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A probable case of hepatitis B virus transfusion transmission revealed after a 13‐month‐long window period
Author(s) -
Wendel Silvano,
Levi José E.,
Biagini Silvana,
Candotti Daniel,
Allain JeanPierre
Publication year - 2008
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2008.01723.x
Subject(s) - window period , hepatitis b virus , seroconversion , hbsag , medicine , virology , hepatitis b , immunology , blood transfusion , antibody , hepadnaviridae , serology , viral load , orthohepadnavirus , transmission (telecommunications) , hepatitis , virus , electrical engineering , engineering
BACKGROUND: Transfusion‐transmitted hepatitis B virus (HBV) infection in recipients with drug‐related immunodeficiency is rarely described in endemic areas. Hepatitis B surface antigen (HBsAg)–negative infectious donor blood can be identified by sensitive nucleic acid testing (NAT). Two immunodeficient patients who received blood components from a single seronegative blood donor subsequently found to contain HBV DNA are described. MATERIALS AND METHODS: Multiple samples from the implicated donor and the two recipients were tested for HBV serologic and molecular markers. HBV genome fragments were amplified, sequenced, and phylogenetically analyzed. RESULTS: The implicated donation had low‐level HBV DNA due to the donor being in the window period before the donor's seroconversion. Recipient 1 had been vaccinated to HBV and carried anti‐HBs but remained negative for all other HBV markers until she developed acute hepatitis B (viral load 2.7 × 10 8 IU/mL and alanine aminotransferase [ALT] level 1744 IU/L) 13 months after transfusion of red cells. Identical HBV sequences from both donor and recipient provided evidence of transfusion‐related infection. Recipient 2, who received platelets from the same donation while receiving major chemotherapy, remained uninfected. CONCLUSIONS: In unusual circumstances, HBV incubation time can be considerably prolonged. Both active and passive neutralizing antibodies to HBV likely delayed, but did not prevent, acute infection when the immune system was impaired. HBV NAT may have interdicted the infectious unit, although the donation viral load could not be quantified and odds of detection calculated.