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

Abstract

Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China. Less is known about the clinical characteristics and natural history of HEV-4 than HEV genotype 3 infections in immunocompromised patients. We report transmission of HEV-4 from a deceased organ donor to 5 transplant recipients. The donor had been viremic but HEV IgM and IgG seronegative, and liver function test results were within reference ranges. After a mean of 52 days after transplantation, hepatitis developed in all 5 recipients; in the liver graft recipient, disease was severe and with progressive portal hypertension. Despite reduced immunosuppression, all HEV-4 infections progressed to persistent hepatitis. Four patients received ribavirin and showed evidence of response after 2 months. This study highlights the role of organ donation in HEV transmission, provides additional data on the natural history of HEV-4 infection, and points out differences between genotype 3 and 4 infections in immunocompromised patients.

Hepatitis E Infections in Transplants

“…The incubation period ranged between 34 and 67 days. In this case, all the HEV infections evolved to chronic hepatitis [28]. No reactivation of HEV infection was noted after solid organ transplantation for anti-HEV IgG-positive patients [16].…”

“…Rare cases of graft-transmitted HEV infections have been reported for genotype 3 in kidney and liver recipients [26,27]. For genotype 4, multiple HEV transmissions that have affected five transplant recipients have been recently described from the HEV hepatitis E virus same donor with HEV viremia [28]. The incubation period ranged between 34 and 67 days.…”

“…Most chronic HEV infections that have been reported are genotype 3-infected immunocompromised patients [10]. Recently, 12 cases of genotype 4 chronic infections were also published [11,28,34]. Moreover, one case of chronic HEV genotype 7 infection was reported in a liver transplant recipient from the Middle East who consumed camel-derived food products including milk and meat [5].…”

Prevalence of anti-hepatitis E virus antibodies in domestic animal from three representative provinces of Burkina Faso

“…Some positive specimens seem stackable to negative; this is explained by the fact that some samples, particularly in sheep, have an OD value close to or equal to the CUT-OFF value. These samples could correspond to indeterminable cases and should be re-examined by another test such as Western Blot, in order to eliminate false positive cases caused by potential agents antigenically-related to HEV ( Sridhar et al., 2019 , Yugo et al., 2019 ).…”

Risk of Hepatitis E among Persons Who Inject Drugs in Hong Kong: A Qualitative and Quantitative Serological Analysis

“…In addition to foodborne transmission, HEV-A genotypes 3 and 4 can also be transmitted via contaminated blood products or organs [ 8 , 9 ]. Asymptomatic viremic blood donors have been documented in several countries [ 10 ].…”