DONOR INFECTIOUS DISEASE TESTING Prevalence of serologic markers for hepatitis B and C viruses in Brazilian blood donors and incidence and residual risk of transfusion transmission of hepatitis C virus Cesar de Almeida-Neto, Ester Cerdeira Sabino, Jing Liu, Paula Fraiman Blatyta, Alfredo Mendrone-Junior, Nanci Alves Salles, Silvana Carneiro Leão, David J. Wright, Fernando Valadares Basques, João Eduardo Ferreira, Michael P. Busch, and Edward L. Murphy for the NHLBI Retrovirus Epidemiology Donor Study-II (REDS-II), International Component BACKGROUND: We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepa- titis C virus (HCV) in blood donors and estimated HCV incidence and residual transfusion-transmitted risk at three large Brazilian blood centers. STUDY DESIGN AND METHODS: Data on whole blood and platelet donations were collected from January through December 2007, analyzed by center; donor type; age; sex; donation status; and serologic results for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HCV. HBV and HCV prevalence rates were calculated for all first-time donations. HCV incidence was derived includ- ing interdonation intervals that preceded first repeat donations given during the study, and HCV residual risk was estimated for transfusions derived from repeat donors. RESULTS: There were 307,354 donations in 2007. Overall prevalence of concordant HBsAg and anti-HBc reactivity was 289 per 100,000 donations and of anti- HCV confirmed reactivity 191 per 100,000 donations. There were significant associations between older age and hepatitis markers, especially for HCV. HCV inci- dence was 3.11 (95% confidence interval, 0.77-7.03) per 100,000 person-years, and residual risk of HCV window-phase infections was estimated at 5.0 per million units transfused. CONCLUSION: Improvement in donor selection, socio- economic conditions, and preventive measures, imple- mented over time, may have helped to decrease prevalence of HBV and HCV, relative to previous reports. Incidence and residual risk of HCV are also diminishing. Ongoing monitoring of HBV and HCV markers among Brazilian blood donors should help guide improved recruitment procedures, donor selec- tion, laboratory screening, and counseling strategies. D onor selection, serologic and molecular screening tests, and pathogen inactivation are measures applied to decrease transfusion- transmitted diseases. The implementation of nucleic acid test (NAT) technology has dramatically reduced the residual risk of transfusion-transmitted human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in developed coun- tries. 1,2 However, NATs are not available all over the world and residual risk of infection transmission persists mainly due to the window period of infectious agents and the high prevalence of disease in the source population. 3 A better understanding of the prevalence and inci- dence of hepatitis virus infections among blood donors is needed to monitor blood safety and identify and establish measures to minimize transfusion risk, as well as to inform public health policies focused not only on blood donors but also on the general community. In Brazil, which has an area of approximately 8,500,000 km 2 and From the Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brazil; the Department of Infectious Diseases, Medical School, and the Mathematics and Statistics Institute, University of São Paulo, São Paulo, SP, Brazil; Westat, Rockville, Maryland; the Fundação Hemope, Recife, PE, Brazil; the Fundação Hemo- minas, Belo Horizonte, MG, Brazil; and Blood Systems Research Institute, San Francisco, California. Address reprint requests to: Cesar de Almeida-Neto, MD, PhD, Avenida Dr Enéas de Carvalho Aguiar, 155 1° andar, bloco 12, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil; e-mail: cesarnt@uol.com.br. Supported by the National Heart Lung and Blood Institute, National Institutes of Health, Retrovirus Epidemiology Donor Study-II: International Component. Received for publication March 2, 2012; revision received June 24, 2012, and accepted June 25, 2012. doi: 10.1111/j.1537-2995.2012.03840.x TRANSFUSION 2013;53:827-834. Volume 53, April 2013 TRANSFUSION 827