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Hepatitis B Blood Donor Screening Data: An Under-Recognized Resource for Canadian Public Health Surveillance
Sheila F O'Brien1,2, Cassandra N Reedman1,3, Carla Osiowy4,5,6
1Epidemiology and Surveillance, Canadian Blood Services, Ottawa, ON K1G 4J5, Canada.
Insights
Hepatitis B surveillance in Canada reveals higher chronic infection rates in males and unvaccinated groups. Blood donor data is crucial for understanding prevalence and improving vaccination strategies to meet elimination goals.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Virology
Background:
- Hepatitis B surveillance is critical for Canada's 2030 elimination target.
- Understanding infection rates and risk factors among blood donors informs public health strategies.
Purpose of the Study:
- To analyze Hepatitis B virus (HBV) infection rates and associated risk factors in Canadian blood donors.
- To evaluate the utility of blood donor data for HBV surveillance and vaccination program assessment.
Main Methods:
- Analysis of HBV markers (HBsAg, anti-HBc, HBV NAT) in 1,401,603 first-time Canadian blood donors (2005-2020).
- Classification of infections as likely chronic or resolved/occult.
- Risk factor interviews conducted with chronically infected and control donors (1:4 ratio).
Main Results:
- In 2019, the rate of likely chronic HBV infection was 61.9/100,000 and resolved/occult infection was 1449.5/100,000.
- Chronic infections were significantly associated with males (OR 3.2) and vaccine-ineligible birth cohorts (OR 1.9).
- Key risk factors included cohabitation with an infected individual (OR 12.5) and ethnic origin from high-prevalence countries (OR 8.4).
Conclusions:
- Blood donor data suggests undiagnosed chronic HBV may be more prevalent than previously reported in Canada.
- This data is valuable for refining HBV surveillance and evaluating the effectiveness of vaccination programs.
- Targeted interventions for high-risk groups can aid in achieving HBV elimination goals.
Abstract:
Hepatitis B surveillance is essential to achieving Canada's goal of eliminating hepatitis B by 2030. Hepatitis B rates, association of infection with vaccine age-eligibility, and risk factors were analyzed among 1,401,603 first-time Canadian blood donors from 2005 to 2020. Donors were classified as having likely chronic or likely resolved/occult infections based on hepatitis B surface antigen, anti-hepatitis B core antigen, and hepatitis B nucleic acid test results. Likely chronically infected and control donors (ratio 1:4) participated in risk-factor interviews. The 2019 rate of likely chronic infection was 61.9 per 100,000 (95% CI 46.5-80.86) and 1449.5 per 100,000 for likely resolved/occult infections (95% CI 1370.7-1531.7). Likely chronic infections were higher in males (OR 3.2; 95% CI 2.7-3.7) and the vaccine-ineligible birth cohort (OR 1.9; 95% CI 1.6-2.2). The main risk factors were living with someone who had hepatitis (OR 12.5; 95% CI 5.2-30.0) and ethnic origin from a high-prevalence country (OR 8.4; 95% CI 5.9-11.9). Undiagnosed chronic hepatitis B may be more prevalent in Canada than currently determined by traditional passive hepatitis B reporting. Blood donor data can be useful in informing hepatitis B rates and evaluating vaccination programs in Canada.
