Hepatitis E virus infection in haemodialysis patients: A case‐control study in Saudi Arabia

Abstract

To determine the prevalence of antibody to hepatitis E virus (IgM anti-HEV) among haemodialysis patients and evaluate whether there was an increased risk of infection and exposure to HEV in an area of endemic viral hepatitis, serum samples obtained from 83 Saudi patients on chronic haemodialysis (group 1), 400 sex- and age-matched healthy subjects (group 2) and hospital patients (group 3) were tested for the IgM anti-HEV and IgG anti-HEV. The prevalence of anti-HEV among the patients (group 1) and the healthy controls were 4.8% and 0.3%, respectively. The difference (4.5%) was statistically significant, with a calculated odds ratio (OR) of 20.2 (95% CI = 2.1-481.0; P = 0.0002). In contrast, there was no significant difference in the prevalence rates of IgG anti-HEV (7.2% vs 10.8%) in both groups. In nonhaemodialysis patients with various diseases, 1.6% (1 of 64) of outpatients (group 3) and none (0 of 113) of the ward patients (group 4) was positive for IgM anti-HEV. Thus, the prevalence (4 of 83) of IgM anti-HEV in the haemodialysis patients was significantly higher than the rate (1 of 177) in the combined groups of nonhaemodialysis hospital patients. The calculated OR was 8.9 (95% CI = 0.92, 212.8; P = 0.037). IgM antibody to hepatitis A virus (IgM anti-HAV) was not detected in any subjects, and the prevalence rates of IgG anti-HAV were similar in the patients and controls (72.3% and 74.3% in groups 1 and 2, respectively, and 75.7% combined groups 3 and 4). The study indicated a significantly higher risk of acute HEV infection among patients on chronic haemodialysis. It is possible that these were nosocomial infections acquired by person-to-person transmission in the haemodialysis unit. However, it is more probable that the infections were community acquired, a conclusion supported albeit indirectly by the lack of a significant difference between the prevalence in haemodialysis patients (4.8%) and outpatients (1.6%). In areas of endemic HEV, appropriate strategies should be adopted to prevent the risk of HEV among haemodialysis patients.

Seroprevalence of Hepatitis E Virus Among Injection Drug Users and Non-Injection Drug Users in Hamadan, West of Iran

“…However, another study did not support this hypothesis (14). In addition, transmission of HEV infection from prenatal transmission was reported in some studies (15)(16)(17). Some studies in Iran indicated a higher transmission rate of HEV infection among injection drug users (IDUs) and hemodialysis patients than the general population (18-23).…”

The seroprevalance of hepatitis E, hepatitis G and TTV in haemodialysis patients

“…Başlıca fekal-oral yolla bulaşan, parenteral ve vertikal yolla da bulaşabileceği bildirilen hepatit E virüsünün prevalansının da hemodiyaliz hastalarında normal popülasyondan daha yüksek olduğu bildirilmiştir [8][9][10][11].…”

“…Hemodiyaliz hastalarında hepatite neden olan hepatit E (HEV), Hepatit G (HGV) , transfüzyonla bulaşan virus (TTV) viruslerinin sıklığına ilişkin çeşitli çalışmalar yapılmıştır ve Transfusion transmitted virus (TTV)'un bulaş yolu tam olarak aydınlatılamasa da, hemodiyaliz hastalarında TTV seroprevalansı %9,3-83 arasında değişmektedir [3][4][5][6][7][8][9][10][11][12][13].…”

“…Hemodiyalize giren hastalar kan yoluyla bulaşan infeksiyon etkenleri açısından yüksek risk taşırlar. Pek çok çalışmada hemodiyaliz hastalarında HEV seroprevalansının normal popülasyondan daha yüksek olduğu bildirilmiştir [8][9][10][11].…”

Chronic Hepatitis E Virus Infection and Treatment

“…HEV transmission has been reported in a hemodialysis unit 34 and a hematology ward. 35 Hence, we wondered whether nosocomial HEV transmission could occur in organ transplant recipients who have frequent hospitalizations, especially within the early post-transplant period.…”