Long-term HEV carriers without antibody seroconversion among eligible immunocompetent blood donors

Abstract

Hepatitis E virus (HEV) is emerging as a potential threat to the safety of blood transfusions. In many countries and regions endemic for HEV, such as China, blood donors are not routinely tested for HEV infection. In this study, 11747 eligible blood donors were screened for anti-HEV immunoglobulin M (IgM)/immunoglobulin G (IgG) and HEV RNA and antigen in China. Twenty-four donors who were positive for both HEV antigen and RNA were followed for ≥ 70 days, and none of these donors reported clinical hepatitis or illness. At least 1 follow-up sample was provided by 17 donors, including 10 with viremia and/or antigenemia for ≥ 70 days and 3 with antigen and RNA positivity for >90 days. Fourteen of the 17 donors did not present with an obvious serologic response during the follow-up period. These results differed from previous reports, in which viremia lasted for 68 days and elicited an antibody response. These donors showed atypical HEV infection progression that differed from that of hepatitis E patients. The presence of these donors presents a challenge for transfusion transmission screening.

Evaluation of hepatitis E antigen kinetics and its diagnostic utility for prediction of the outcomes of hepatitis E virus genotype 1 infection

“…Furthermore, the kinetic of HEV Ag during chronic HEV infections and its impact on HEV diagnosis was studied in human liver chimeric mice [ 35 ]. Long-term HEV viremia and/or antigenemia and without a serologic response or symptoms of AHE were recorded in immunocompetent blood donors [ 38 , 39 ]. However, limited data is available on the diagnostic utility of the HEV Ag assay on HEV-1 infections.…”

Prevalence of hepatitis E viraemia among blood donors: a systematic review

“…On review of full‐text articles for the remaining 140 citations, 83 did not meet selection criteria. Of the 57 citations selected for final data synthesis , one provided three data sets ; hence, we had a total of 59 data sets from 28 countries (Fig. ).…”

“…Ten studies described the temporal course of viraemia in the viraemic blood donors. Of the 144 such donors included in these studies, 111 (genotype 3 in 92, genotype 4 in 17 and unknown in 2) had been followed up, and all showed clearance of HEV RNA.…”

Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018

“…The donor in our study was a young woman whose liver function test results were within reference ranges and whose premortem serum was negative for HEV IgM but positive for HEV RNA; these values are compatible with organ donation during the window period of hepatitis E infection. However, subclinical long-term HEV carriage without seroconversion, a recently described entity in immunocompetent blood donors ( 21 , 22 ), cannot be excluded. Adoptive transfer of functional hepatitis B immunity via transplantation has been reported ( 23 , 24 ).…”