Key Challenges in Screening Blood Donors for Hepatitis B Virus

Area of Science:

• Transfusion Medicine
• Virology
• Public Health

Background:

• Blood donor screening for hepatitis B virus (HBV) has improved blood safety through technological advancements.
• Occasional transfusion transmission of HBV still occurs, primarily due to donors in the window period or with occult HBV infection.
• Professionals in transfusion medicine, infectious diseases, gastroenterology, and public health must recognize ongoing challenges.

Purpose of the Study:

• To review current recommendations and advancements for enhancing HBV test sensitivity in blood donor screening.
• To highlight challenges impacting the performance of serologic and nucleic acid tests for HBV.
• To emphasize the need for understanding these challenges to improve policies and manage atypical cases.

Main Methods:

• Review of current literature and technological advancements in blood donor screening for HBV.
• Analysis of factors affecting test sensitivity, including viral genotypes, mutations, and sample interferences.
• Examination of recommendations for maintaining high test sensitivity.

Main Results:

• Maintaining high test sensitivity is paramount for blood safety.
• Viral genotype diversity and mutations can impact both serologic and nucleic acid test performance.
• Endogenous and exogenous interferences can affect serologic test accuracy.

Conclusions:

• Despite advancements, HBV screening faces persistent challenges, including window period and occult infections.
• Optimizing test sensitivity and understanding factors affecting test performance are critical for enhancing blood safety.
• A comprehensive understanding of these challenges is essential for effective policy development and management of transfusion-transmitted HBV.