Prevalence of occult hepatitis B infection among blood donors from 2015 to 2025: A meta-analysis based on testing modalities and temporal trends

BACKGROUND AND OBJECTIVES: Occult hepatitis B infection (OBI) remains an important concern for global blood safety. Published studies have reported inconsistent OBI prevalence among blood donors, and the influencing factors remain unclear. This meta-analysis aimed to estimate the pooled OBI prevalence and explore potential sources of heterogeneity. MATERIALS AND METHODS: We retrieved eligible studies published from 2015 to 2026. Pooled prevalence was calculated using a random-effects model. Subgroup analyses were conducted by testing method, study period, sample size, region, and national hepatitis B virus (HBV) screening conditions. Publication bias and result robustness were assessed via multiple statistical approaches. RESULTS: Significant between-study heterogeneity was identified. All subgroup analyses produced statistically significant interaction results (p for interaction ≤ 0.015). The prevalence of OBI varied remarkably across subgroups stratified by HBV-DNA testing method, research period, sample size, geographic region, national HBV endemicity, and blood screening level. The pooled OBI prevalence was higher in the 2023-2024 subgroup, although this likely reflects geographic confounding rather than a genuine temporal increase. No substantial publication bias was detected, and the overall pooled estimate was stable. High residual heterogeneity still persisted in all stratified subgroups. CONCLUSION: OBI is prevalent among global blood donors and affected by detection techniques, study period, sample size, region, and local screening capacity. Standardized molecular testing and long-term surveillance are recommended to reduce transfusion-transmitted HBV risks and ensure blood safety.