Prevalence and Transfusion Risks of Occult Hepatitis B Infection Among HBcAb-Positive Blood Donors in a High-Endemic Region.

Hepatitis B virus (HBV) remains a significant global health concern, particularly in sub-Saharan Africa, where endemicity is high. Occult hepatitis B infection (OBI) presents a unique challenge to transfusion safety, as HBV DNA may persist in HBsAg-negative individuals. This study examines the prevalence of HBcAb positivity among blood donors at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, and assesses the risk of HBV transmission. A cross-sectional study was conducted among 200 blood donors. Samples were screened for HBsAg and HBV serological markers using a rapid assay and ELISA. HBcAb-positive samples were analyzed for HBV DNA using real-time polymerase chain reaction (qRT-PCR). Viral loads were quantified, and socio-demographic characteristics were recorded. HBcAb was detected in 57 (28.5%) of the 200 donors. The most common serological pattern among donors was HBsAg-negative and HBcAb-negative (69%). Among these HBcAb-positive donors, HBV DNA was detected in three cases (1.5%), with viral loads of 753.1, 2.193 × 10, and 4.538 × 10 IU/mL. The presence of HBV DNA in these donors confirms the risk of OBI transmission through transfusion. Socio-demographic analysis revealed that 48.5% of donors were aged 26-35 years, 23.5% were aged 18-25 years, 23% were aged 36-42 years, and 2.5% were either 43-50 or above 50 years of age, of which 99.5% were male. These findings highlight a significant prevalence of HBcAb positivity and OBI, aligning with studies in similar high-endemic settings. HBcAb positivity and OBI represent significant transfusion risks in endemic regions. The presence of HBV DNA in 1.5% of HBcAb-positive donors in the study population highlights the limitations of HBsAg-based screening. Incorporating nucleic acid testing (NAT) into routine blood donor screening protocols is critical to enhancing transfusion safety. Further research is needed to evaluate the feasibility and cost-effectiveness of such interventions in resource-limited settings.