transcriptional mechanisms including HBV RNA splicing. Asymptomatic HBV infected blood donors are at risk of long-term complications through mechanisms to be understood for appropriate counselling. Infectivity of occult HBV infection (OBI) by transfusion appears low, anti-HBc (anti-core antigen) only being more infectious than anti-HBs (anti-S protein) positive units.

Hepatitis B core IgM antibody (anti-HBcIgM) among hepatitis B surface antigen (HBsAg) negative blood donors in Nigeria

BACKGROUND

Transfusion associated Hepatitis B virus (TAHBV) continues to be a major problem despite mandatory screening for Hepatitis B surface Antigen (HBsAg). Presence of HBsAg is the common method for detecting hepatitis B infection. Unfortunately, this marker is not detected during the window period of the infection. Nigeria being a developing country cannot afford DNA testing of all collected units of blood which serve as the only possibility of achieving zero risk of transfusion associated HBV. Five different serological makers of hepatitis B virus (HBV) infection were therefore assessed to evaluate the reliability of using HBsAg marker alone in diagnosis of HBV infection among blood donors and to detect the serological evidence of the infection at the window period. This will preclude the possibility of transmitting hepatitis B through transfusion of Hepatitis B surface antigen (HBsAg) negative blood in Nigeria.

METHODS

Between July and August 2009, 92 blood donors were enrolled for the study. The prevalence of 5 different markers of Hepatitis B virus infection was detected using Enzyme Linked Immunosorbent Assay (ELISA). Demographic factors were assessed during the study.

RESULTS

HBsAg and its antibody (anti-HBs) was detected in 18 (19.6%) and 14(15.2%) of the 92 blood donors respectively. Anti-HBc IgM was found in 12(13.0%) of the 92 blood donors while Hepatitis B envelope antigen (HBeAg) and its antibody (anti-HBe) were detected in 4(8.9%) and 12(26.7%) respectively from 45 donors sampled. HBeAg is a marker of high infectivity and appears after HBsAg. At least one serological marker was detected in 30(32.6%) of the blood donors. Five (5.4%) of the 92 donors had anti-HBc IgM as the only serological evidence of hepatitis B virus infection.

CONCLUSIONS

The result of this study shows that five donors have anti-HBcIgM as the only serological evidence of HBV infection. Inclusion of anti-HBcIgM in routine screening of blood donors in Nigeria should be encouraged. This is the first study to assess anti-HBcIgM in the country.

Lack of occult hepatitis B virus infection among blood donors with isolated hepatitis B core antibody living in an HBV low prevalence region of Iran

BACKGROUND

Occult hepatitis B virus (HBV) infection in blood donors is considered a potential threat for the safety of the blood supply, however conclusive studies on this issue are lacking. The aim of this study was to assess the occult HBV infection in blood donors with isolated hepatitis B core antibody (anti-HBc) living in the city of Arak, in the Central Province of Iran, as a low prevalence region for HBV.

METHODS

A total of 531 voluntary blood donors in Arak, Iran were included in this study. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), anti-HBc, and hepatitis C antibody (anti-HCV) were tested in all subjects. The presence of HBV-DNA was determined quantitatively in plasma samples of cases with isolated anti-HBc (HBsAg-negative, anti-HBs-negative, and anti-HBc-positive) by real-time PCR using the artus HBV RG PCR kit on the Rotor-Gene 3000 real-time thermal cycler.

RESULTS

Of 531 subjects enrolled in this study, 11 (2.1%, 95% confidence interval 0.8-3.2%) had isolated anti-HBc. HBV-DNA was not detected in any of the cases with isolated anti-HBc.

CONCLUSIONS

Our study showed that all the blood donors with isolated anti-HBc were negative for HBV-DNA, and occult HBV infection did not occur in the blood donors of this low prevalence region for HBV infection.