Isolated serum hepatitis B core antibody seropositivity: A diagnostic risk factor for occult hepatitis B infection

Anti‐HBc screening and nucleic acid testing for hepatitis B viral DNA (HBV DNA) detection in blood donors are not routinely performed in clinical settings in Nigeria. This raises serious concerns for safety of blood at a time that global health standards advocate for transfusion safety. The aim of this research is to investigate if presence of anti‐HBc in blood donors is actually associated with occult hepatitis B infection through basic and advanced procedures. Prospective blood donors who were seronegative for HBsAg but sero‐positive for anti‐HBc (with or without other markers) among the four hundred and seventy enrolled in a cross‐sectional study were selected for this study. Samples were further screened for hepatitis B core immunoglobulin M by enzyme‐linked immunosorbent assay. Nucleic acid testing was performed for confirmation of occult hepatitis B infection. Anti‐HBc was detected in 20 (32.8%) of the sixty‐one HBsAg antigen‐negative blood donors which constituted 13.0% of the total number of enrolled blood donors. Anti‐HBc total‐positive differentiation showed eighteen (90.0%) anti‐HBc (IgG) and two (10%) anti‐HBc (IgM) were detected. Nucleic acid testing showed 5.0% prevalence of occult hepatitis B infection among the anti‐HBc‐positive blood donors with estimated HBV DNA viral load of 58 IU/ml. Demonstration of 5.0% occult hepatitis B prevalence showed the possibility of post‐transfusion hepatitis B infection in transfusion recipients with consequent possible liver damage should hepatitis B surface antigen alone be the continued practice in clinical settings. The inclusion of antibody to hepatitis B core antigen screening in addition to hepatitis B surface antigen marker is an essential step to ensuring optimal blood safety and prevent post‐transfusion hepatitis.