来自未检测到的隐匿性感染的多次HBV输血传播：修改最小感

StephenW

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Hepatology
Original article
Multiple HBV transfusion transmissions from undetected occult infections: revising the minimal infectious dose

    Daniel Candotti1, Sonny Michael Assennato2, Syria Laperche1, Jean-Pierre Allain2, Snezna Levicnik-Stezinar3

Author affiliations

    Department of Blood Transmitted Agents, National Institute of Blood Transfusion, Paris, France
    Department of Haematology, University of Cambridge, Cambridge, UK
    Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia

    Correspondence to Dr Daniel Candotti, Department of Blood Transmitted Agents, National Institute of Blood Transfusion, 75015 Paris, France; [email protected]

Abstract

Objective HBV infection by blood components is currently prevented in most developed countries by combining sensitive HBV surface antigen (HBsAg) 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 HBsAg and HBV DNA with a highly sensitive screening test (limit of detection (LOD): 3.4 IU/mL) were investigated.

Design 30 of the 47 recipients of components produced from these three donors were examined. Transfusion transmission was confirmed by phylogenetic analysis of viral sequences obtained from recipients and donors following viral particle concentration.

Results 9 of 31 (29%) recipients were infected: 7 infections were related to 200 mL of fresh frozen plasma and 2 infections to red blood cells containing 20 mL plasma. Transfusion 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. These data enabled to revise previous estimate of the minimal infectious dose from approximately 100 to 16 copies (or 3 IU) of HBV DNA.

Conclusions HBV transfusion 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 DNA NAT with a LOD of 0.8 copies/mL (0.15 IU/mL) or pathogen reduction of blood components.

http://dx.doi.org/10.1136/gutjnl-2018-316490

StephenW

肝病
来源文章
来自未检测到的隐匿性感染的多次HBV输血传播：修改最小感染剂量

    Daniel Candotti1，Sonny Michael Assennato2，叙利亚Laperche1，Jean-Pierre Allain2，Snezna Levicnik-Stezinar3

作者隶属关系

    法国巴黎国家输血研究所血液传播代理部
    剑桥大学血液学系，英国剑桥
    斯洛文尼亚的输血中心，斯洛文尼亚卢布尔雅那

    与法国巴黎75015国家输血研究所血液传播代理部Daniel Candotti博士的通信; [email protected]

抽象

目前，大多数发达国家通过结合敏感的HBV表面抗原（HBsAg）检测，核酸检测（NAT）以及少数针对HBV核心抗原（抗-HBc）筛选的抗体来预防血液成分的HBV感染。通过高灵敏度筛选试验（检测限（LOD）：3.4 IU / mL）对来自三个重复供体的血液成分进行的HBV传播测试为HBsAg和HBV DNA阴性。

设计了从这三个捐赠者生产的47个成分受试者中的30个。通过病毒颗粒浓度后从受体和供体获得的病毒序列的系统发育分析证实了输血传播。

结果31名患者中有9名（29％）被感染：7名感染与200 mL新鲜冰冻血浆有关，2名感染与含有20 mL血浆的红细胞有关。输血传播通过5个病例中> 99％的供体/受体序列同一性证实，可能在3个病例中，可能在1个病例中。三名受者中HBV活动性感染仍未被预期24-57个月。五名未感染的受者在输血时携带抗-HBs。用病原体减少方法治疗的输注血小板浓缩物的6名患者未被感染。这些数据使得能够将大约100至16个拷贝（或3IU）HBV DNA的最小感染剂量的先前估计值修改。

结论携带极低病毒载量的隐匿性HBV感染的HBV输血传播与输注的血浆体积有关，并且可能被抗HBs预防。通过抗HBc筛查，HBV DNA NAT，LOD为0.8拷贝/ mL（0.15 IU / mL）或血液成分的病原体减少，可进一步提高HBV血液安全性。

http://dx.doi.org/10.1136/gutjnl-2018-316490