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Credit: Daniel Gay
Roughly 1 in 3000 English blood donors have hepatitis E virus (HEV) in their plasma, according to research published in The Lancet.
This suggests that about 1200 HEV-containing blood components may be transfused in England every year.
“HEV genotype 3 infections are widespread in the English population, including blood donors,” said study author Richard Tedder, MB ChB, of National Health Service Blood and Transplant in London.
“We estimate that between 80,000 and 100,000 human HEV infections are likely to have occurred in England during the year of our study.”
These figures seem to indicate a need for screening blood donations. But Dr Tedder and his colleagues found evidence suggesting a low overall burden of harm from transfusion-transmitted HEV.
The researchers retrospectively screened 225,000 individual blood donations collected in south east England between October 2012 and September 2013 for HEV RNA.
Seventy-nine donors—about 1 in 2848—were infected with genotype 3 HEV, which can spread directly from animals to humans. The 79 donations had been used to prepare 129 blood components, 62 of which had been transfused.
Follow-up of 43 exposed recipients showed that transmission had occurred in 18 (42%) patients.
Immunosuppression extended the duration of viremia in these patients, but 3 cleared their infection following a change in immunosuppressive therapy or after receiving ribavirin.
Ten of the patients developed prolonged or persistent infection. Transaminitis was common, and 1 patient developed hepatitis.
“Although rarely causing any acute illness, hepatitis E infections may become persistent in immunosuppressed patients, putting them at risk of future chronic liver disease, and a policy is needed to identify these persistently infected patients and provide them with appropriate antiviral treatment,” Dr Tedder said.
“However, our study indicates that the overall burden of harm resulting from transfusion-transmitted HEV is slight. Although, on a clinical basis alone, there appears no pressing need at this time for blood donations to be screened, a broader discussion over harm mitigation is now required.”
A related comment article in The Lancet suggested there is, in fact, a need for the systematic screening of blood components.
“The potential clinical results of blood-borne HEV infection should not be downplayed; in particular, the risk of serious complications and death exists,” wrote Jean-Michel Pawlotsky, MD, PhD, of Hôpital Henri Mondor in Créteil, France.
“Thus, on the basis of [the current] and other studies, I believe that systematic screening of blood components for markers of hepatitis E infection should be implemented in areas where HEV is endemic (eg, the European Union), based on HEV RNA detection.” 
Credit: Daniel Gay
Roughly 1 in 3000 English blood donors have hepatitis E virus (HEV) in their plasma, according to research published in The Lancet.
This suggests that about 1200 HEV-containing blood components may be transfused in England every year.
“HEV genotype 3 infections are widespread in the English population, including blood donors,” said study author Richard Tedder, MB ChB, of National Health Service Blood and Transplant in London.
“We estimate that between 80,000 and 100,000 human HEV infections are likely to have occurred in England during the year of our study.”
These figures seem to indicate a need for screening blood donations. But Dr Tedder and his colleagues found evidence suggesting a low overall burden of harm from transfusion-transmitted HEV.
The researchers retrospectively screened 225,000 individual blood donations collected in south east England between October 2012 and September 2013 for HEV RNA.
Seventy-nine donors—about 1 in 2848—were infected with genotype 3 HEV, which can spread directly from animals to humans. The 79 donations had been used to prepare 129 blood components, 62 of which had been transfused.
Follow-up of 43 exposed recipients showed that transmission had occurred in 18 (42%) patients.
Immunosuppression extended the duration of viremia in these patients, but 3 cleared their infection following a change in immunosuppressive therapy or after receiving ribavirin.
Ten of the patients developed prolonged or persistent infection. Transaminitis was common, and 1 patient developed hepatitis.
“Although rarely causing any acute illness, hepatitis E infections may become persistent in immunosuppressed patients, putting them at risk of future chronic liver disease, and a policy is needed to identify these persistently infected patients and provide them with appropriate antiviral treatment,” Dr Tedder said.
“However, our study indicates that the overall burden of harm resulting from transfusion-transmitted HEV is slight. Although, on a clinical basis alone, there appears no pressing need at this time for blood donations to be screened, a broader discussion over harm mitigation is now required.”
A related comment article in The Lancet suggested there is, in fact, a need for the systematic screening of blood components.
“The potential clinical results of blood-borne HEV infection should not be downplayed; in particular, the risk of serious complications and death exists,” wrote Jean-Michel Pawlotsky, MD, PhD, of Hôpital Henri Mondor in Créteil, France.
“Thus, on the basis of [the current] and other studies, I believe that systematic screening of blood components for markers of hepatitis E infection should be implemented in areas where HEV is endemic (eg, the European Union), based on HEV RNA detection.”
Credit: Daniel Gay
Roughly 1 in 3000 English blood donors have hepatitis E virus (HEV) in their plasma, according to research published in The Lancet.
This suggests that about 1200 HEV-containing blood components may be transfused in England every year.
“HEV genotype 3 infections are widespread in the English population, including blood donors,” said study author Richard Tedder, MB ChB, of National Health Service Blood and Transplant in London.
“We estimate that between 80,000 and 100,000 human HEV infections are likely to have occurred in England during the year of our study.”
These figures seem to indicate a need for screening blood donations. But Dr Tedder and his colleagues found evidence suggesting a low overall burden of harm from transfusion-transmitted HEV.
The researchers retrospectively screened 225,000 individual blood donations collected in south east England between October 2012 and September 2013 for HEV RNA.
Seventy-nine donors—about 1 in 2848—were infected with genotype 3 HEV, which can spread directly from animals to humans. The 79 donations had been used to prepare 129 blood components, 62 of which had been transfused.
Follow-up of 43 exposed recipients showed that transmission had occurred in 18 (42%) patients.
Immunosuppression extended the duration of viremia in these patients, but 3 cleared their infection following a change in immunosuppressive therapy or after receiving ribavirin.
Ten of the patients developed prolonged or persistent infection. Transaminitis was common, and 1 patient developed hepatitis.
“Although rarely causing any acute illness, hepatitis E infections may become persistent in immunosuppressed patients, putting them at risk of future chronic liver disease, and a policy is needed to identify these persistently infected patients and provide them with appropriate antiviral treatment,” Dr Tedder said.
“However, our study indicates that the overall burden of harm resulting from transfusion-transmitted HEV is slight. Although, on a clinical basis alone, there appears no pressing need at this time for blood donations to be screened, a broader discussion over harm mitigation is now required.”
A related comment article in The Lancet suggested there is, in fact, a need for the systematic screening of blood components.
“The potential clinical results of blood-borne HEV infection should not be downplayed; in particular, the risk of serious complications and death exists,” wrote Jean-Michel Pawlotsky, MD, PhD, of Hôpital Henri Mondor in Créteil, France.
“Thus, on the basis of [the current] and other studies, I believe that systematic screening of blood components for markers of hepatitis E infection should be implemented in areas where HEV is endemic (eg, the European Union), based on HEV RNA detection.”