Abstract Background & aims In China, blood donations are routinely screened for both HBsAg and HBV DNA to prevent transfusion-transmitted hepatitis B virus (HBV) infection. However, the benefit of implementing universal anti-HBc screening to intercept occult HBV infection remains debated, primarily due to concerns over donor loss and cost-effectiveness. This study aimed to assess the prevalence of anti-HBc among blood donors in Guangzhou and to evaluate whether the current HBV screening strategy in China requires further optimization. Methods In this study, we enrolled 25,056 voluntary blood donors who tested negative for both HBsAg and HBV DNA. All samples were first screened for anti-HBc using ELISA. A subset of positive samples was then retested with an electrochemiluminescence (ECL) assay. Subsequently, quantitative anti-HBs testing was performed on samples that were positive by both assays, and those that were anti-HBs-negative underwent HBV RNA testing. Results The initial anti-HBc-positive rate was 27.1% (6795/25,056), which exhibited a strong age-dependent increase but showed no association with gender. Of the 1343 samples that underwent retesting, 82.1% (1102/1343) were confirmed positive. Among the double-positive samples, 91.2% (990/1085) were also anti-HBs positive, and 53.5% (580/1085) presented with anti-HBs levels ≥ 200 IU/L. No statistically significant difference in anti-HBs levels was observed between genders or across age groups. Furthermore, HBV RNA was not detected in any of the 95 anti-HBs-negative samples tested. Conclusion The high prevalence of anti-HBc, coupled with a substantial proportion of donors having protective levels of anti-HBs, suggests that the incremental benefit of universal anti-HBc screening in Guangzhou’s current donor population may be limited. While implementing such assays is not considered feasible at present, future declines in prevalence of HBV infection may warrant a re-evaluation and optimization of the screening strategy.
Shan et al. (2026) studied this question.