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Background &amp; aims <p>In China, blood donations are routinely screened for both HBsAg and HBV DNA to prevent transfusion-transmitted hepatitis B virus (HBV) infection. However, the benefit of implementing universal anti-HBc screening to intercept occult HBV infection remains debated, primarily due to concerns over donor loss and cost-effectiveness. This study aimed to assess the prevalence of anti-HBc among blood donors in Guangzhou and to evaluate whether the current HBV screening strategy in China requires further optimization.</p> Methods <p>In this study, we enrolled 25,056 voluntary blood donors who tested negative for both HBsAg and HBV DNA. All samples were first screened for anti-HBc using ELISA. A subset of positive samples was then retested with an electrochemiluminescence (ECL) assay. Subsequently, quantitative anti-HBs testing was performed on samples that were positive by both assays, and those that were anti-HBs-negative underwent HBV RNA testing.</p> Results <p>The initial anti-HBc-positive rate was 27.1% (6795/25,056), which exhibited a strong age-dependent increase but showed no association with gender. Of the 1343 samples that underwent retesting, 82.1% (1102/1343) were confirmed positive. Among the double-positive samples, 91.2% (990/1085) were also anti-HBs positive, and 53.5% (580/1085) presented with anti-HBs levels ≥ 200 IU/L. No statistically significant difference in anti-HBs levels was observed between genders or across age groups. Furthermore, HBV RNA was not detected in any of the 95 anti-HBs-negative samples tested.</p> Conclusion <p>The high prevalence of anti-HBc, coupled with a substantial proportion of donors having protective levels of anti-HBs, suggests that the incremental benefit of universal anti-HBc screening in Guangzhou’s current donor population may be limited. While implementing such assays is not considered feasible at present, future declines in prevalence of HBV infection may warrant a re-evaluation and optimization of the screening strategy.</p>

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Prevalence of anti-HBc and anti-HBs among blood donors in Guangzhou: implications for HBV screening strategies in China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月6日

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  • Zhengang Shan,
  • Min Wang,
  • Ru Xu,
  • Fenfang Liao,
  • Qiao Liao,
  • Jieting Huang,
  • Bochao Liu,
  • Huishan Zhong,
  • Yongshui Fu,
  • Huaqin Liang,
  • Xia Rong

摘要

Background & aims

In China, blood donations are routinely screened for both HBsAg and HBV DNA to prevent transfusion-transmitted hepatitis B virus (HBV) infection. However, the benefit of implementing universal anti-HBc screening to intercept occult HBV infection remains debated, primarily due to concerns over donor loss and cost-effectiveness. This study aimed to assess the prevalence of anti-HBc among blood donors in Guangzhou and to evaluate whether the current HBV screening strategy in China requires further optimization.

Methods

In this study, we enrolled 25,056 voluntary blood donors who tested negative for both HBsAg and HBV DNA. All samples were first screened for anti-HBc using ELISA. A subset of positive samples was then retested with an electrochemiluminescence (ECL) assay. Subsequently, quantitative anti-HBs testing was performed on samples that were positive by both assays, and those that were anti-HBs-negative underwent HBV RNA testing.

Results

The initial anti-HBc-positive rate was 27.1% (6795/25,056), which exhibited a strong age-dependent increase but showed no association with gender. Of the 1343 samples that underwent retesting, 82.1% (1102/1343) were confirmed positive. Among the double-positive samples, 91.2% (990/1085) were also anti-HBs positive, and 53.5% (580/1085) presented with anti-HBs levels ≥ 200 IU/L. No statistically significant difference in anti-HBs levels was observed between genders or across age groups. Furthermore, HBV RNA was not detected in any of the 95 anti-HBs-negative samples tested.

Conclusion

The high prevalence of anti-HBc, coupled with a substantial proportion of donors having protective levels of anti-HBs, suggests that the incremental benefit of universal anti-HBc screening in Guangzhou’s current donor population may be limited. While implementing such assays is not considered feasible at present, future declines in prevalence of HBV infection may warrant a re-evaluation and optimization of the screening strategy.