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HEV RNA found among blood donations in England

Hepatitis E virus genotype 3 was found among blood donations and led to multiple new cases of infected patients in England, according to new study data.

Researcher Richard S. Tedder, FRCPath, Blood Borne Virus Unit at Public Health England, United Kingdom, and colleagues conducted a systematic analysis screening 225,000 blood donations collected in southeast England between October 2012 and September 2013. Researchers searched for evidence of hepatitis E virus (HEV) RNA. Most donors were seronegative at donation.

Analysis revealed that 79 donors were positive for HEV RNA, resulting in an RNA prevalence of one in 2,848 (0.04%). The donations had been used for 129 blood components, including 62 for transfusion before infection was detected. Fifty-four samples had HEV genotype 3. Fifty-six donors remained seronegative after analysis.

In follow-up with 43 donor recipients, 18 displayed evidence of HEV, 10 of whom developed persistent infection and one with mild post-transfusion hepatitis. Three recipients were cleared of any infection after alternate immunosuppression therapy or intervention with ribavirin.

Researchers believed red blood cells to be the least likely component of transmitting infection. HEV antibody was detected in four of 18 donations associated with infection transmission and in 13 of 25 donations not associated with transmission. Decreased antibody levels were observed in the donations resulting in transmission vs. those that did not. HEV viral load was 1.5 log₁₀ higher in donations that were transmitted compared to those that were not.

“Although rarely causing any acute illness, hepatitis E infections may become persistent in immunosuppressed patients, putting them at risk of future chronic liver disease, and a policy is needed to identify these persistently infected patients and provide them with appropriate antiviral treatment,” Tedder said in a press release. “However, our study indicates that the overall burden of harm … is slight. Although on a clinical basis alone there appears no pressing need at this time for blood donations to be screened, a broader discussion over harm mitigation is now required.”

Disclosure: The researchers report no relevant financial disclosures.