Transfusion‐associated hepatitis before the screening of blood for hepatitis risk factors

Abstract

BACKGROUND The true incidence of transfusion-associated hepatitis (TAH) before blood screening is unknown. Our aims were to reevaluate blood recipients receiving unscreened blood and analyze hepatitis viruses circulating more than 45 years ago. STUDY DESIGN AND METHODS Cryopreserved serum samples from 66 patients undergoing open heart surgery in the 1960s were reevaluated with modern diagnostic tests to determine the incidence of TAH and its virologic causes. RESULTS In this heavily transfused population receiving a mean of 20 units per patient of predominantly paid-donor blood, 30 of 66 (45%) developed biochemical evidence of hepatitis; of these, 20 (67%) were infected with hepatitis C virus (HCV) alone, four (13%) with hepatitis B virus (HBV) alone, and six (20%) with both viruses. Among the 36 patients who did not develop hepatitis, four (11%) were newly infected with HCV alone, nine (25%) with HBV alone, and one (3%) with both viruses. Overall, 100% of patients with hepatitis and 39% of those without hepatitis were infected with HBV and/or HCV; one patient was also infected with hepatitis E virus. The donor carrier rate for HBV and/or HCV was estimated to be more than 6%; contemporaneously prepared pooled normal human plasma was also contaminated with multiple hepatitis viruses. CONCLUSION TAH virus infections were a larger problem than perceived 50 years ago and HCV was the predominant agent transmitted. All hepatitis cases could be attributed to HCV and/or HBV and hence there was no evidence to suggest that an additional hepatitis agent existed undetected in the blood supply.

Molecular biology of hepatitis B virus infection

“…Many of the remaining cases, including from paid donors, were thought due to an agent referred to as NonANonB hepatitis virus(es). A major cause of NonANonB hepatitis, hepatitis C virus (Engle et al , 2014), was identified in 1989 (Choo et al , 1989; Choo et al , 1990)). The HBsAg assay also confirmed the suspected association between chronic HBV infection and HCC in humans (Beasley et al , 1981; Blumberg et al , 1975; Prince et al , 1975).…”

Declining prevalence of hepatitis E antibodies among Danish blood donors

“…In Europe and other Western countries the focus on hepatitis E virus (HEV) has increased within the past decade because of an increasing number of reported cases of HEV infections. HEV transmission by blood transfusion is well documented . Recently, a British study found 0.04% of blood donors to be HEV RNA positive and that 42% of these transmitted the infection to their recipients .…”

Probable transmission of hepatitis E virus (HEV) via transfusion in the United States

“…Two patient‐recipients, including one who received an HEV RNA–containing and a “high‐titer” anti‐HEV product shortly before death, became reactive for IgG anti‐HEV, but the authors concluded that neither patient had a transfusion‐associated exposure to HEV. Another publication reported the results of retrospectively assaying cryopreserved specimens that were collected during the 1960s, prior to routine donor screening for viral markers, from 66 NIH CC cardiac surgery patients who developed posttransfusion hepatitis: 4 (6%), 20 (31%), and 1 (2%), respectively, were infected with hepatitis B virus, hepatitis C virus, and HEV . It is highly likely that many transfusion transmissions of HEV have gone unrecognized in the United States.…”

“…Another publication reported the results of retrospectively assaying cryopreserved specimens that were collected during the 1960s, prior to routine donor screening for viral markers, from 66 NIH CC cardiac surgery patients who developed posttransfusion hepatitis: 4 (6%), 20 (31%), and 1 (2%), respectively, were infected with hepatitis B virus, hepatitis C virus, and HEV. 46 It is highly likely that many transfusion transmissions of HEV have gone unrecognized in the United States. Linking donations to American recipients has been difficult because most blood product collection, processing, and distribution are centralized, and the products are often transfused after a substantial interval.…”