Hepatitis E virus infection may be transmitted through blood transfusion in an endemic area

Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Journal of Gastroenterology and Hepatology (Impact Factor: 3.5). 07/2004; 19(7):778-84. DOI: 10.1111/j.1440-1746.2004.03437.x
Source: PubMed


To address the issue of whether or not hepatitis E virus (HEV) is transmitted parenterally.
We conducted a retrospective study which involved 145 multiple transfused patients and 250 healthy controls. A prospective study was also undertaken involving 50 hospitalized patients, 25 of whom were transfused with 107 blood units, while the other 25 did not receive any transfusions.
In our retrospective study, markers of acute HEV infection (IgM anti-HEV and HEV RNA) were detected in a significantly higher number of multiple transfused patients (13 of 145) compared to controls (two of 250) (P < 0.001; OR = 12.21 [95% confidence interval: 2.71-54.70]). All 13 HEV-infected patients had been transfused at least once in a 3-month period before testing. Overall, patients positive for any of the HEV markers (IgG, IgM or HEV RNA) had received more blood transfusions, had higher occurrence of icteric disease and higher serum alanine aminotransferase levels. In our prospective study, IgG anti-HEV was detected in 11 of 107 donor samples, three of 25 patients in their pretransfusion samples (one sample was positive for IgM anti-HEV as well) and two of 25 control patients. Post-transfusion HEV infection developed in three of 22 susceptible (IgG anti-HEV negative) transfused patients; the infection was traced to their four respective donors who were asymptomatic, HEV RNA positive (4/4) and IgM anti-HEV positive (3/4). In contrast, none of the non-transfused patients developed HEV infection during the follow-up period.
Frequent transmission of HEV by blood transfusion places recipients at risk and warrants redefining of the donor screening policy by blood banks, especially in endemic areas.

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Available from: Mohammad Sultan Khuroo, Nov 18, 2014
    • "Infection generally occurs by drinking water contaminated with hepatitis E virus, indicating a preferential fecal-oral route of transmission (Krawczynski 1993). Virus contaminated food (Meng 2011) or blood transfusion (Khuroo, et al. 2004) might also be indicated as potential source of infection Hepatitis E virus (HEV) is an icosahedral, non-enveloped, spherical virus particle with a diameter of approximately 32-34 nm (Meng 2010). The HEV belongs to the Hepeviridae family, genus Hepevirus and contains a single-stranded, positivesense RNA genome with three open-reading frames (ORFs): ORF1 encodes for a protein containing domains present in nonstructural proteins (Koonin, et al. 1992), ORF2 codifies for the viral capsid protein (Li, et al. 1997) and ORF3 codifies for a small cytoskeleton-associated phosphoprotein (Zafrullah, et al. 1997). "
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    ABSTRACT: Hepatitis E, caused by hepatitis E virus (HEV), is a viral infectious pathology of great importance in the public health. Hepatitis E outbreaks were registered in developing countries with poor or no sanitation, where drinking water was contaminated with fecal material, but also in many industrialized countries probably due to consumption of HEV-positive swine meat. In this study, we present the development and characterization of a recombinant antigen from ORF2 HEV genotype 3. Viral RNA was extracted from swine feces infected with the native virus. 267 residues from the C-terminal ORF2(394-661) coding sequence were cloned into the pET20a vector and expressed in Escherichia coli ER2566. Recombinant protein was purified by liquid chromatography and the fragment obtained a 98% homology against other human or swine HEV genotype 3 ORF2 sequences. Wistar rats were inoculated with ORF2p, developing antibodies able to recognize both the homologous antigen and the native HEV genotype 3 ORF2 present in infected stool. In parallel, HEV-negative swine were experimentally challenged with HEV genotype 3. ORF2 was detected by PCR 14 days post-inoculation in 3/4 piglets’ feces and one week later by dot blot. In conclusion, this study proved the immunogenic and antigenic properties of the recombinant protein ORF2p.
    No preview · Article · Jan 2016 · FEMS Microbiology Letters
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    • "Although the parenteral route of transmission is not thought to be a frequent occurrence, and its clinical consequences have not been systematically evaluated, the potential risk of transmission of HEV by transfusion has been suggested by several studies.2,110–112 Additionally, comparative molecular analysis of HEV sequences from blood donor and recipient have been performed, and direct evidence for parenteral transmission (HEV genotypes 1 and 3) has been reported.72,113 "
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    ABSTRACT: Hepatitis E virus (HEV) infection is an important public health concern in many developing countries, causing waterborne outbreaks as well as sporadic autochthonous hepatitis. HEV is mainly transmitted by the fecal-oral route in endemic areas through drinking of contaminated water. However, zoonotic transmission from animal reservoirs to humans has also been suggested. Three additional routes of HEV transmission have been proposed to occur: blood borne, human to human, and vertical transmission from mother to child. Acute HEV infection is usually diagnosed by detecting specific anti-HEV antibodies. However, the performance of the available assays in different settings is not optimal. Analysis of HEV ribonucleic acid in biologic specimens such as stools, serum, and liver biopsy by using nucleic acid amplification techniques is also employed. Nonetheless, additional consensus regarding the best technologies suitable for serosurveys and diagnosis of acute HEV infection is also needed. This review article summarizes the current status of HEV infection end epidemiology with particular emphasis in transmission, diagnosis, and clinical management.
    Full-text · Article · Jun 2014 · Hepatic Medicine: Evidence and Research
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    • "Transmission of HEV primarily occurs by the fecal-oral route through contaminated water or food similar to that of hepatitis A virus. Vertical transmission, blood transfusions, person-to-person contact are not considered as important routes of HEV transmission, however some studies have indicated that they play role in HEV transmission, particularly in endemic areas (4-7). "
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    ABSTRACT: Background:Many studies have been done on the epidemiology of Hepatitis E on general population, but the data among patients with end stage renal disease (ESRD) are few and give conflicting results.Objectives:The aim of this study was to investigate the prevalence of hepatitis E virus (HEV) infection and its relationship in ESRD patients undergoing maintenance hemodialysis (HD).Patients and Methods:This cross-sectional study was carried out on ESRD patients treated with HD in Imam Khomeini Hospital, Ahvaz city, Southwest of Iran. Blood sampling of patients was collected immediately before the dialysis session and the serum were evaluated for anti-HEV IgG titers by enzyme-linked immunosorbent assays. The statistical package for social sciences (SPSS) version 15 software was used for data analysis.Results:Out of 47 ESRD patients, 27 were male (57.4%) and 20 were female (42.6%), with mean age of 55.27 ± 8.1 years. The prevalence of anti-HEV antibody was 10.6 % (five patients, four male and one female). The mean age of HEV positive and negative patients were 58 ± 5.52 and 53.82 ± 15.55 years, respectively without any significant difference (P = 0.058). There also was no significant association between HEV and gender (P = 0.28). The mean time of HD in HEV positive and negative patients were 1224.2 and 1168.5 days, respectively with no significant association (P = 0.88). In addition, there also was no association between HEV and HCV (P = 0.61).Conclusions:According to the present study, the prevalence of anti-HEV IgG antibody was 10.63 % among chronic HD patients and there was no association between HEV, age, gender, duration of HD and HCV antibody titer.
    Full-text · Article · May 2014 · Jundishapur Journal of Microbiology
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