Prevalence of hepatitis E virus infection among hemodialysis patients in Japan: Evidence for infection with a genotype 3 HEV by blood transfusion

Abstract

To investigate the prevalence of hepatitis E virus (HEV) infection among patients on maintenance hemodialysis, serum samples collected in January 2003 from 416 patients who had been undergoing hemodialysis for 7.6 +/- 6.3 (mean +/- standard deviation) (range, 0.3-26.0) years in a dialysis unit in Japan and serum samples that had been collected from these patients at the start of hemodialysis were tested for IgG antibodies to HEV (anti-HEV IgG) by an "in-house" enzyme-linked immunosorbent assay (ELISA). Overall, 39 patients (9.4%) had anti-HEV IgG in January 2003, and included 35 patients (8.4%) who had already been positive for anti-HEV IgG at the start of hemodialysis and 4 patients (1%) who seroconverted after initiation of hemodialysis. Periodic serum samples that had been collected from the four seroconverted patients were tested for HEV antibodies and HEV RNA. The four patients became positive for anti-HEV IgG in 1979, 1980, 1988, or 2003, and continued to be seropositive until the end of the observation period. Although anti-HEV IgM was not detectable in the four patients, three were infected transiently with apparently Japanese indigenous HEV strains of genotype 3. The patient who contracted HEV infection in 1979 had been transfused with 2 U of blood 21 days before the transient viremia: one of the two stored pilot serum samples had detectable HEV RNA with 100% identity to that recovered from the patient. Our study provides evidence of transfusion-transmitted HEV infection in Japan in 1979, and that the prevalence of de novo HEV infection during hemodialysis was low (1.1% or 4/374).

Temporal Changes in Environmental Health Risks and Socio-Psychological Status in Areas Affected by the 2011 Tsunami in Ishinomaki, Japan

“…The HEVs associated with human hepatitis are classified into four genotypes (Lu, Li & Hagedorn, 2006). Genotypes 1 and 2 cause waterborne outbreaks in developing countries and genotypes 3 and 4 are considered to be zoonotic and transmitted through the consumption of uncooked or undercooked contaminated meat (Mitsui et al, 2004;Wong, Purcell, Sreenivasan, Prasad, & Pavri, 1980). Total RNA was extracted from sludge suspensions using QIAamp Viral RNA Kits (QIAGEN, Hilden, Germany).…”

Hepatitis-E-Virus

“…In einigen Untersuchungen wurde gezeigt, dass Hämodialysepatienten ein erhöhtes HEV-Infektionsrisiko haben [190,195]. In der Regel war dabei unbekannt, ob die Infektion auf die Gabe von Blutprodukten zurückzuführen war oder auf anderem Weg erworben worden war.…”

“…Über transfusionsassoziierte HEV-Übertragun-gen wurde aus Saudi-Arabien berichtet, einem Land, in dem HEV-1 endemisch ist [181]. Erste Berichte aus Japan, das nicht als HEV-Endemiegebiet eingestuft wird, über transfusionsassoziierte HEV-Infektionen erfolgten etwa zeitgleich [188,190]. In einem Fall konnte gezeigt werden, dass eine Übertragung durch die Transfusion von therapeutischem Plasma erfolgte, jedoch nicht durch das Erythrozytenkonzentrat des gleichen Spenders [188].…”

Chronic Hepatitis E Virus Infection and Treatment

“…Although, no case of HEV transmission via blood transfusion has been reported in the transplant population, 9 HEV seroprevalence in blood donors is high 29 and cases of HEV transmission via blood products have been reported in other populations. [30][31][32] Hence, if HEV infection is detected a few days after a blood transfusion, this mode of contamination should be investigated.…”