Transfusion-transmitted hepatitis E: What we know so far?

Abstract

Hepatitis E virus (HEV) is a major cause of viral hepatitis globally. There is growing concern about transfusion-transmitted HEV (TT-HEV) as an emerging global health problem. HEV can potentially result in chronic infection in immunocompromised patients, leading to a higher risk of liver cirrhosis and even death. Between 0.0013% and 0.281% of asymptomatic blood donors around the world have HEV viremia, and 0.27% to 60.5% have anti-HEV immunoglobulin G. HEV is infectious even at very low blood concentrations of the virus. Immunosuppressed patients who develop persistent hepatitis E infection should have their immunosuppressant regimen reduced; ribavirin may be considered as treatment. Pegylated interferon can be considered in those who are refractory or intolerant to ribavirin. Sofosbuvir, a nucleotide analog, showed modest antiviral activity in some clinical studies but sustained viral response was not achieved. Therefore, rescue treatment remains an unmet need. The need for HEV screening of all blood donations remains controversial. Universal screening has been adopted in some countries after consideration of risk and resource availability. Various pathogen reduction methods have also been proposed to reduce the risk of TT-HEV. Future studies are needed to define the incidence of transmission through transfusion, their clinical features, outcomes and prognosis.

Hepatitis E Virus in Finland: Epidemiology and Risk in Blood Donors and in the General Population

“…Parenteral transmission of HEV infections via blood transfusion has been documented in Japan and several European countries since the mid-2000s [ 2 , 5 , 10 , 11 ]. In addition, Australia reported one transfusion-transmitted HEV infection in 2017 [ 12 ].…”

Hepatitis E virus is effectively inactivated by methylene blue plus light treatment

“…5 To lower the risk of HEV transmission, safety precautions (e.g., donor evaluation and laboratory screening tests) have been implemented in a number of European countries as well as in parts of Japan and China. 2,6 Pathogen-inactivation (PI) procedures can provide an alternative strategy to minimize the risk of transfusion-hepatitis E. By reducing the amount of discarded blood donations, safe and effective PI strategies can potentially contribute toward decreasing the total cost of blood collection and reducing supply shortages. Different PI technologies have been developed to eliminate pathogens from blood components while retaining product quality.…”

“…Its prevalence in Europe, North America, and Asian countries with high or high‐middle income has been estimated at 21.6 to 658.1 per million donor units 5 . To lower the risk of HEV transmission, safety precautions (e.g., donor evaluation and laboratory screening tests) have been implemented in a number of European countries as well as in parts of Japan and China 2,6 . Pathogen‐inactivation (PI) procedures can provide an alternative strategy to minimize the risk of transfusion‐hepatitis E. By reducing the amount of discarded blood donations, safe and effective PI strategies can potentially contribute toward decreasing the total cost of blood collection and reducing supply shortages.…”

Hepatitis E Virus; An Underestimated Threat for the Viral Hepatitis Elimination Program

“…For instance, while HEV-3 mainly contributes to the infection burden in developed countries, HEV-4 is the primary cause of HEV infection in developing countries. Both HEV-1 and HEV-2 are prevalent in endemic and hyperendemic regions (11,12).…”

“…Some distinct features of HEV impede its eradication. For instance, unlike HBV, there is no efficient vaccine, and unlike HCV, there is no specific antiviral against HEV (12).…”