Fulminant Transfusion-Associated Hepatitis E Virus Infection Despite Screening, England, 2016–2020

Abstract

In England, all blood donations are screened in pools of 24 by nucleic acid test (NAT) for hepatitis E virus (HEV) RNA. During 2016–2020, this screening successfully identified and intercepted 1,727 RNA-positive donations. However, review of previous donations from infected platelet donors identified 9 donations in which HEV RNA detection was missed, of which 2 resulted in confirmed transmission: 1 infection resolved with ribavirin treatment, and 1 proceeded to fatal multiorgan failure within a month from infection. Residual risk calculations predict that over the 5-year study period, HEV RNA detection was missed by minipool NAT in 12–23 platelet and 177–354 whole-blood donations, but transmission risk remains undetermined. Although screening has been able to largely eliminate infectious HEV from the blood supply in England, missed detection of low levels of HEV RNA in donated blood can lead to a severe, even fulminant, infection in recipients and could be prevented by more sensitive screening.

Longitudinal analysis of annual national hemovigilance data to assess pathogen reduced platelet transfusion trends during conversion to routine universal clinical use and 7‐day storage

“…Nucleic acid testing (NAT) as used in the United Kingdom 53 has been considered but not yet adopted 37 . Pathogen reduction may still play a role in mitigating TT HEV risk, especially given recent reports of TT HEV cases in NAT screened PCs 54 . Further research is required to optimize the effectiveness of the amotosalen/UVA PR technology against HAV and HEV 35 …”

“…37 Pathogen reduction may still play a role in mitigating TT HEV risk, especially given recent reports of TT HEV cases in NAT screened PCs. 54 Further research is required to optimize the effectiveness of the amotosalen/ UVA PR technology against HAV and HEV. 35 The trends documented by ANSM since 2010 should be considered in the context of stable PC utilization in the EU.…”

Clinical performance of a new multiplex assay for the detection of HIV‐1, HIV‐2, HCV, HBV, and HEV in blood donations in Catalonia (Spain)

“…In contrast, HEV ID‐NAT screening using UPxE assay allows blood banks to increase the detection of donations with low HEV viral load (95% limit of HEV detection is 3.6 IU/mL). Although MP HEV screening strategies have largely reduced the risk of transfusion‐transmitted HEV infections, two cases of missed low levels of HEV RNA in donated blood in England produced severe, even fulminant, infection in recipients 15 . Thus, more sensitive HEV screening strategies could prevent transfusion‐transmitted HEV infections.…”

“…Several studies have reported the distribution of HEV viral loads detected in blood donors, showing that approximately 30%-50% of HEV-positive donations have a viral load <100 IU/mL. 9,12,13 Furthermore, estimates of the infectious dose resulting in transfusion-transmitted HEV have varied between different studies, ranging from approximately 20,000 IU HEV RNA 7,16 to <6660 IU HEV RNA in more recent reports, 8,15 underscoring the need for sensitive nucleic acid testing to screen donations for HEV. Notably, it has been reported that transfusion-transmitted HEV can occur from blood products that have been treated with pathogen inactivation technologies.…”

Dual Infection of Hepatitis A Virus and Hepatitis E Virus— What Is Known?

“…Extrahepatic disorders are rare in HAV-infected patients, which include renal, arthritis, cutaneous vasculitis, and neurological diseases [ 107 , 108 , 109 , 110 ]. HEV infection could result in fulminant hepatic failure (FHF) [ 100 , 111 ], while FHF is rare in HAV monoinfection [ 112 , 113 ].…”