Prevalence and Implications of Occult Hepatitis B Virus Infection Among Blood Donors in Saudi Arabia: A Systematic...

Background: Hepatitis B virus (HBV) remains a transfusion-transmissible infection of global concern. While mandatory screening for hepatitis B surface antigen (HBsAg) has reduced overt infections, occult hepatitis B infection (OBI) poses ongoing risk. This meta-analysis aimed to estimate the pooled prevalence of anti-HBc, HBsAg, and OBI in Saudi blood donors, as well as to assess regional variations and temporal trends. Methods: A systematic meta-analysis was conducted using nine studies published between 2013 and 2024, encompassing a total of 87,820 blood donors. Prevalence was pooled using random-effects models with logit transformation and Hartung-Knapp adjustment. Heterogeneity was quantified with I² and τ². Subgroup analyses examined geographic regions; meta-regression assessed publication year. Publication bias was evaluated with Egger's regression; sensitivity analyses tested robustness. Results: The pooled prevalence of anti-HBc was 5% (95% CI: 3-7%), HBsAg was 0.46% (95% CI: 0.31-0.69%), and OBI was 0.12% (95% CI: 0.03-0.39%). High heterogeneity was observed (I² = 90.6-98.9%). Subgroup analyses revealed regional disparities, and meta-regression showed no significant temporal trends. Conclusions: The findings suggest that past HBV exposure remains relatively common among Saudi blood donors, while current active infection and OBI are infrequent. These results support continued enhanced screening, including anti-HBc and nucleic acid testing (NAT), to ensure transfusion safety. The lack of a national hemovigilance system that monitors transfusion-transmitted infections among recipients represents a critical gap in Saudi Arabia's transfusion safety framework. Addressing this gap is essential to fully assess residual risks, evaluate the real-world effectiveness of screening policies, and align with global best practices in blood safety.