Prevalence and Implications of Occult Hepatitis B Virus Infection Among Blood Donors in Saudi Arabia: A Systematic Review and Meta-Analysis.

Background

Hepatitis B virus (HBV) remains a transfusion-transmissible infection of global concern. While mandatory screening for hepatitis B surface antigen (HBsAg) has reduced overt infections, occult hepatitis B infection (OBI) poses ongoing risk. This meta-analysis aimed to estimate the pooled prevalence of anti-HBc, HBsAg, and OBI in Saudi blood donors, as well as to assess regional variations and temporal trends.

Methods

A systematic meta-analysis was conducted using nine studies published between 2013 and 2024, encompassing a total of 87,820 blood donors. Prevalence was pooled using random-effects models with logit transformation and Hartung-Knapp adjustment. Heterogeneity was quantified with I2 and τ2. Subgroup analyses examined geographic regions; meta-regression assessed publication year. Publication bias was evaluated with Egger's regression; sensitivity analyses tested robustness.

Results

The pooled prevalence of anti-HBc was 5% (95% CI: 3-7%), HBsAg was 0.46% (95% CI: 0.31-0.69%), and OBI was 0.12% (95% CI: 0.03-0.39%). High heterogeneity was observed (I2 = 90.6-98.9%). Subgroup analyses revealed regional disparities, and meta-regression showed no significant temporal trends.

Conclusions

The findings suggest that past HBV exposure remains relatively common among Saudi blood donors, while current active infection and OBI are infrequent. These results support continued enhanced screening, including anti-HBc and nucleic acid testing (NAT), to ensure transfusion safety. The lack of a national hemovigilance system that monitors transfusion-transmitted infections among recipients represents a critical gap in Saudi Arabia's transfusion safety framework. Addressing this gap is essential to fully assess residual risks, evaluate the real-world effectiveness of screening policies, and align with global best practices in blood safety.