Residual Risk of Transmission of Hepatitis B Virus through Blood Transfusion in Ghana: Evaluation of the performance of Rapid Immunochromatographic Assay with Enzyme Linked Immuno-sorbent 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 nega-tive. Plasma from the blood was obtained through centrifugation, separated into well labeled micro-tubes 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 IgM anti-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 sero-logical 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.