Multiple HBV transfusion transmissions from undetected occult infections : revising the minimal infectious dose
Candotti, Daniel ...
Objective HBV infection by blood components is currently prevented in most developed countries by combining sensitive HBV surface antigen (HBs a g) assays, nucleic acid testing ( nat ) and in a few ...of them antibodies against the HBV core antigen (anti-HBc) screening. HBV transmissions by blood components from three repeat donors tested negative for HBs a g and HBV D na with a highly sensitive screening test (limit of detection ( l OD): 3.4 i U/m l ) were investigated. Design 30 of the 47 recipients of components produced from these three donors were examined. t r ansfusion transmission was confirmed by phylogenetic analysis of viral sequences obtained from recipients and donors following viral particle concentration. r esults 9 of 31 (29%) recipients were infected: 7 infections were related to 200 m l of fresh frozen plasma and 2 infections to red blood cells containing 20 m l plasma. t r ansfusion transmission was confirmed by >99% identity of donor/recipient sequences in five cases , probable in three and possible in one. HBV active infection remained unsuspected for 24%57 months in three recipients. Five non-infected recipients carried anti-HBs when transfused. Six patients transfused with platelet concentrates treated with a pathogen reduction method were not infected. t hese data enabled to revise previous estimate of the minimal infectious dose from appro ximately 100 to 16 copies (or 3 i U) of HBV D na . Conclusions HBV tr ansfusion transmission from occult HBV infection carrying extremely low viral loads is related to plasma volume transfused and possibly prevented by anti-HBs. HBV blood safety could be further improved by either anti-HBc screening, HBV D na nat with a l OD of 0.8 copies/m l (0.15 i U/m l ) or pathogen reduction of blood components.
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