Hepatitis E and blood donation safety in selected European countries: a shift to screening?

Abstract

The public health implications of hepatitis E virus (HEV) in Europe have changed due to increasing numbers of hepatitis E cases and recent reports of chronic, persistent HEV infections associated with progression to cirrhosis in immunosuppressed patients. The main infectious risk for such immunosuppressed patients is exposure to undercooked infected pork products and blood transfusion. We summarised the epidemiology of HEV infections among blood donors and also outlined any strategies to prevent transfusion-transmitted HEV, in 11 European countries. In response to the threat posed by HEV and related public and political concerns, most of the observed countries determined seroprevalence of HEV in donors and presence of HEV RNA in blood donations. France, Germany, Spain and the United Kingdom (UK) reported cases of transfusion-transmitted HEV. Ireland and the UK have already implemented HEV RNA screening of blood donations; the Netherlands will start in 2017. Germany and France perform screening for HEV RNA in several blood establishments or plasma donations intended for use in high-risk patients respectively and, with Switzerland, are considering implementing selective or universal screening nationwide. In Greece, Portugal, Italy and Spain, the blood authorities are evaluating the situation. Denmark decided not to implement the HEV screening of blood donations.

Hepatitis E virus seroprevalence among blood donors in Pune, India

“…Till recently, HEV genotype 3 was the sole cause of chronic infection in organ transplants, but with the very recent report that HEV genotype 4 can also cause chronic hepatitis in transplant recipients, HEV becomes a virus of emerging importance to vulnerable transfusion recipients . Despite the high prevalence, high rate of transmission by HEV infected blood or blood products and narrow range of HEV‐specific efficient antiviral therapy, factors like associated low level of morbidity, mortality, and economic benefit of donation screening have resulted in implementation of HEV screening only in the developed countries like United Kingdom, Ireland and the Netherlands …”

Risk factors and seroprevalence of hepatitis E evaluated in frozen‐serum samples (2002‐2003) of pregnant women compared with female blood donors in a Southern region of Brazil

“…Additionally, in recent publications in Europe, using the more sensitive Wantai assay, many different HEV seroprevalences were described. As reported, there seems to be a broad variation of results depending on the geographical area, as shown by a French study in blood donors, with an overall HEV IgG seroprevalence of 22.4% (8% to 86.4%), in Spain 19.9%, in Switzerland from 12.8% to 33.6%, and in Ireland 5.3% . Furthermore, in the group of blood donors seroprevalence between 11% in England and 6% in Scotland was described, however, the assay used was not cited by the author …”

Blood Donor Screening for Hepatitis E Virus in the European Union

“…During this time frame, 80% of HEV infections (16,810/21,018) were reported in 3 EU countries: Germany, France, and the UK. Another 2017 publication which followed an ECDC expert consultation meeting ­assessing the risk and prevention of HEV transmission through substances of human origin (Lisbon, May 27, 2016; participants from 11 EU countries) commented: “if implemented, the screening of blood donations should go hand in hand with raising clinicians’ awareness and strict dietary recommendation for patients at risk” [5]. A consultation survey on HEV screening involving 16 different countries suggested that “blood screening is an option but according to the majority of responders requires additional data and analyses” with the preferred solution being the eradication of HEV from environmental sources [6].…”