Scientists in France recently found evidence for possible hepatitis E virus (HEV) transmission in plasma treated with solvent/detergent from two different lots of 100 pooled single-donor plasma units. Solvent/detergent-treated plasma, which has been used since the 1980s, reduces the risk of transfusion-transmission of enveloped viruses including hepatitis B, hepatitis C, and HIV. HEV, however, is a small non-enveloped (naked) RNA virus and is not closely related to hepatitis B nor C virus. HEV is usually transmitted via the fecal-oral route, though transfusion-transmission has been reported. Out of 557 solvent/detergent treated units that had one HEV RNA positive donor in each lot, 143 recipients were transfused. Two recipients developed HEV symptoms, and sequencing data confirmed transfusion-transmission of HEV from the solvent/detergent plasma. One other recipient was HEV RNA positive, but this recipient was also HEV RNA positive before transfusion. Follow-up data were available for 27 additional recipients: one recipient was HEV IgG negative and IgM positive; 5 were both IgG and IgM positive, 7 were IgG positive and IgM negative, and 14 were IgG and IgM negative. Risk of transfusion-transmission likely depends on several factors, such as viral load and genotypes, concentration of HEV antibodies within the pooled plasma, and recipient immune competence. HEV testing of solvent/detergent-treated plasma is now required within HEV endemic regions of the European Union.
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