Prevalence and characteristics of Hepatitis B and other transfusion-transmitted infections among blood donors in Albania: Implications for blood safety and screening strategies

• Overall, a prevalence of 3.1% for active infections (HBV, HCV, HIV and syphilis) was found • The most prevalent infection was HBV with 2.8% HBsAg positivity and 0.2% OBI • OBI cases had a statistically significant older age compared with HBsAg positive cases • No key differences between anti-HBs positive and negative donors were found • Lack of vaccination, low education, and low ALT predicted HBV infection Blood transfusion, although lifesaving, may carry inherit risks, including transfusion-transmitted infections (TTIs). This study aims to assess the prevalence and characteristics of HBV infection, including occult HBV and other TTIs (HCV, HIV and syphilis) among blood donors in Albania. This retrospective observational study analysed blood donor samples from the National Blood Transfusion Center in Tirana (January–December 2024). Serological assays and nucleic acid testing (NAT) were performed following standard protocols. All donations positive for HBsAg, HCV, syphilis, HIV, NAT triple assay, or with ALT >2 × ULN were included. Demographic and clinical data collected comprised age, gender, region, education level, blood type, BMI, and ALT values. Among 25,474 donors, 6.4% tested positive at the first screening for at least one infection marker or liver injury indicator. Most positive cases were male (82%), with a median age of 40 years, and had secondary education (42%). Serology identified HBsAg 2.8%, anti HCV 0.6%, HIV 0.1% (confirmed positive 0.057%), and syphilis 0.4% (confirmed positive 0.15%). Overall, a prevalence of 3.1% for confirmed active infections (HBV, HCV, HIV and syphilis) was found. NAT triple assay was reactive in 860 samples; 65 HBsAg-negative cases (0.2%) were confirmed as HBV-DNA positive (occult HBV infection, OBI). OBI cases had a median anti-HBc and anti-HBs titers 6.3 and 7.3 respectively, with 40% showing positive anti-HBs levels. No significant demographic or clinical differences were found between anti-HBs positive and negative individuals. In multivariable analysis, lack of vaccination, lower education, and lower ALT remained independent predictors of HBV infection. This study emphasizes the importance of comprehensive screening strategies, including NAT, to identify occult infections that could compromise blood safety. Continued promotion of vaccination, education, and regional surveillance is essential to reduce the burden of HBV and other TTIs in blood donors and the general population.