1. Affected Individual – Person who has hepatitis B infection at present or has ever had hepatitis B infection

PERMANENTLY EXCLUDE:

• If donor has infection with hepatitis B virus at present
• If donor has ever had infection with hepatitis B virus, at any age, even if they made a complete recovery i.e past resolved infection

ADDITIONAL INFORMATION

Hepatitis B is a serious viral infection that can lead to chronic liver disease and liver cancer (hepatoma). Individuals who are chronically infected are sometimes referred to as ‘carriers’. They often, have no or minimal symptoms associated with their infection. Cases are often linked to the place of birth or the mother’s place of birth. Hepatitis B infection is very common in some parts of the world and vertical spread from mother to baby is often a major route of transmission Hepatitis B may also be acquired by injecting drug use, sexual transmission and more rarely tattoos and piercings. The IBTS test routinely for hepatitis B surface antigen i.e. Hep BsAg, hepatitis B core antibody and hepatitis B virus DNA by NAT testing. Because we test for core-antibody routinely we will pick up cases where the donor had hepatitis B many years previously, and made a complete recovery and does not carry the Hep BsAg, but is core antibody positive

This is why, we do not accept donations from people who have had hepatitis B in the past, as they will be core-antibody positive, even if they have made a complete recovery, and their blood cannot be issued for transfusion. Testing for core-antibody also identifies donors who have had hepatitis B in the past and who did not make a complete recovery, but who carry very low levels of hepatitis BsAg in their blood. These donors could potentially transmit hepatitis B to patients who receive their blood, but for the fact that we test for core-antibody. We carry out a hepatitis B NAT testing on single donations, rather than on pooled samples which is the standard in some other countries. This also makes our testing more sensitive to very low levels of hepatitis BsAg, than that of some other countries

2. Current sexual partner of the donor has acute or chronic hepatitis B

PERMANENTLY EXCLUDE:

• If donor’s current sexual partner has acute or chronic hepatitis B. This exclusion applies even if the donor was vaccinated against Hepatitis B

ADDITIONAL INFORMATION

The sexual partner of a person who has hepatitis B infection should be offered vaccination against hepatitis B. However, vaccination is not always 100% effective, as some people do not respond to it. This is why, we do not depend on vaccination, to protect the donor from acquiring hepatitis B infection. Also if the relationship started after the diagnosis of hepatitis B, the person may not have been offered vaccination

3. Former sexual partner of the donor had acute or chronic hepatitis B at the time of the last sexual contact

DEFER:

• for 4 months from the date of the last sexual contact. This deferral applies even if the donor was vaccinated against Hepatitis B

4. Current sexual partner of the donor has completely recovered from hepatitis B and required medication to do so

 PERMANENTLY EXCLUDE:

•  If donor’s current sexual partner required medication to recover from hepatitis B 

        This exclusion applies even if the donor was vaccinated against Hepatitis B

5. Current sexual partner of the donor has completely recovered from hepatitis B and did NOT require medication to do so

DEFER and REFER:

• To Specialist  Medical Officer 

This deferral applies even if the donor was vaccinated against Hepatitis B

Obtain the following details from the donor:

• Name of the sexual partner
• The source of sexual partner’s infection
• When sexual partner became infected with hepatitis B
• When sexual partner cleared the infection with hepatitis B virus
• Confirm if the donor and their partner were sexually active at the time of the acute infection / after the infection etc
• Ask if the donor was vaccinated
• Explain to the donor that they cannot donate until / unless information has been obtained from their sexual partner’s GP. Advise the donor to inform their sexual partner of this
• Advise the donor a medical assessment of their eligibility to donate will be made at the NBC / MRTC after the relevant information has been obtained
• If the donor does not want their sexual partner to be contacted, advise them that they will be permanently excluded from donation
• Document all the above details on a Confidential form and return to the NBC/MRTC

MEDICAL ASSESSMENT

If it is established, following receipt of a GP’s letter that the donor’s sexual partner made a full recovery from hepatitis B without requiring medication, the donor can donate 4 months after their sexual partner’s full recovery

ADDITIONAL INFORMATION

If the donor’s current sexual partner recovered from hepatitis B naturally and did not require medication to do so, it is more likely that they will not relapse than if they required medication to recover

6. Former sexual partner of the donor had completely recovered from hepatitis B at the time of the last sexual contact (and may or may not have required medication to do so)

DEFER:

• For 4 months from the date of the last sexual contact

This deferral applies even if the donor was vaccinated against Hepatitis B

7. Current household contact of the donor has acute or chronic hepatitis B

PERMANENTLY EXCLUDE:

• If donor currently shares a home with a person who has acute or chronic hepatitis B

This exclusion applies even if the donor was vaccinated against Hepatitis B

ADDITIONAL INFORMATION

Household contacts are defined as: permanent residents of the household. The risk relates to items that may be shared and may contain trace amounts of blood such as toothbrushes, scissors, razors and tweezers

Visitors to the household are not defined as household contacts. This includes family members who are not permanent members of the household. However, all visitors should be asked if they have shared items of risk (including inadvertently) and be accepted or deferred based on their response/s

8. Former household contact of the donor had acute or chronic hepatitis B at that time

DEFER:

• For 4 months from the date of the last household contact

This deferral applies even if the donor was vaccinated against Hepatitis B

9. Current household contact of the donor has completely recovered from hepatitis B and required medication to do so

 PERMANENTLY EXCLUDE:

• This deferral applies even if the donor was vaccinated against Hepatitis B

10. Current household contact of the donor completely recovered from hepatitis B and did NOT require medication to do so

DEFER and REFER:

• To Specialist Medical Officer. This deferral applies even if the donor was vaccinated against Hepatitis B

 When referring to a Specialist Medical Officer, obtain the following details from the donor:

• Name of the household contact
• The source of household contact’s infection
• When household contact became infected with hepatitis B
• When household contact cleared the infection with hepatitis B virus
• Ask if the donor was vaccinated
• Explain to the donor that they cannot donate until/unless information has been obtained from his/her household contact’s GP. Advise the donor to inform their household contact of this
• Advise the donor a medical assessment of their eligibility to donate will be made at the NBC/MRTC after the relevant information has been obtained from the household contact’s GP, with that person’s written consent
• If the donor does not want their household contact to be contacted, advise them that they will be permanently excluded from donation

Document all the above details on a Confidential form and return to the NBC/MRTC

MEDICAL ASSESSMENT

If it is established, that the donor’s household contact made a complete recovery from hepatitis B without requiring medication, the donor can donate 4 months after their household contact’s complete recovery

11. Former household contact of the donor had completely recovered from hepatitis B at the time of the last household contact (and may or may not have required medication to do so)

DEFER:

• 4 months from the date of the last household contact

This deferral applies even if the donor was vaccinated against Hepatitis B

12. Any other current contact – the donor is in contact that is not sexual and not household contact with a person who has acute or chronic hepatitis B e.g. social contact

ACCEPT:

• As long as the donor has not suffered an inoculation injury

13. Any other former contact – the donor was in contact that is not sexual and not household contact with a person who has acute or chronic hepatitis B e.g. social contact

ACCEPT:

• As long as the donor has not suffered an inoculation injury

14. Immunisation/Vaccination

14.1 Known Exposure plus Vaccination and/or Immunoglobulin (Donor had active immunisation for hepatitis B, i.e. vaccination and/or immunoglobulin after known exposure to hepatitis B)

DEFER:

• for 4 months if the donor had active immunisation for hepatitis B Virus, but did not have Hepatitis B Immunoglobulin (HBIG), following a known exposure to hepatitis B such as an occupational blood exposure or human bite
• for 4 month  if the donor had active immunisation for hepatitis B Virus, following a known exposure to hepatitis B such as sexual or household contact
• if the donor is still under follow-up, even if 4 months has elapsed since the exposure
• for 12 months if the donor had Hepatitis B Immunoglobulin (HBIG), following a known exposure to hepatitis B, regardless of the type of exposure

A longer deferral period may be required if the exposure is continuing

14.2 Routine Vaccination ( donor hadno known exposure)

DEFER:

• For 28 days after routine vaccination against hepatitis B

ADDITIONAL INFORMATION

Donors who have had hepatitis B vaccination should be deferred for 28 days thereafter as long as there has been no known exposure. This is because some sensitive assays for HbsAg may test positive following recent administration of vaccine. Hepatitis B immunoglobulin (HBIG) administered after a known exposure (with or without the vaccine) can prolong the incubation period. Therefore, we have extended the deferral period from 4 months to 12 months after an inoculation injury if HBIG was given