Prevalence of Hepatitis B Core Antibodies and Occult Hepatitis B Infection among Blood Donors in Erbil Governorate, Iraq

The Hepatitis B Virus (HBV) remains a considerable risk to blood transfusion safety, especially through occult hepatitis B infection (OBI), defined by undetectable Hepatitis B surface antigen (HBsAg) yet the presence of HBV DNA in the bloodstream. Identifying and investigating the prevalence of OBI is essential as these infections can get past normal screening tests, which can lead to accidental transmission through transfusion. This study aimed to evaluate the prevalence of total hepatitis B core antibody (HBcAb) and identify OBI among blood donors in Erbil Governorate, Iraq. A total of 31,631 blood donors were tested for total HBcAb between September 2024 and January 2025, using the Liaison XL chemiluminescence immunoassay machine. Out of these 31,631 blood donors, 388 (1.23%) showed positive results for the total HBcAb. Among the positive cases, 65 samples were randomly chosen to detect OBI by viral load detection using quantitative real-time polymerase chain reaction. All samples were negative for HBsAg during routine screenings. Occult OBI was detected within 17 (26.15%) of the HBcAb-positive, HBsAg-negative blood donors. Despite the application of HBcAb screening, the absence of molecular testing may continue to provide an opportunity for HBV transmission. Incorporating HBV DNA testing for positive cases may enhance the safety of blood transfusions.