Transmission of hepatitis through blood transfusion was first reported in 1943 (Beeson, 1943; Morgan and Williamson, 1943). Hepatitis transmitted through faecal-oral mechanisms was termed hepatitis A (‘epidemic hepatitis’), while hepatitis transmitted through blood and its derivatives (‘serum hepatitis’) was termed hepatitis B. These terms were formally adopted by the World Health Organization in the 1970s (Dienstag, 2002).
Prevention of the transmission of hepatitis by blood transfusions began with donor screening through the use of a donor questionnaire, primarily for a history of hepatitis, commonly referred to as ‘yellow jaundice’. Laboratory screening for hepatitis B virus began in 1969, with the testing of blood donors for what eventually became known as the hepatitis B surface antigen (HBsAg). Soon after regular testing of donor blood for HBsAg was initiated and tests for antibody to the hepatitis A virus became available, it became apparent that the majority of cases of transfusion-transmitted viral hepatitis were not related to hepatitis A or hepatitis B. The then undefined virus, named non-A, non-B (NANB) hepatitis virus, was believed to be the cause of a large number of transfusion-related infections. In an effort to reduce the number of transfusion-transmitted NANB viral hepatitis infections, ‘surrogate’ or substitute testing of donor blood was evaluated in the 1970s, initially in the USA.
In 1981, an association between elevated serum levels of alanine aminotransferase (ALT) in blood donors and transfusion-transmitted NANB hepatitis in recipients was reported (Aach et al., 1981; Alter et al., 1981).