1887
Surveillance Open Access
Like 0

Abstract

Introduction

Hepatitis E virus (HEV), the most common cause of acute hepatitis in many European countries, is transmitted through consumption of processed pork but also via blood transfusion and transplantation. HEV infection can become persistent in immunocompromised individuals.

Aim

We aimed to determine the incidence and epidemiology of HEV infection in English blood donors since the introduction of donation screening in 2016.

Methods

Between March 2016 and December 2017, 1,838,747 blood donations were screened for HEV RNA. Donations containing HEV RNA were further tested for serological markers, RNA quantification and viral phylogeny. Demographics, travel and diet history were analysed for all infected donors.

Results

We identified 480 HEV RNA-positive blood donations during the 22-month period, most (319/480; 66%) donors were seronegative. Viral loads ranged from 1 to 3,230,000 IU/ml. All sequences belonged to genotype 3, except one which likely represents a new genotype. Most viraemic donors were over 45 years of age (279/480; 58%), donors aged between 17 and 24 years had a seven-times higher incidence of HEV infection than other donors between March and June 2016 (1:544 donations vs 1:3,830). HEV-infected blood donors were evenly distributed throughout England. Screening prevented 480 HEV RNA-positive blood donations from reaching clinical supply.

Conclusion

HEV screening of blood donations is a vital step in order to provide safer blood for all recipients, but especially for the immunosuppressed. The unusually high rates of HEV infection in young blood donors may provide some insight into specific risks associated with HEV infection in England.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2019.24.10.1800386
2019-03-07
2024-04-25
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.10.1800386
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/24/10/eurosurv-24-10-4.html?itemId=/content/10.2807/1560-7917.ES.2019.24.10.1800386&mimeType=html&fmt=ahah

References

  1. Boxall E, Herborn A, Kochethu G, Pratt G, Adams D, Ijaz S, et al. Transfusion-transmitted hepatitis E in a ‘nonhyperendemic’ country. Transfus Med. 2006;16(2):79-83.  https://doi.org/10.1111/j.1365-3148.2006.00652.x  PMID: 16623913 
  2. Pérez-Gracia MT, García M, Suay B, Mateos-Lindemann ML. Current Knowledge on Hepatitis E. J Clin Transl Hepatol. 2015;3(2):117-26.  https://doi.org/10.14218/JCTH.2015.00009  PMID: 26355220 
  3. Schlosser B, Stein A, Neuhaus R, Pahl S, Ramez B, Krüger DH, et al. Liver transplant from a donor with occult HEV infection induced chronic hepatitis and cirrhosis in the recipient. J Hepatol. 2012;56(2):500-2.  https://doi.org/10.1016/j.jhep.2011.06.021  PMID: 21798217 
  4. Hewitt PE, Ijaz S, Brailsford SR, Brett R, Dicks S, Haywood B, et al. Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. Lancet. 2014;384(9956):1766-73.  https://doi.org/10.1016/S0140-6736(14)61034-5  PMID: 25078306 
  5. Adlhoch C, Avellon A, Baylis SA, Ciccaglione AR, Couturier E, de Sousa R, et al. Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15. J Clin Virol. 2016;82:9-16.  https://doi.org/10.1016/j.jcv.2016.06.010  PMID: 27393938 
  6. Kamar N, Selves J, Mansuy JM, Ouezzani L, Péron JM, Guitard J, et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med. 2008;358(8):811-7.  https://doi.org/10.1056/NEJMoa0706992  PMID: 18287603 
  7. Pischke S, Suneetha PV, Baechlein C, Barg-Hock H, Heim A, Kamar N, et al. Hepatitis E virus infection as a cause of graft hepatitis in liver transplant recipients. Liver Transpl. 2010;16(1):74-82.  https://doi.org/10.1002/lt.21958  PMID: 19866448 
  8. Kamar N, Rostaing L, Abravanel F, Garrouste C, Lhomme S, Esposito L, et al. Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection. Gastroenterology. 2010;139(5):1612-8.  https://doi.org/10.1053/j.gastro.2010.08.002  PMID: 20708006 
  9. Kamar N, Izopet J, Tripon S, Bismuth M, Hillaire S, Dumortier J, et al. Ribavirin for chronic hepatitis E virus infection in transplant recipients. N Engl J Med. 2014;370(12):1111-20.  https://doi.org/10.1056/NEJMoa1215246  PMID: 24645943 
  10. Tedder RS, Ijaz S, Kitchen A, Ushiro-Lumb I, Tettmar KI, Hewitt P, et al. Hepatitis E risks: pigs or blood-that is the question. Transfusion. 2017;57(2):267-72.  https://doi.org/10.1111/trf.13976  PMID: 28194857 
  11. Tedder RS, Tettmar KI, Brailsford SR, Said B, Ushiro-Lumb I, Kitchen A, et al. Virology, serology, and demography of hepatitis E viremic blood donors in South East England. Transfusion. 2016;56(6 Pt 2):1529-36.  https://doi.org/10.1111/trf.13498  PMID: 26841005 
  12. Said B, Ijaz S, Chand MA, Kafatos G, Tedder R, Morgan D. Hepatitis E virus in England and Wales: indigenous infection is associated with the consumption of processed pork products. Epidemiol Infect. 2014;142(7):1467-75.  https://doi.org/10.1017/S0950268813002318  PMID: 24054519 
  13. Recommendations from the expert advisory committee on the Safety of Blood, Tissues and Organs (SaBTO) on measures to protect patients from acquiring hepatitis E virus via transfusion or transplantation. These recommendations were approved by SaBTO on 1 Nov 2016. [Accessed 10 May 2018]. Available from: http://hospital.blood.co.uk/media/28794/sabto-recommendations-nov-2016.pdf
  14. Guidelines from the expert advisory committee on the Safety of Blood, Tissues and Organs (SaBTO) on measures to protect patients from acquiring hepatitis E virus via transfusion or transplantation. These guidelines were approved by SaBTO on 1 Nov 2016 and updated and approved in September 2017. [Accessed 10 May 2018]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/680297/Hepatitis_E_Guidelines.pdf
  15. Ijaz S, Arnold E, Banks M, Bendall RP, Cramp ME, Cunningham R, et al. Non-travel-associated hepatitis E in England and Wales: demographic, clinical, and molecular epidemiological characteristics. J Infect Dis. 2005;192(7):1166-72.  https://doi.org/10.1086/444396  PMID: 16136458 
  16. Stecher G, Liu L, Sanderford M, Peterson D, Tamura K, Kumar S. MEGA-MD: molecular evolutionary genetics analysis software with mutational diagnosis of amino acid variation. Bioinformatics. 2014;30(9):1305-7.  https://doi.org/10.1093/bioinformatics/btu018  PMID: 24413669 
  17. Domanović D, Tedder R, Blümel J, Zaaijer H, Gallian P, Niederhauser C, et al. Hepatitis E and blood donation safety in selected European countries: a shift to screening? Euro Surveill. 2017;22(16):30514.  https://doi.org/10.2807/1560-7917.ES.2017.22.16.30514  PMID: 28449730 
  18. Nelson KE, Kmush B, Labrique AB. The epidemiology of hepatitis E virus infections in developed countries and among immunocompromised patients. Expert Rev Anti Infect Ther. 2011;9(12):1133-48.  https://doi.org/10.1586/eri.11.138  PMID: 22114964 
  19. Lapa D, Capobianchi MR, Garbuglia AR. Epidemiology of Hepatitis E Virus in European Countries. Int J Mol Sci. 2015;16(10):25711-43.  https://doi.org/10.3390/ijms161025711  PMID: 26516843 
  20. Public Health England (PHE). Common animal associated infections quarterly report (England and Wales). London: PHE. [Accessed 25 Jun 2018]. Available from: https://www.gov.uk/government/publications/common-animal-associated-infections-quarterly-reports-2018
  21. Ijaz S, Said B, Boxall E, Smit E, Morgan D, Tedder RS. Indigenous hepatitis E in England and wales from 2003 to 2012: evidence of an emerging novel phylotype of viruses. J Infect Dis. 2014;209(8):1212-8.  https://doi.org/10.1093/infdis/jit652  PMID: 24273173 
  22. Smith DB, Ijaz S, Tedder RS, Hogema B, Zaaijer HL, Izopet J, et al. Variability and pathogenicity of hepatitis E virus genotype 3 variants. J Gen Virol. 2015;96(11):3255-64.  https://doi.org/10.1099/jgv.0.000264  PMID: 26282123 
  23. Grierson S, Heaney J, Cheney T, Morgan D, Wyllie S, Powell L, et al. Prevalence of Hepatitis E Virus Infection in Pigs at the Time of Slaughter, United Kingdom, 2013. Emerg Infect Dis. 2015;21(8):1396-401.  https://doi.org/10.3201/eid2108.141995  PMID: 26196216 
  24. Said B, Usdin M, Warburton F, Ijaz S, Tedder RS, Morgan D. Pork products associated with human infection caused by an emerging phylotype of hepatitis E virus in England and Wales. Epidemiol Infect. 2017;145(12):2417-23.  https://doi.org/10.1017/S0950268817001388  PMID: 28756783 
  25. O’Riordan J, Boland F, Williams P, Donnellan J, Hogema BM, Ijaz S, et al. Hepatitis E virus infection in the Irish blood donor population. Transfusion. 2016;56(11):2868-76.  https://doi.org/10.1111/trf.13757  PMID: 27522065 
  26. Matsubayashi K, Sakata H, Ikeda H. Hepatitis E virus infection and blood transfusion in Japan. ISBT Sci Ser. 2011;6(2):344-9.  https://doi.org/10.1111/j.1751-2824.2011.01512.x 
  27. Harritshøj LH, Holm DK, Saekmose SG, Jensen BA, Hogema BM, Fischer TK, et al. Low transfusion transmission of hepatitis E among 25,637 single-donation, nucleic acid-tested blood donors. Transfusion. 2016;56(9):2225-32.  https://doi.org/10.1111/trf.13700  PMID: 27385646 
  28. Hoad VC, Seed CR, Fryk JJ, Harley R, Flower RLP, Hogema BM, et al. Hepatitis E virus RNA in Australian blood donors: prevalence and risk assessment. Vox Sang. 2017;112(7):614-21.  https://doi.org/10.1111/vox.12559  PMID: 28833229 
  29. Huzly D, Umhau M, Bettinger D, Cathomen T, Emmerich F, Hasselblatt P, et al. Transfusion-transmitted hepatitis E in Germany, 2013. Euro Surveill. 2014;19(21):20812.  https://doi.org/10.2807/1560-7917.ES2014.19.21.20812  PMID: 24906377 
/content/10.2807/1560-7917.ES.2019.24.10.1800386
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error