{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:44:52Z","timestamp":1789771492876,"version":"4.0.1"},"reference-count":144,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Occult hepatitis B virus infection (OBI) represents a specific form of hepatitis B virus (HBV)infection characterized by the presence of replication-competent HBV DNA in the liver despite a negative blood test for hepatitis B surface antigen (HBsAg). Due to the incompletely-known mechanisms underlying its occurrence and the limitations of existing screening technologies, the viral loads in the blood of OBI patients are intermittent and often undetectable. Furthermore, lack of effective screening and shielding strategies in blood collection and supply institutions fail to prevent OBI individuals from donating blood, resulting in its susceptibility to transmission through blood transfusion, which poses a significant threat to blood safety. In this review, we summarize current understanding of OBI, challenges, and its implication in blood safety.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1663306","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T06:24:29Z","timestamp":1761632669000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Transfusion-transmitted occult hepatitis B virus infection: current understanding, challenges, and its implication in blood safety"],"prefix":"10.3389","volume":"16","author":[{"given":"Linbin","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baoren","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuhong","family":"Mo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xipeng","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongji","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinlian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingshuang","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jujun","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianlin","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01468-4","article-title":"Hepatitis B","volume":"401","author":"Jeng","year":"2023","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-022-00649-z","article-title":"A roadmap for serum biomarkers for hepatitis B virus: current status and future outlook","volume":"19","author":"Kramvis","year":"2022","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.219469","article-title":"Countdown to 2030: eliminating hepatitis B disease, China","volume":"97","author":"Liu","year":"2019","journal-title":"Bull World Health Organ"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(22)00201-1","article-title":"Prevalence of occult hepatitis B virus infection in adults: a systematic review and meta-analysis","volume":"7","author":"Im","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197806222982502","article-title":"Type B hepatitis after transfusion with blood containing antibody to hepatitis B core antigen","volume":"298","author":"Hoofnagle","year":"1978","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1979.19680104098.x","article-title":"Studies of donors who transmit posttransfusion hepatitis","volume":"19","author":"Tabor","year":"1979","journal-title":"Transfusion"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(94)90934-2","article-title":"Occult\u201d hepatitis B virus as source of infection in liver transplant recipients","volume":"343","author":"Chazouilleres","year":"1994","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8278(91)90023-5","article-title":"Hepatitis B virus DNA in HBsAg-negative patients. Molecular characterization and clinical implications","author":"Brechot","year":"1991","journal-title":"J Hepatol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(88)92891-7","article-title":"Transmission of hepatitis B from hepatitis-B-seronegative subjects","volume":"2","author":"Thiers","year":"1988","journal-title":"Lancet"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199907013410104","article-title":"Occult hepatitis B virus infection in patients with chronic hepatitis C liver disease","volume":"341","author":"Cacciola","year":"1999","journal-title":"N Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(92)91523-7","article-title":"Hepatitis C and B viruses in hepatitis B surface antigen-negative hepatocellular carcinoma","volume":"103","author":"Sheu","year":"1992","journal-title":"Gastroenterology"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840170106","article-title":"Persistence of hepatitis B and hepatitis C viral genomes in primary liver cancers from HBsAg-negative patients: a study of a low-endemic area","volume":"17","author":"Paterlini","year":"1993","journal-title":"Hepatology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.jhep.2019.03.034","article-title":"Update of the statements on biology and clinical impact of occult hepatitis B virus infection","volume":"71","author":"Raimondo","year":"2019","journal-title":"J Hepatol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3390\/v14071504","article-title":"Occult hepatitis B virus infection: an update","volume":"14","author":"Saitta","year":"2022","journal-title":"Viruses"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2008.07.014","article-title":"Statements from the Taormina expert meeting on occult hepatitis B virus infection","volume":"49","author":"Raimondo","year":"2008","journal-title":"J Hepatol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2018-316900","article-title":"How infectious is the hepatitis B virus? Readings from the occult","volume":"68","author":"Locarnini","year":"2019","journal-title":"Gut"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e0207124","DOI":"10.1128\/jcm.02071-24","article-title":"Identification and characteristics of mutations promoting occult HBV infection by ultrasensitive HBsAg assay","volume":"63","author":"Song","year":"2025","journal-title":"J Clin Microbiol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.754383","article-title":"High-frequency notable HBV mutations identified in blood donors with occult hepatitis B infection from heyuan city of southern China","volume":"13","author":"Ye","year":"2022","journal-title":"Front Immunol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1111\/trf.14784","article-title":"Blood donor testing for hepatitis B virus in the United States: is there a case for continuation of hepatitis B surface antigen detection","volume":"58","author":"Dodd","year":"2018","journal-title":"Transfusion"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e0220421","DOI":"10.1128\/jcm.02204-21","article-title":"Detection of the hepatitis B surface antigen in patients with occult hepatitis B by use of an assay with enhanced sensitivity","volume":"60","author":"Wong","year":"2022","journal-title":"J Clin Microbiol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3390\/v13102053","article-title":"Molecular and serological characterization of hepatitis B virus (HBV)-positive samples with very low or undetectable levels of HBV surface antigen","volume":"13","author":"Kuhns","year":"2021","journal-title":"Viruses"},{"key":"B22","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1186\/s12879-024-09786-z","article-title":"Cost-benefit analysis of serological and nucleic acid testing for hepatitis B virus in blood donors in southern China","volume":"24","author":"Ye","year":"2024","journal-title":"BMC Infect Dis"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(02)00345-6","article-title":"Occult hepatitis B","volume":"2","author":"Torbenson","year":"2002","journal-title":"Lancet Infect Dis"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.05.042","article-title":"Occult hepatitis B infection and hepatocellular carcinoma: Epidemiology, virology, hepatocarcinogenesis and clinical significance","volume":"73","author":"Mak","year":"2020","journal-title":"J Hepatol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens8020063","article-title":"Hepatitis B virus molecular epidemiology, host-virus interaction, coinfection, and laboratory diagnosis in the MENA region: an update","volume":"8","author":"Al-Sadeq","year":"2019","journal-title":"Pathogens"},{"key":"B26","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1111\/trf.13819","article-title":"Detection of different categories of hepatitis B virus (HBV) infection in a multi-regional study comparing the clinical sensitivity of hepatitis B surface antigen and HBV-DNA testing","volume":"57","author":"Lelie","year":"2017","journal-title":"Transfusion"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00046-19","article-title":"Hepatitis B virus: advances in prevention, diagnosis, and therapy","volume":"33","author":"Nguyen","year":"2020","journal-title":"Clin Microbiol Rev"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2011.03355.x","article-title":"Hepatitis B virus transmission by blood transfusion during 4 years of individual-donation nucleic acid testing in South Africa: estimated and observed window period risk","volume":"52","author":"Vermeulen","year":"2012","journal-title":"Transfusion"},{"key":"B29","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1186\/s12916-022-02481-3","article-title":"Occult infection with hepatitis B virus PreS variants synergistically promotes hepatocellular carcinoma development in a high-fat diet context by generating abnormal ceramides","volume":"20","author":"Liu","year":"2022","journal-title":"BMC Med"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2022.2114849","article-title":"Role of S protein transmembrane domain mutations in the development of occult hepatitis B virus infection","volume":"11","author":"Jiang","year":"2022","journal-title":"Emerg Microbes Infect"},{"key":"B31","doi-asserted-by":"publisher","first-page":"104816","DOI":"10.1016\/j.antiviral.2020.104816","article-title":"Mechanisms of HBV immune evasion","volume":"179","author":"Kuipery","year":"2020","journal-title":"Antiviral Res"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.850665","article-title":"Hepatitis B virus-specific cellular immunity contributes to the outcome of occult hepatitis B virus infection","volume":"13","author":"Zhang","year":"2022","journal-title":"Front Microbiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"8194","DOI":"10.1038\/s41598-022-12288-0","article-title":"Molecular characteristics of the full-length genome of occult hepatitis B virus from blood donors in China","volume":"12","author":"Wang","year":"2022","journal-title":"Sci Rep"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.1063616","article-title":"Circulating immune complexes and mutations of HBsAg are associated with the undetectable HBsAg in anti-HBs and HBeAg positive occult hepatitis B virus infection","volume":"13","author":"Yan","year":"2022","journal-title":"Front Microbiol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.775461","article-title":"The impact of HBV quasispecies features on immune status in HBsAg+\/HBsAb+ Patients with HBV genotype C using next-generation sequencing","volume":"12","author":"Wang","year":"2021","journal-title":"Front Immunol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.09.005","article-title":"Effects of amino acid substitutions in hepatitis B virus surface protein on virion secretion, antigenicity, HBsAg and viral DNA","volume":"66","author":"Xiang","year":"2017","journal-title":"J Hepatol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e0312126","DOI":"10.1371\/journal.pone.0312126","article-title":"Incidence of Occult Hepatitis B Infection (OBI) and hepatitis B genotype characterization among blood donors in Cameroon","volume":"19","author":"Mbencho","year":"2024","journal-title":"PloS One"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.12.023","article-title":"Role of core protein mutations in the development of occult HBV infection","volume":"74","author":"Chen","year":"2021","journal-title":"J Hepatol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.1017\/erm.2022.38","article-title":"Hepatitis B virus DNA methylation and its potential role in chronic hepatitis B","volume":"25","author":"Low","year":"2022","journal-title":"Expert Rev Mol Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.1018053","article-title":"Role of epigenetic modification in interferon treatment of hepatitis B virus infection","volume":"13","author":"Yang","year":"2022","journal-title":"Front Immunol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1002\/hep.29133","article-title":"PRMT5 restricts hepatitis B virus replication through epigenetic repression of covalently closed circular DNA transcription and interference with pregenomic RNA encapsidation","volume":"66","author":"Zhang","year":"2017","journal-title":"Hepatology"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3390\/cells9061404","article-title":"Branza-nichita N. N-glycosylation and N-glycan processing in HBV biology and pathogenesis","volume":"9","author":"Dobrica","year":"2020","journal-title":"Cells"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3390\/v16030412","article-title":"Occult HBV infection in patients infected by HIV or HCV: comparison between HBV-DNA and two assays for HBsAg","volume":"16","author":"Meschi","year":"2024","journal-title":"Viruses"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.2174\/157016208783885029","article-title":"Impact of occult HBV infection in HIV\/HCV co-infected patients: HBV-DNA detection in liver specimens and in serum samples","volume":"6","author":"Fabris","year":"2008","journal-title":"Curr HIV Res"},{"key":"B45","doi-asserted-by":"publisher","first-page":"ofy227","DOI":"10.1093\/ofid\/ofy227","article-title":"Occult hepatitis B virus infection: an old entity with novel clinical involvements","volume":"5","author":"Malagnino","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13733","article-title":"Anti-HBc-nonreactive occult hepatitis B infections with HBV genotypes B and C in vaccinated immunocompetent adults","volume":"29","author":"Deng","year":"2022","journal-title":"J Viral Hepat"},{"key":"B47","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1186\/s12879-021-06468-y","article-title":"Characteristic of HBV nucleic acid amplification testing yields from blood donors in China","volume":"21","author":"Wu","year":"2021","journal-title":"BMC Infect Dis"},{"key":"B48","doi-asserted-by":"publisher","first-page":"8","DOI":"10.2450\/2020.0213-20","article-title":"Alternative hepatitis B virus DNA confirmatory algorithm identified occult hepatitis B virus infection in Chinese blood donors with non-discriminatory nucleic acid testing","volume":"20","author":"Deng","year":"2022","journal-title":"Blood Transfus"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2018-316490","article-title":"Multiple HBV transfusion transmissions from undetected occult infections: revising the minimal infectious dose","volume":"68","author":"Candotti","year":"2019","journal-title":"Gut"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3390\/v16010071","article-title":"Serological and molecular characterization of occult HBV infection in blood donors from south Italy","volume":"16","author":"Damiani","year":"2023","journal-title":"Viruses"},{"key":"B51","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jviromet.2015.11.016","article-title":"The Lumipulse G HBsAg-Quant assay for screening and quantification of the hepatitis B surface antigen","volume":"228","author":"Yang","year":"2016","journal-title":"J Virol Methods"},{"key":"B52","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1186\/s12879-019-4215-9","article-title":"Nearly half of Ultrio plus NAT non-discriminated reactive blood donors were identified as occult HBV infection in South China","volume":"19","author":"Ye","year":"2019","journal-title":"BMC Infect Dis"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1159\/000499166","article-title":"Safe-testing algorithm for individual-donation nucleic acid testing: 10 years of experience in a low-prevalence country","volume":"46","author":"Stolz","year":"2019","journal-title":"Transfus Med Hemother"},{"key":"B54","doi-asserted-by":"publisher","first-page":"104507","DOI":"10.1016\/j.jcv.2020.104507","article-title":"The contribution of more sensitive hepatitis B surface antigen assays to detecting and monitoring hepatitis B infection","volume":"129","author":"Pronier","year":"2020","journal-title":"J Clin Virol"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00324-13","article-title":"Highly sensitive detection of hepatitis B virus surface antigen by use of a semiautomated immune complex transfer chemiluminescence enzyme immunoassay","volume":"51","author":"Takeda","year":"2013","journal-title":"J Clin Microbiol"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2012.01.003","article-title":"Variable capacity of 13 hepatitis B virus surface antigen assays for the detection of HBsAg mutants in blood samples","volume":"53","author":"Servant-Delmas","year":"2012","journal-title":"J Clin Virol"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-016-1244-7","article-title":"Novel and highly sensitive immunoassay for total hepatitis B surface antigen, including that complexed with hepatitis B surface antibody","volume":"52","author":"Matsumoto","year":"2017","journal-title":"J Gastroenterol"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1111\/trf.12556","article-title":"Hepatitis B virus nucleic acid amplification testing of Australian blood donors highlights the complexity of confirming occult hepatitis B virus infection","volume":"54","author":"Kiely","year":"2014","journal-title":"Transfusion"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1111\/voxs.12106","article-title":"Nucleic A cid T echnology (NAT) testing for blood screening: impact of individual donation and M ini P ool\u2013NAT testing on analytical sensitivity, screening sensitivity and clinical sensitivity","volume":"9","author":"Shyamala","year":"2014","journal-title":"ISBT Science Series"},{"key":"B60","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3389\/fmed.2018.00029","article-title":"Hepatitis B virus blood screening: need for reappraisal of blood safety measures","volume":"5","author":"Candotti","year":"2018","journal-title":"Front Med (Lausanne)"},{"key":"B61","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1111\/trf.12818","article-title":"What is the meaning of a nonresolved viral nucleic acid test-reactive minipool","volume":"55","author":"Wang","year":"2015","journal-title":"Transfusion"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.2450\/2012.0219-12","article-title":"Molecular virology in transfusion medicine laboratory","volume":"11","author":"Candotti","year":"2013","journal-title":"Blood Transfus"},{"key":"B63","doi-asserted-by":"publisher","first-page":"e29144","DOI":"10.1002\/jmv.29144","article-title":"Ultrasensitive PCR system for HBV DNA detection: Risk stratification for occult hepatitis B virus infection in English blood donors","volume":"95","author":"Fu","year":"2023","journal-title":"J Med Virol"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1016\/j.jviromet.2010.02.004","article-title":"Analytical and clinical performance evaluation of the cobas TaqScreen MPX Test for use on the cobas s 201 system","volume":"165","author":"Ohhashi","year":"2010","journal-title":"J Virol Methods"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1159\/000525480","article-title":"Prevalence of occult hepatitis B virus infection in blood donors with negative ID-NAT in Switzerland","volume":"49","author":"Zbinden","year":"2022","journal-title":"Transfus Med Hemother"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.3390\/v14112507","article-title":"Insights on 21 years of HBV surveillance in blood donors in France","volume":"14","author":"Cappy","year":"2022","journal-title":"Viruses"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16543","article-title":"Hepatitis B infections among blood donors in England between 2009 and 2018: Is an occult hepatitis B infection a risk for blood safety","volume":"61","author":"Harvala","year":"2021","journal-title":"Transfusion"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(23)00321-7","article-title":"Progress towards elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission update","volume":"9","author":"Cooke","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13928","article-title":"Occult hepatitis B virus infection and current perspectives on global WHO 2030 eradication","volume":"31","author":"Saravanan","year":"2024","journal-title":"J Viral Hepat"},{"key":"B70","doi-asserted-by":"publisher","first-page":"e70006","DOI":"10.1002\/rmv.70006","article-title":"Seroprevalence of viral hepatitis B and occult hepatitis B among blood donors in africa: A systematic review and meta-analysis","volume":"34","author":"Simpore","year":"2024","journal-title":"Rev Med Virol"},{"key":"B71","doi-asserted-by":"publisher","first-page":"e0272920","DOI":"10.1371\/journal.pone.0272920","article-title":"Global epidemiology of occult hepatitis B virus infections in blood donors, a systematic review and meta-analysis","volume":"17","author":"Takuissu","year":"2022","journal-title":"PloS One"},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v22i3.63","article-title":"Frequency of transfusion transmissible infections among blood donors of Rawalpindi District, Pakistan","volume":"22","author":"Ghazanfar","year":"2022","journal-title":"Afr Health Sci"},{"key":"B73","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.20-0740","article-title":"Thalassemia patients from baluchistan in Pakistan are infected with multiple hepatitis B or C virus strains","volume":"104","author":"Ahmed","year":"2021","journal-title":"Am J Trop Med Hyg"},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.18502\/ijm.v14i3.9793","article-title":"Prevalence of occult hepatitis B virus infection among the blood donors in Golestan province: cross-sectional study","volume":"14","author":"Bahrami","year":"2022","journal-title":"Iran J Microbiol"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.1111\/trf.15656","article-title":"Follow-up program for blood donors with unconfirmed screening results reveals a high false-positive rate in Dalian, China","volume":"60","author":"Deng","year":"2020","journal-title":"Transfusion"},{"key":"B76","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.12411","article-title":"Occult hepatitis B virus infection in Sudan: A systematic review and meta-analysis","volume":"4","author":"Eltom","year":"2020","journal-title":"JGH Open"},{"key":"B77","doi-asserted-by":"publisher","first-page":"59","DOI":"10.36233\/0507-4088-92","article-title":"Prevalence of viral hepatitis B markers among blood donors in the Republic of Guinea","volume":"67","author":"Boumbaly","year":"2022","journal-title":"Vopr Virusol"},{"key":"B78","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s42506-023-00138-4","article-title":"Prevalence of occult hepatitis B virus infection in Egypt: a systematic review with meta-analysis","volume":"98","author":"Azzam","year":"2023","journal-title":"J Egypt Public Health Assoc"},{"key":"B79","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens11121524","article-title":"Low risk of occult hepatitis B infection among Vietnamese blood donors","volume":"11","author":"Tung","year":"2022","journal-title":"Pathogens (Basel, Switzerland)"},{"key":"B80","doi-asserted-by":"publisher","first-page":"2049936120982122","DOI":"10.1177\/2049936120982122","article-title":"Overt and occult hepatitis B among immigrants and native blood donors in Madrid, Spain","volume":"7","author":"Gonzalez","year":"2020","journal-title":"Ther Adv Infect Dis"},{"key":"B81","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1111\/vox.12744","article-title":"International forum on Occult hepatitis B infection and transfusion safety","volume":"114","author":"Seed","year":"2019","journal-title":"Vox Sang"},{"key":"B82","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1016\/j.jhep.2009.05.020","article-title":"Transfusion-transmitted hepatitis B virus infection","volume":"51","author":"Candotti","year":"2009","journal-title":"J Hepatol"},{"key":"B83","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.06.016","article-title":"Poor efficacy of nucleic acid testing in identifying occult HBV infection and consequences for safety of blood supply in Italy","volume":"63","author":"Spreafico","year":"2015","journal-title":"J Hepatol"},{"key":"B84","doi-asserted-by":"publisher","DOI":"10.1111\/trf.12096","article-title":"Infectivity of blood products from donors with occult hepatitis B virus infection","volume":"53","author":"Allain","year":"2013","journal-title":"Transfusion"},{"key":"B85","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2023.1186877","article-title":"High-sensitivity HBV DNA test for the diagnosis of occult HBV infection: commonly used but not reliable","volume":"13","author":"Wang","year":"2023","journal-title":"Front Cell Infect Microbiol"},{"key":"B86","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jhep.2005.06.016","article-title":"Transmission of occult hepatitis B virus by transfusion to adult and pediatric recipients in Taiwan","volume":"44","author":"Liu","year":"2006","journal-title":"J Hepatol"},{"key":"B87","doi-asserted-by":"publisher","DOI":"10.14218\/JCTH.2021.00291","article-title":"Protective effect of neonatal hepatitis B vaccine against HBV breakthrough infection in children with leukemia: A real-world study","volume":"10","author":"Yang","year":"2022","journal-title":"J Clin Transl Hepatol"},{"key":"B88","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2007.01276.x","article-title":"Infectivity of blood components with low hepatitis B virus DNA levels identified in a lookback program","volume":"47","author":"Satake","year":"2007","journal-title":"Transfusion"},{"key":"B89","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq247","article-title":"Transmissibility of hepatitis B virus (HBV) infection through blood transfusion from blood donors with occult HBV infection","volume":"52","author":"Yuen","year":"2011","journal-title":"Clin Infect Dis"},{"key":"B90","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1111\/j.1365-3148.2010.01036.x","article-title":"The clinical significance of occult hepatitis B transfusion in Taiwan\u2013a look-back study","volume":"21","author":"Su","year":"2011","journal-title":"Transfus Med"},{"key":"B91","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12198","article-title":"Infectivity of blood components from donors with occult hepatitis B infection - results from an Australian lookback programme","volume":"108","author":"Seed","year":"2015","journal-title":"Vox Sang"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.1111\/trf.13401","article-title":"Rare transmission of hepatitis B virus by Dutch donors with occult infection","volume":"56","author":"Lieshout-Krikke","year":"2016","journal-title":"Transfusion"},{"key":"B93","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2013.08.012","article-title":"Reprint of: Epidemiological serosurvey of Hepatitis B in China\u2013declining HBV prevalence due to Hepatitis B vaccination","author":"Liang","year":"2013","journal-title":"Vaccine"},{"key":"B94","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.12901","article-title":"Incidence of hepatitis B virus infection in young Chinese blood donors born after mandatory implementation of neonatal hepatitis B vaccination nationwide","volume":"25","author":"Tang","year":"2018","journal-title":"J Viral Hepat"},{"key":"B95","doi-asserted-by":"publisher","DOI":"10.1111\/trf.12902","article-title":"High prevalence of anti-hepatitis B core antigen in hepatitis B virus-vaccinated Chinese blood donors suggests insufficient protection but little threat to the blood supply","volume":"55","author":"Zheng","year":"2015","journal-title":"Transfusion"},{"key":"B96","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2893.2010.01312.x","article-title":"Evidence of protection against clinical and chronic hepatitis B infection 20 years after infant vaccination in a high endemicity region","volume":"18","author":"Poovorawan","year":"2011","journal-title":"J Viral Hepat"},{"key":"B97","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.903685","article-title":"The investigation of hepatitis B vaccine immune responses in occult hepatitis B virus-infected patients","volume":"13","author":"Peng","year":"2022","journal-title":"Front Immunol"},{"key":"B98","doi-asserted-by":"publisher","first-page":"e0138552","DOI":"10.1371\/journal.pone.0138552","article-title":"Occult HBV infection may be transmitted through close contact and manifest as an overt infection","volume":"10","author":"Hu","year":"2015","journal-title":"PloS One"},{"key":"B99","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.24245","article-title":"Occult hepatitis B virus infection among people with a family history of chronic hepatitis B virus infection","volume":"87","author":"Zhang","year":"2015","journal-title":"J Med Virol"},{"key":"B100","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2023.05.003","article-title":"Exploring risk factors and transmission dynamics of Hepatitis B infection among Indian families: Implications and perspective","volume":"16","author":"Athalye","year":"2023","journal-title":"J Infect Public Health"},{"key":"B101","doi-asserted-by":"publisher","first-page":"e37097","DOI":"10.1016\/j.heliyon.2024.e37097","article-title":"An overview of occult hepatitis B infection (OBI) with emphasis on HBV vaccination","volume":"10","author":"Delghandi","year":"2024","journal-title":"Heliyon"},{"key":"B102","doi-asserted-by":"publisher","first-page":"e29823","DOI":"10.1002\/jmv.29823","article-title":"Incidences of new hepatitis B infection and anti-hepatitis B core-negative occult hepatitis B infection among Japanese blood donors in relation to anti-hepatitis B surface antigen levels","volume":"96","author":"Satake","year":"2024","journal-title":"J Med Virol"},{"key":"B103","doi-asserted-by":"publisher","first-page":"e29006","DOI":"10.1002\/jmv.29006","article-title":"The high prevalence of occult hepatitis B infections among the partners of chronically infected HBV blood donors emphasizes the potential residual risk to blood safety","volume":"95","author":"Ye","year":"2023","journal-title":"J Med Virol"},{"key":"B104","doi-asserted-by":"publisher","first-page":"e0262990","DOI":"10.1371\/journal.pone.0262990","article-title":"Increased prevalence of transfusion-transmitted diseases among people with tattoos: A systematic review and meta-analysis","volume":"17","author":"Lim","year":"2022","journal-title":"PloS One"},{"key":"B105","doi-asserted-by":"publisher","first-page":"31","DOI":"10.11604\/pamj.2019.34.31.17885","article-title":"Prevalence and associated risk factors of transfusion transmissible infections among blood donors at Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital, Kenya","volume":"34","author":"Bartonjo","year":"2019","journal-title":"Pan Afr Med J"},{"key":"B106","doi-asserted-by":"publisher","DOI":"10.2450\/2017.0320-16","article-title":"Improving the safety of whole blood-derived transfusion products with a riboflavin-based pathogen reduction technology","volume":"15","author":"Yonemura","year":"2017","journal-title":"Blood Transfus"},{"key":"B107","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.699217","article-title":"High frequency occult hepatitis B virus infection detected in non-resolved donations suggests the requirement of anti-HBc test in blood donors in southern China","volume":"12","author":"Ye","year":"2021","journal-title":"Front Immunol"},{"key":"B108","doi-asserted-by":"publisher","DOI":"10.1111\/vox.13576","article-title":"Seroreactivity of antibodies to hepatitis B core antigen among hepatitis B surface antigen-screened negative blood donors and its implications for blood safety in a resource-constrained country","volume":"119","author":"Yu","year":"2024","journal-title":"Vox Sang"},{"key":"B109","doi-asserted-by":"publisher","DOI":"10.1111\/trf.18018","article-title":"International review of blood donation screening for anti-HBc and occult hepatitis B virus infection","volume":"64","author":"Fu","year":"2024","journal-title":"Transfusion"},{"key":"B110","doi-asserted-by":"publisher","DOI":"10.1111\/trf.17546","article-title":"Marked reduction in the incidence of transfusion-transmitted hepatitis B virus infection after the introduction of antibody to hepatitis B core antigen and individual donation nucleic acid amplification screening in Japan","volume":"63","author":"Tanaka","year":"2023","journal-title":"Transfusion"},{"key":"B111","doi-asserted-by":"publisher","DOI":"10.1111\/trf.13135","article-title":"Evaluation of an individual-donation nucleic acid amplification testing algorithm for detecting hepatitis B virus infection in Chinese blood donors","volume":"55","author":"Gou","year":"2015","journal-title":"Transfusion"},{"key":"B112","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1111\/trf.18094","article-title":"Correction to \u201cInternational review of blood donation screening for anti-HBc and occult hepatitis B virus infection","volume":"65","author":"Fu","year":"2025","journal-title":"Transfusion"},{"key":"B113","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-301281","article-title":"Occult hepatitis B infection in blood donors from South East Asia: molecular characterisation and potential mechanisms of occurrence","volume":"61","author":"Candotti","year":"2012","journal-title":"Gut"},{"key":"B114","doi-asserted-by":"publisher","DOI":"10.1111\/trf.17390","article-title":"Transfusion-transmitted HBV infection with isolated anti-HBs-positive blood","volume":"63","author":"Satake","year":"2023","journal-title":"Transfusion"},{"key":"B115","doi-asserted-by":"publisher","DOI":"10.1111\/trf.15393","article-title":"Optimal titer of anti-HBs in blood components derived from donors with anti-HBc","volume":"59","author":"Hoshi","year":"2019","journal-title":"Transfusion"},{"key":"B116","doi-asserted-by":"publisher","DOI":"10.3390\/v13060951","article-title":"Novel biomarkers of hepatitis B virus and their use in chronic hepatitis B patient management","volume":"13","author":"Vachon","year":"2021","journal-title":"Viruses"},{"key":"B117","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.05.029","article-title":"Serum hepatitis B virus RNA is encapsidated pregenome RNA that may be associated with persistence of viral infection and rebound","volume":"65","author":"Wang","year":"2016","journal-title":"J Hepatol"},{"key":"B118","doi-asserted-by":"publisher","first-page":"67","DOI":"10.35772\/ghm.2024.01097","article-title":"Current global applications of HBcrAg assays in the management of chronic hepatitis B","volume":"7","author":"Inoue","year":"2025","journal-title":"Glob Health Med"},{"key":"B119","doi-asserted-by":"publisher","first-page":"e22334","DOI":"10.1002\/jcla.22334","article-title":"Evaluation of the highly sensitive chemiluminescent enzyme immunoassay \u201cLumipulse HBsAg-HQ\u201d for hepatitis B virus screening","volume":"32","author":"Deguchi","year":"2018","journal-title":"J Clin Lab Anal"},{"key":"B120","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s10238-024-01540-8","article-title":"Recent developments and future directions in point-of-care next-generation CRISPR-based rapid diagnosis","volume":"25","author":"Hassan","year":"2025","journal-title":"Clin Exp Med"},{"key":"B121","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1038\/d41586-019-00601-3","article-title":"Faster, better, cheaper: the rise of CRISPR in disease detection","volume":"566","author":"Maxmen","year":"2019","journal-title":"Nature"},{"key":"B122","doi-asserted-by":"publisher","first-page":"8819834","DOI":"10.1155\/2024\/8819834","article-title":"Dual detection of hepatitis B and C viruses using CRISPR-cas systems and lateral flow assay","volume":"2024","author":"Shahni","year":"2024","journal-title":"J Nucleic Acids"},{"key":"B123","doi-asserted-by":"publisher","first-page":"e2177088","DOI":"10.1080\/22221751.2023.2177088","article-title":"CRISPR\/Cas13a-assisted rapid and portable HBV DNA detection for low-level viremia patients","volume":"12","author":"Tian","year":"2023","journal-title":"Emerg Microbes Infect"},{"key":"B124","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-022-10311-0","article-title":"CRISPR\/Cas13-assisted hepatitis B virus covalently closed circular DNA detection","volume":"16","author":"Zhang","year":"2022","journal-title":"Hepatol Int"},{"key":"B125","doi-asserted-by":"publisher","first-page":"e7588","DOI":"10.1097\/MD.0000000000007588","article-title":"Integrating nested PCR with high-throughput sequencing to characterize mutations of HBV genome in low viral load samples","volume":"96","author":"Wang","year":"2017","journal-title":"Med (Baltimore)"},{"key":"B126","doi-asserted-by":"publisher","DOI":"10.1080\/14737159.2021.1913055","article-title":"Next-generation sequencing for the diagnosis of hepatitis B: current status and future prospects","volume":"21","author":"Garcia-Garcia","year":"2021","journal-title":"Expert Rev Mol Diagn"},{"key":"B127","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.1101\/2024.12.04.24318256","article-title":"Integrated DNA estimation in tissue biopsy and detection in liquid biopsy by HBV-targeted NGS assay","volume":"5","author":"Liu","year":"2024","journal-title":"medRxiv"},{"key":"B128","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/j.1423-0410.2012.01624.x","article-title":"Ultrio and Ultrio Plus non-discriminating reactives: false reactives or not","volume":"104","author":"Charlewood","year":"2013","journal-title":"Vox Sang"},{"key":"B129","doi-asserted-by":"publisher","first-page":"e25805","DOI":"10.1016\/j.heliyon.2024.e25805","article-title":"Efficacy of combined HBsAg, anti-HBc and anti-HBs screening in minimizing transfusion transmission risk of hepatitis B infection in low resource setting","volume":"10","author":"Athalye","year":"2024","journal-title":"Heliyon"},{"key":"B130","doi-asserted-by":"publisher","first-page":"e18609","DOI":"10.1016\/j.heliyon.2023.e18609","article-title":"Evaluating the cost-effectiveness of low-level HBV DNA screening in occult hepatitis B infection donors: A study from Shandong Blood Center, China","volume":"9","author":"Chen","year":"2023","journal-title":"Heliyon"},{"key":"B131","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.jcv.2018.05.009","article-title":"An ultra-sensitive Abbott ARCHITECT((R)) assay for the detection of hepatitis B virus surface antigen (HBsAg)","volume":"105","author":"Lou","year":"2018","journal-title":"J Clin Virol"},{"key":"B132","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59030443","article-title":"Accuracy validation of the elecsys HBsAg II quant assay and its utility in resolving equivocal qualitative HBsAg results","volume":"59","author":"Lee","year":"2023","journal-title":"Med (Kaunas, Lithuania)"},{"key":"B133","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57121307","article-title":"Analytical performance of the sysmex HISCL HBsAg assay and comparison with the roche elecsys HBsAg II quant assay in the quantification of hepatitis B surface antigen","volume":"57","author":"Park","year":"2021","journal-title":"Med (Kaunas, Lithuania)"},{"key":"B134","doi-asserted-by":"publisher","DOI":"10.2450\/2008.0062-08","article-title":"Diagnostic algorithm for HBV safe transfusion","volume":"7","author":"Allain","year":"2009","journal-title":"Blood Transfus"},{"key":"B135","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32018","article-title":"Comparison of HBV RNA and hepatitis B core related antigen with conventional HBV markers among untreated adults with chronic hepatitis B in north america","volume":"74","author":"Ghany","year":"2021","journal-title":"Hepatology"},{"key":"B136","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21413","article-title":"Characterization of HBV DNA+\/HBsAg- blood donors in Poland identified by triplex NAT","volume":"44","author":"Brojer","year":"2006","journal-title":"Hepatology"},{"key":"B137","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13229","article-title":"Clinical evaluation of a novel and highly sensitive immunoassay for anti-hepatitis B core antigen using a fully automated immunochemical analyzer","volume":"48","author":"Izumida","year":"2018","journal-title":"Hepatol Res"},{"key":"B138","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.894410","article-title":"Quantitative anti-HBc combined with quantitative HBsAg can predict HBsAg clearance in sequential combination therapy with PEG-IFN-alpha in NA-suppressed chronic hepatitis B patients","volume":"13","author":"Wang","year":"2022","journal-title":"Front Immunol"},{"key":"B139","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12985-019-1154-4","article-title":"Molecular and serological characterization of hepatitis B vaccine breakthrough infections in serial samples from two plasma donors","volume":"16","author":"Kuhns","year":"2019","journal-title":"Virol J"},{"key":"B140","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30082","article-title":"Hepatitis B virus serum DNA andRNA levels in nucleos(t)ide analog-treated or untreated patients during chronic and acute infection","volume":"68","author":"Butler","year":"2018","journal-title":"Hepatology"},{"key":"B141","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2893.2000.00248.x","article-title":"Evaluation of an enzyme-linked immunosorbent assay for detection and quantification of hepatitis B virus PreS1 envelope antigen in serum samples: comparison with two commercial assays for monitoring hepatitis B virus DNA","volume":"7","author":"Le Guillou","year":"2000","journal-title":"J Viral Hepat"},{"key":"B142","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2017-1133","article-title":"Performance evaluation of cobas HBV real-time PCR assay on Roche cobas 4800 System in comparison with COBAS AmpliPrep\/COBAS TaqMan HBV Test","volume":"56","author":"Kim","year":"2018","journal-title":"Clin Chem Lab Med"},{"key":"B143","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000838","article-title":"Verification of the Roche cobas((R)) 6800 PCR 200 microl and 500 microl protocols for the quantification of HIV-1 RNA, HBV DNA and HCV RNA and evaluation with COBAS((R)) Ampliprep\/COBAS((R)) TaqMan((R)) assays","volume":"67","author":"Tan","year":"2018","journal-title":"J Med Microbiol"},{"key":"B144","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jcv.2017.09.007","article-title":"Multicenter comparison of the new Cobas 6800 system with Cobas Ampliprep\/Cobas TaqMan and Abbott RealTime for the quantification of HIV, HBV and HCV viral load","volume":"96","author":"Wirden","year":"2017","journal-title":"J Clin Virol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1663306\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T06:24:31Z","timestamp":1761632671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1663306\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,28]]},"references-count":144,"alternative-id":["10.3389\/fimmu.2025.1663306"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1663306","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,28]]},"article-number":"1663306"}}