Residual Risk of Transmission of Hepatitis B Virus through Blood Transfusion in Ghana: Evaluation of the performance of Rapid Immunochromatographic Assay with Enzyme Linked Immunosorbent Assay

Blood transfusion necessitates screening of transmissible infectious pathogens such as hepatitis B virus (HBV) to curtail post transfusion risk of infection. The study re-examined this approach by evaluating the efficiency of solely testing for hepatitis B surface antigen (HbsAg) marker for blood transfusion, the efficacy of the various immunochromatographic assays in the screening process and the residual risk of hepatitis B viral transmission through transfusion in Ghana. A convenient purposive sampling technique was used in selecting ten hospitals, from each of the 10 regions. A total of 480 aliquots of blood were collected anonymously, from blood already tested for HbsAg with immunochromatographic assay in the blood banks of the chosen facilities and declared negative. Plasma from the blood was obtained through centrifugation, separated into well labeled microtubes and transported in cold boxes to the Molecular Medicine Department-KNUST. The samples were then re-examined for all six hepatitis B virus (HBV) (HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc and Ig Manti-HBc) serological markers using ELISA assay. When a total of 480 plasma samples from the blood banks of the ten chosen facilities were re-examined with the ELISA assay, 39(8.13%) samples reacted positive for HBsAg, 60(12.5%) reacted for Anti-HBs, 13(2.71%) reacted for HBeAg, 51(10.63%) for Anti-HBe and 329(68.54%) reacted positively for Anti-HBc. None of the samples reacted positive for IgM anti-HBc. The estimated sero-prevalence for all HBV serological markers is 76.67% whereas the estimated residual risk of HBV infection through blood transfusion caused by the use of immunochromatographic methods in the screening of blood for transfusion was 8.47%(5.98% - 10.94% at 95% CI). An additional risk of 3.10%(1.54% - 4.62% at 95% CI) of HBV infection through transfusion was also estimated for the non-testing of other HBV infectious serological markers. The total residual risk for transfusion transmitted HBV was 11.16%(8.34% - 13.95% at 95% CI). The study revealed that neither the kits in use nor the testing strategy in place now is adequate to prevent transmission of hepatitis B virus through transfusion in Ghana due to the high residual risk of transmission of HBV. There is therefore an urgent need for a sustainable quality control system on the screening of HBsAg in blood for donation in Ghana.