Today we will be discussing transfusion-transmitted hepatitis E infection. Hepatitis E virus, or HEV, is a single-stranded RNA virus which infects 20 million people worldwide each year. Infection occurs through either fecally contaminated food and water or poorly cooked meat products—especially pork. Four genotypes of hepatitis E virus have been identified with varying levels of virulence.
Acute infections of hepatitis E virus are generally mild and self-limiting. However, pregnant women and immunocompromised patients have a higher risk of developing complications such as jaundice and severe hepatitis.
The hepatitis E virus has been detected in blood donors in Europe, Japan and China; and transfusion-transmitted infections have been documented. The frequency, however, of transmission and outcome of the transfusion recipients has been unknown.
In a study published in The Lancet, Dr. Richard Tedder and his team retrospectively screened just under a quarter of a million blood donations from southeast England collected during 2012 and 2013 for the hepatitis E virus. They found approximately 1 in every 3,000 blood donors were viremic with hepatitis E. They were also able to track 79 cases of infected blood donations which had been used to prepare 129 blood components, 62 of which were transfused before identification of the virus. They found a transmission rate of approximately 45%.
Dr. Tedder describes the clinical symptoms in recipients who received the hepatitis E contaminated blood products:
“We found 16 transmission events in 42 recipients. The outcome was only one mild case of jaundice, but nevertheless, infection in others who became viremic for quite some extended periods of time.”
A commentary in The Lancet accompanying Dr. Tedder’s study strongly urges that all blood donations in hepatitis E endemic areas such as the United Kingdom should be screened.
However, the decision to screen all blood donations for hepatitis E virus is controversial even though infections are widespread. Dr. Tedder comments:
“How much money do you spend to save the very occasional case of jaundice? Are there other ways of containing the HEV infection risk in the immunosuppressed? And there is also reputational damage if you are found to be transmitting.”
We’ll be back with another edition of Transfusion News on September 15. Thanks for joining us.
1. Hewitt PE, Ijaz S, Brailsford SR, Brett R, Dicks S, Haywood B, Kennedy IT, Kitchen A, Patel P, Poh J, Russell K, Tettmar KI, Tossell J, Ushiro-Lumb I, Tedder RS. Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. Lancet 2014.