Hepatitis E virus in Spanish donors and the necessity for screening

Abstract

Summary Hepatitis E virus (HEV) represents a major health problem worldwide. As the course of HEV cases is often subclinical, asymptomatic infections could represent an important source of viral spread and infection via routes such as blood donations. Before universal screening for HEV in blood donations can be implemented, studies evaluating the incidence of infection are needed to establish the potential risk of viral transmission. This is a prospective longitudinal study that included blood donors recruited at the Hospital de Ciudad Real Transfusion Service between October 2017 and January 2018. Pools of eight donations were tested for HEV viremia by PCR. Positive pools were individually evaluated following the same procedure. Positive samples were tested for anti‐HEV IgG and IgM. Recipients of blood transfusions obtained from HEV‐positive donors were retrospectively evaluated. The prevalence of HEV was calculated. A total of 11 313 healthy donors were analysed during the study period. Four blood donations from four different donors were HEV RNA‐reactive. The prevalence of HEV infection was 0.035% (95% CI: 0.01%‐0.09%), which meant a ratio of one positive donation per 2828 donations. All donors were negative for anti‐HEV IgM at the time of the donation. Five patients received transfusions from HEV‐positive blood donations, none of them showed an increase in alanine aminotransferase levels after transfusion. In conclusion, our study found a high prevalence of HEV infection in blood donors from south‐central Spain. In view of the prevalence, Spanish blood banks should carefully consider including screening for HEV.

Effect of Hepatitis E Virus RNA Universal Blood Donor Screening, Catalonia, Spain, 2017‒2020

“…In our study, 15 of 151 HEV-positive blood donors showed moderate and transient increases of alanine aminotransferase levels, although none had hepatic or extrahepatic manifestations either at the time of donation or at 6-month follow-up. In our study, HEV RNA clearance in infected donors was achieved after a maximum of 71 days, similar to what was observed in another study in Spain ( 17 ). None of the infected donors showed development of chronic HEV infection, and none were reinfected at follow-up.…”

“…We detected 151 HEV RNA‒positive donations, corresponding to a prevalence of 1 case/4,341 donations, which is consistent with the prevalence reported in the same cohort during 2013, although in this study, HEV RNA was detected in individual samples ( 16 ). This proportion of HEV-infected donors is similar to those reported by Canada (1 case/4,615 donations) and many countries in Europe, including England (1 case/2,848 donations 1 case/4,781 donations), Ireland (1 case/4,745 donations), Austria (1 case/5,369 donations), and Belgium (1 case/5,448 donations) ( 13 , 17 – 20 ). Although we observed lower prevalence than Germany (1 case/1,241 donations), France (1 case/1,317 donations), and the Netherlands (1 case/1,987 donations) ( 21 – 23 ), the results cannot be compared directly because different pool size and methods have been used.…”

“…During 2013, the prevalence of HEV RNA in blood donations in Catalonia was 1 case/3,333 donations, tested individually, whereas HEV IgG seroprevalence was 20% ( 16 ). Another study conducted in south-central Spain during 2017‒2018 showed a similar prevalence of HEV infection among blood donors (1 case/2,828 donations) ( 17 ). Furthermore, 2 cases of HEV transfusion-transmitted infection by supernatant of cryoprecipitate and erythrocyte concentrate were documented in Catalonia during 2015 and 2017 ( 11 , 12 ).…”

A Novel In-House Enzyme-Linked Immunosorbent Assay for Genotype 3 Hepatitis E Virus Reveals High Seroprevalence in Blood Donors in Northern Argentina

“…The main infection mechanism seems to be the consumption of contaminated raw or undercooked meat (Cai et al, 2017; Cook et al, 2017) or contact with infected animals (Vonesch et al, 2019). Certain concern has arisen regarding the need to control blood transfusion units for the presence of HEV nucleic acids (Kraef et al, 2018; Harvala et al, 2019; Rivero-Juarez et al, 2019). Still, there is no clear consensus on whether HEV detection should be included in routine blood product screenings.…”

Transfusion-transmitted hepatitis E: What we know so far?

“…The infectivity of the non-enveloped form is different to that of enveloped HEV[ 9 ]. Data reporting outcomes of recipients of HEV-infected blood products are sparse[ 47 , 49 , 50 , 60 , 64 ].…”