The Impact of Blood Bags of Screening Egyptian Blood Donors on Hepatitis B Virus Infection 20 Years After the Perinatal Vaccination Program

A universal infant vaccination program against hepatitis B has been in place for three decades, and the vaccine is considered a highly effective strategy for preventing infection. Desired improvements include increasing birth-dose coverage rates and strengthening the prevention of mother-to-child transmission; however, by adolescence, most individuals vaccinated in infancy lose circulating antibodies against the hepatitis B virus (HBV), and some fail to mount an adequate immune response to the vaccine. This study aims to evaluate protective antibody levels against the hepatitis B virus surface antigen (anti-HBs) and the rate of breakthrough infection among Egyptian blood donors, 20 years after their initial vaccination against the virus. This cross-sectional study included 1,500 blood donors from various Egyptian governorates; all donors were born after 1992 and had previously received the routine hepatitis B vaccination. The total antibodies against the hepatitis B virus core antigen (Anti-HBC) and the total anti-HBs in their 16-25 ages were detected. Furthermore, donors who tested positive for HBs Ag or anti-HBC antibodies underwent additional testing for HBV-DNA. The study included 1,500 blood donors in the city of Tanta; the vast majority of participants (876 donors, or 58.4%) were from rural areas, while the remainder (624 donors, or 41.6%) came from various urban areas. Mean age of blood donors was 20.2±1.93 years. Among all participants, 1499 individuals tested negative for the HBs Ag, with the exception of one case (0.06%) that tested positive. Anti-HBc were detected in 8 blood donors (0.53%); of these, 7 (0.46%) were HBs Ag-negative, only one donor (0.06%) tested positive for both HBs Ag and anti-HBc. Among the anti-HBc-positive donors (n=8), seven were found to have anti-HBs levels below <10 IU/mL, whereas one donor (12.5%) showed evidence of active hepatitis B infection, testing positive for both HBs Ag and HBV-DNA (n=1/8; 12.5%). In conclusion, despite the notable decline in HBV exposure and infection rates among blood donors in Egypt following vaccination, HBV infections can still occur even 20 years after vaccination; furthermore, the prevalence of anti-HBc remains unknown in Egypt, particularly among specific population groups such as patients receiving repeated blood transfusions.