Nosocomial transmission of hepatitis E virus and development of chronic infection: The wider impact of COVID-19

Abstract

Background Transmission of hepatitis E virus (HEV) within the healthcare setting is extremely rare. Additionally, the development of chronic HEV infection in association with severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection and/or its immunomodulatory therapy has not been reported previously. Aims To describe the investigation and management of a nosocomial HEV transmission incident during the coronavirus disease 2019 (COVID-19) pandemic. Methods Epidemiological and molecular investigation of two individuals hospitalised with COVID-19 who were both diagnosed with HEV infection. Results Findings from our investigation were consistent with transmission of HEV from one patient with a community-acquired HEV infection to another individual (identical HEV sequences were identified in the two patients), most likely due to a breach in infection control practices whilst both patients shared a bed space on the intensive care unit (ICU). Chronic HEV infection requiring treatment with ribavirin developed in one patient with prolonged lymphopaenia attributable to COVID-19 and/or the immunomodulators received for its treatment. Further investigation did not identify transmission of HEV to any other patients or to healthcare workers. Conclusions The extraordinary demands that the COVID-19 pandemic has placed on all aspects of healthcare, particularly within ICU settings, has greatly challenged the ability to consistently maintain optimal infection prevention and control practices. Under the significant pressures of the COVID-19 pandemic a highly unusual nosocomial HEV transmission incident occurred complicated further by progression to a chronic HEV infection in one patient.

The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review

“… 39 , 41 , 45 , 59 , 66 This focus on keeping HCP safe increased the risk of patient-to-patient MDRO transmission due to reuse of gowns and even gloves between patients on the same unit, 67 as exemplified by an outbreak of hepatitis E between hospitalized patients in the UK. 68 Use of indwelling devices including urinary catheters, central lines and ventilators increased, providing more opportunities for device-related infections. 69 , 70 IV infusion pumps were kept outside of patient rooms to conserve PPE and minimize the number and duration of interactions between patients and HCP.…”

Chronic hepatitis E: Advancing research and patient care

“…One case further progressed to chronic infection, which is likely to have been associated with prolonged lymphopenia and treatment with immunosuppressive medications including tocilizumab and steroids. 23 Chronic infection with genotype 4 HEV was first reported in a Chinese boy with acute lymphoblastic leukaemia during chemotherapy (Fig. 1).…”

The Diagnosis, Pathophysiology, and Treatment of Chronic Hepatitis E Virus Infection—A Condition Affecting Immunocompromised Patients

“…Although the frequency of persistent viremia and the route of infection are quite different between HCV and HEV, both are hepatotrophic RNA viruses, and the immunological approach to HCV could be analogously applied for HEV. COVID-19 has also been reported to cause CHE [ 60 ], but no additional convincing reports regarding the relationships between COVID-19 and chronic HEV infection have been documented recently. Further studies are needed to elucidate the mechanism of CHE and to document the many hidden cases of undiscovered CHE.…”