Occult hepatitis B in Iranian blood donors, an overview of the challenges: A narrative review

BACKGROUND: Occult hepatitis B infection (OBI) is a transfusion‐transmitted infection. Although, screening the hepatitis B virus among blood donors can play an important role in increasing the health of blood products, OBI screening in blood transfusion centers is still a challenge. This review study aimed to appraise the challenges of OBI screening and its associated do's and don'ts in blood transfusion centers. METHODS: In this review study, a search was conducted on the electronic databases of PubMed, Web of Science, Scopus, Ovid, Irandoc, and Magiran from January 1996 to December 2020. Also, cross‐sectional studies that determined the prevalence of OBI or anti‐HBc were included in the study. In addition, studies with incomplete data on the prevalence of OBI were excluded. RESULTS: The prevalence of OBI varies among Iranian blood donors. The rates reported by blood transfusion centers of Mashhad, Ahvaz, and Tehran were 0%, and Isfahan, Shiraz, and Kerman were 0.9%, 0.08%, and 2.36%, respectively. In areas with high prevalence of hepatitis B virus, OBI screening only by anti‐HBc test led to the exemption of blood donors from donating blood. Avoiding OBI screening also effected the risk of virus transmission to blood recipients. Plasma products had a higher risk (85%) of virus transmission. CONCLUSIONS: Determining an appropriate screening strategy based on prevalence status, the cost‐effectiveness of screening tests, and the policies of each blood transfusion center is essential.