Hepatitis A virus (HAV) RNA detection in Polish blood donors and likely transmissions through blood components during the 2017–2019 epidemic

Abstract

Background In Poland, hepatitis A virus (HAV) RNA screening was performed in plasma for fractionation usually immediately before shipment. Objective Our goal was to study epidemiology, rate of transfusion transmitted HAV during epidemic (2017–2019), and viral characteristics of infected plasma donors. Study Design and Methods HAV RNA was tested in 1,866,590 donations from 1,210,423 donors using RT‐PCR in mini pools of 96 (MP96) or TMA in MP16. Virological characteristics included RNA level (RL), antibody testing, and sequencing. Results Twenty‐one HAV infections were identified (1.13/100,000 donations; 95% confidence interval [95% CI]: 0.74–1.72) and (1.73/100,000 donors; 95% CI: 1.35–2.65). The Blood Transfusion Centers were also informed about three donors, who were hospitalized for hepatitis A soon after their blood donation. In addition, we identified a donor, who had reactive result for HAV after receiving HAV vaccination. He tested positive twice 10 days after receiving the first and the second dose. The highest RL was 16 million IU/ml, mean 1,706,905 IU/ml, and median 220 IU/ml. The longest detectable RL lasted for 113 days. HAV‐infected donors were seronegative (36%) or IgM positive (64%). We followed up on 12 HAV contaminated blood components issued for transfusion. In two out of seven identified patients viral transmission was confirmed (28.6%). Conclusion Based on our results, we propose a 6 month deferral after HAV infection and 14 days post HAV vaccination. The infectivity rate was below 30%. The HAV RNA testing could be considered as an additional safeguard against HAV transmission at the time of increased incidence of HAV infections in the general population.

Hepatitis A in Latin America: The current scenario

“…Although no studies in South America have examined the risk of HAV transmission through blood products, transfusion transmitted HAV infection has been demonstrated during outbreak periods in Europe, highlighting a new associated risk. 24,25…”

“…Additionally, the risk of HAV transmission through blood transfusion should be considered in our region during periods of increased incidence. Although no studies in South America have examined the risk of HAV transmission through blood products, transfusion transmitted HAV infection has been demonstrated during outbreak periods in Europe, highlighting a new associated risk 24,25 …”

In Response: Getting the measure of hepatitis A virus (HAV): A better understanding of the RNA content of HAV reference material and blood donations

“…Sulkowska et al demonstrated transfusion transmission of HAV for two recipients by two window-period donations with RLs of between 5.3 and 6.5 log 10 IU/mL, although it is unclear what the total RL transfused was and the serostatus of the recipients at the time of transfusion. With declining incidence of anti-HAV antibodies (both natural and vaccineinduced) in Europe and higher RLs in donors than previously reported, 1,5 in real terms-at the copy number level, there is still much to learn about transfusion transmission of HAV. This includes minimum RLs that can result in transmission and the effect of existing anti-HAV antibodies in recipients.…”

“…We read with interest the report by Sulkowska et al, about the characterization of hepatitis A virus (HAV) RNA-positive blood donations during the 2017-2019 epidemic in Poland. 1 Two nucleic acid amplification technique (NAT)-based methods were used to screen the Polish donations for HAV RNA, that is, transcription mediated amplification (TMA) or real-time reverse transcription polymerase chain reaction (rRT-PCR) using systems provided by Gen-Probe Incorporated/Hologic Inc. or Roche Molecular Systems Inc., respectively. Dependent upon platform, the TMA assay had a sensitivity (95% limit of detection-LOD) of 0.87-1.06 International Units (IU)/mL and the PCR assay a sensitivity of 1.06-1.1 IU/mL.…”

Hepatitis A Virus Seropositivity in Young Individuals: Five-Year Retrospective Evaluation

“…Bununla birlikte, gelişmiş ülkelerde bildirilen yeni birkaç salgında kontamine gıdaların rolü olduğu gösterilmiştir (3) . Viremik fazdaki enfekte hastalar, kan nakliyle hastalığı nadir de olsa bulaştırabilir (4) .…”