Mary E. Wilson, MD

About 1 in 2850 blood donations contained hepatitis E virus RNA; infection in recipients was associated with little acute morbidity.

Prevalence of hepatitis E virus (HEV) infection has been increasing in the U.K. since 2010. Now, investigators have assessed HEV RNA prevalence in blood donations, as well as transmission of the virus in various blood components and morbidity in recipients.

Plasma samples from 225,000 blood donations collected in southeastern England in 2012 and 2013 were retrospectively screened. Donations positive for HEV RNA by real-time polymerase reaction were subjected to phylogenetic and serologic analysis. Recipients of components from any of the HEV-positive donations were located and — when possible — tested.

Overall, 79 donations (0.04%) tested HEV-RNA positive; 56 (71%) of these donations had no detectable HEV IgM or IgG antibodies. The median viral load was 3900 IU/mL, with values highest in antibody-negative donations. All 54 samples that could be genotyped had genotype 3 virus.

Components made from the 79 donations were most often red blood cells and platelets. Among 60 exposed recipients, 43 were available for follow-up. The overall HEV transmission rate was 42% (18 of 43 exposed patients). Viral sequences in the recipients matched those in the involved donations. Viral load was higher — and antibody levels lower — in donations that transmitted infection than in those that did not. Likelihood of seroconversion in recipients increased as level of immunosuppression increased. Only one recipient had clinical hepatitis; four had asymptomatic transaminitis coincident with seroconversion. One recipient with persistent viremia was treated with ribavirin.

Citation(s):

Hewitt PE et al. Hepatitis E virus in blood components: A prevalence and transmission study in southeast England. Lancet 2014 Nov 15; 384:1766.