Unique clinical courses of transfusion‐transmitted hepatitis E in patients with immunosuppression

Satake, Masahiro; Matsubayashi, Keiji; Hoshi, Yuji; Taira, Rikizo; Furui, Yasumi; Kokudo, Norihiro; Akamatsu, Nobuhisa; Yoshizumi, Tomoharu; Ohkohchi, Nobuhiro; Okamoto, Hiroaki; Miyoshi, Masato; Tamura, Akinori; Fuse, Kyoko; Tadokoro, Kenji

doi:10.1111/trf.13994

Cited by 62 publications

(70 citation statements)

References 36 publications

(72 reference statements)

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“…The prevalence of HEV infection among blood donors varies depending on the geographical location, ranging from the highest reports in countries such as Germany (1 in 814 donors), France (1 in 1000 donors) and Scotland (1 in 2481 donors), to the relatively lower prevalence reported in Northeast Spain (1 in 4720), Ireland (1 in 4997), Sweden (1 in 8416) and Austria (1 in 8416) . Although the risk of infection due to blood transfusion has been estimated at 0.38% in the United Kingdom, the likelihood of developing acute HEV infection after receiving a blood transfusion using contaminated blood has been estimated at 42%‐50% . For this reason, and also taking into consideration that HEV seems to be resistant to most treatments applied to blood products, implementation of screening could be the most cost‐effective strategy for minimizing the risk of transmission by this route .…”

Section: Introductionmentioning

confidence: 99%

Hepatitis E virus in Spanish donors and the necessity for screening

Rivero‐Juárez

Jarilla‐Fernandez

Frías

et al. 2019

Journal of Viral Hepatitis

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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.

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Section: Introductionmentioning

confidence: 99%

Hepatitis E virus in Spanish donors and the necessity for screening

Rivero‐Juárez

Jarilla‐Fernandez

Frías

et al. 2019

Journal of Viral Hepatitis

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“…Cases of imported hepatitis E have occurred in individuals returning from travel to endemic countries . In addition, some cases of infection have occurred through the transfusion of blood products contaminated with HEV . In a report involving 254 cases of Japanese hepatitis E, approximately 60% of the cases had no clear risk factors for HEV infection and the etiology remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

Changing clinical and molecular characteristics of hepatitis E virus infection in Mie Prefecture, Japan: Disappearance of indigenous subtype 3e strains

Nakano

Okano²,

Takahashi

et al. 2019

Hepatology Research

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Aim To evaluate the clinical and molecular characteristics of hepatitis E virus (HEV) infection in Mie Prefecture, Japan, from 2004 through 2018. Methods The clinical information of hepatitis E cases was collected from 21 medical institutions in Mie Prefecture. The nucleotide sequences of infecting HEV strains were determined for cases with available serum samples. The origins or transmission routes were inferred from phylogenetic analyses of the nucleotide sequences. Results Fifty‐three patients were diagnosed with HEV infection. The number of cases increased each year through 2012 and then decreased. Analyses of the clinical characteristics of the cases indicated that even mild cases were detected in the latter 10 years of the study. Nucleotide sequence analyses were undertaken on 38 of the 53 cases. The HEV subtype 3e (HEV‐3e) strains identified for 13 cases were closely related to a swine HEV‐3e strain that was isolated from the liver of a pig bred in Mie Prefecture. The number of cases infected with the indigenous Mie HEV‐3e strains increased until 2012 but have not been reported since 2014. In the latter half of the study, cases involving various HEV strains of different genotypes and subtypes emerged. Conclusions The disappearance of indigenous Mie HEV‐3e strains appeared to be the primary cause for the decrease in hepatitis E cases in Mie Prefecture. The disappearance might have been associated with improved hygienic conditions on pig farms or the closure of contaminated farms. The results suggest that indigenous HEV strains can be eradicated by appropriate management.

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“…HEV transmission by transfusion has been reported since 2004 from Europe and Japan . A study of 225,000 southeastern UK donors identified 79 (0.035%) with detectable HEV RNA .…”

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confidence: 99%

“…Chinese, European, and American investigators have detected HEV RNA in blood products, including pooled plasma, from otherwise acceptable donors . In Japan, a total of 20 patients were reported to have acquired HEV by transfusion of blood products . Consequently, blood centers in Hokkaido prefecture of northern Japan have routinely screened donors for HEV RNA during the past 10 years to prevent transmission by transfusion …”

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Probable transmission of hepatitis E virus (HEV) via transfusion in the United States

et al. 2019

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BACKGROUND Hepatitis E virus (HEV) can inapparently infect blood donors. To assess transfusion transmission of HEV in the United States, which has not been documented, a donor‐recipient repository was evaluated. STUDY DESIGN AND METHODS To identify donations that contained HEV RNA and were linked to patient‐recipients with antibody evidence of HEV exposure, we assayed samples from the Retrovirus Epidemiology Donor Study (REDS) Allogeneic Donor and Recipient repository that represents 13,201 linked donations and 3384 transfused patients. Posttransfusion samples, determined to contain IgG anti‐HEV by enzyme‐linked immunosorbent assay, were reassayed along with corresponding pretransfusion samples for seroconversion (incident exposure) or at least fourfold IgG anti‐HEV increase (reexposure). HEV‐exposed patients were linked to donations in which HEV RNA was then detected by reverse‐transcription quantitative polymerase chain reaction, confirmed by transcription‐mediated amplification, and phylogenetically analyzed as subgenomic cDNA sequences. RESULTS Among all patients, 19 of 1036 (1.8%) who had IgG anti‐HEV before transfusion were reexposed; 40 of 2348 (1.7%) without pretransfusion IgG anti‐HEV seroconverted. These 59 patients were linked to 257 donations, 1 of which was positive by reverse‐transcription quantitative polymerase chain reaction and transcription‐mediated amplification. Plasma from this donation contained 5.5 log IU/mL of HEV RNA that grouped with HEV genotype 3, clade 3abchij. The patient‐recipient of RBCs from this donation had a greater than eightfold IgG increase; however, clinical data are unavailable. CONCLUSIONS This is the first report of probable HEV transmission via transfusion in the United States, although it has been frequently observed in Europe and Japan. Additional data on the magnitude of the risk in the United States are needed.

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Unique clinical courses of transfusion‐transmitted hepatitis E in patients with immunosuppression

Cited by 62 publications

References 36 publications

Hepatitis E virus in Spanish donors and the necessity for screening

Hepatitis E virus in Spanish donors and the necessity for screening

Changing clinical and molecular characteristics of hepatitis E virus infection in Mie Prefecture, Japan: Disappearance of indigenous subtype 3e strains

Probable transmission of hepatitis E virus (HEV) via transfusion in the United States

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