Prevalence of Acute Hepatitis E Virus Infections in Swiss Blood Donors 2018-2020.

Publisher: MDPI Country of Publication: Switzerland NLM ID: 101509722 Publication Model: Electronic Cited Medium: Internet ISSN: 1999-4915 (Electronic) Linking ISSN: 19994915 NLM ISO Abbreviation: Viruses Subsets: MEDLINE

Original Publication: Basel, Switzerland : MDPI

Hepatitis E*/epidemiology ; Hepatitis E*/transmission ; Hepatitis E*/virology ; Blood Donors*/statistics & numerical data ; Hepatitis E virus*/genetics ; Hepatitis E virus*/immunology ; Hepatitis E virus*/classification ; Hepatitis E virus*/isolation & purification ; RNA, Viral*/genetics ; RNA, Viral*/blood ; Genotype*; Humans ; Switzerland/epidemiology ; Male ; Female ; Adult ; Prevalence ; Middle Aged ; Hepatitis Antibodies/blood ; Immunoglobulin M/blood ; Young Adult ; Immunoglobulin G/blood ; Viral Load ; Aged ; Adolescent

Introduction: Hepatitis E virus (HEV) genotype 3 is the major cause of acute viral hepatitis in several European countries. It is acquired mainly by ingesting contaminated pork, but has also been reported to be transmitted through blood transfusion. Although most HEV infections, including those via blood products, are usually self-limiting, they may become chronic in immunocompromised persons. It is thus essential to identify HEV-infected blood donations to prevent transmission to vulnerable recipients.
Aims: Prior to the decision whether to introduce HEV RNA screening for all Swiss blood donations, a 2-year nationwide prevalence study was conducted.
Methods: All blood donations were screened in pools of 12-24 samples at five regional blood donation services, and HEV RNA-positive pools were subsequently resolved to the individual donation index donation (X). The viral load, HEV IgG and IgM serology, and HEV genotype were determined. Follow-up investigations were conducted on future control donations (X + 1) and previous archived donations of the donor (X - 1) where available.
Results: Between October 2018 and September 2020, 541,349 blood donations were screened and 125 confirmed positive donations were identified (prevalence 1:4331 donations). At the time of blood donation, the HEV RNA-positive individuals were symptom-free. The median viral load was 554 IU/mL (range: 2.01-2,500,000 IU/mL). Men (88; 70%) were more frequently infected than women (37; 30%), as compared with the sex distribution in the Swiss donor population (57% male/43% female, p < 0.01). Of the 106 genotyped cases (85%), all belonged to genotype 3. Two HEV sub-genotypes predominated; 3h3 (formerly 3s) and 3c. The remaining sub-genotypes are all known to circulate in Europe. Five 3ra genotypes were identified, this being a variant associated with rabbits. In total, 85 (68%) X donations were negative for HEV IgM and IgG. The remaining 40 (32%) were positive for HEV IgG and/or IgM, and consistent with an active infection. We found no markers of previous HEV in 87 of the 89 available and analyzed archive samples (X - 1). Two donors were HEV IgG-positive in the X - 1 donation suggesting insufficient immunity to prevent HEV reinfection. Time of collection of the 90 (72%) analyzed X + 1 donations varied between 2.9 and 101.9 weeks (median of 35 weeks) after X donation. As expected, none of those tested were positive for HEV RNA. Most donors (89; 99%) were positive for anti-HEV lgG/lgM (i.e., seroconversion). HEV lgM-positivity (23; 26%) indicates an often-long persistence of lgM antibodies post-HEV infection.
Conclusion: The data collected during the first year of the study provided the basis for the decision to establish mandatory HEV RNA universal screening of all Swiss blood donations in minipools, a vital step in providing safer blood for all recipients, especially those who are immunosuppressed.

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244 Humanitarian Foundation of the Swiss Red Cross

Keywords: Switzerland; blood donors; hepatitis E virus phylogenetic analysis; surveillance; universal blood donor screening genotype; zoonotic infection

0 (RNA, Viral)
0 (Hepatitis Antibodies)
0 (Immunoglobulin M)
0 (Immunoglobulin G)

Date Created: 20240525 Date Completed: 20240525 Latest Revision: 20240528

20240529

PMC11125967

10.3390/v16050744

38793625