Blood donor screening for hepatitis E reveals incidence is higher than previously reported

April 21, 2017, Amsterdam, The Netherlands: Results from a study presented today found that the incidence of HEV RNA in asymptomatic blood donors from Germany is higher than previously reported. The study, presented at The International Liver Congress™ 2017 in Amsterdam, The Netherlands, showed that 0.11% of donations tested were HEV RNA positive (15 out of 13,441 donors) and that one of the asymptomatic HEV RNA positive donors had previously donated HEV RNA positive blood products, which were then transfused into nine immunocompromised patients. Screening for HEV RNA at blood donation centres has been debated in recent years but is not compulsory as yet.

There are an estimated 20 million new infections with HEV worldwide every year. However, HEV infection is often asymptomatic and will usually clear within two to six weeks.1 HEV infection can persist in immunocompromised individuals,2 leading to development of liver cirrhosis or liver failure.3,4 For this reason there have been calls to introduce routine HEV RNA screening of blood donations.

"We identified a higher percentage of HEV RNA donors in our study cohort than has previously been reported in Germany," said Dirk Westhölter, University Hospital Hamburg-Eppendorf, Germany, and lead author of the study. "Since HEV infection can have serious consequences among the immunocompromised and a single positive donor can give rise to HEV infection in several other patients, there is a need for longer term studies to analyse the effectiveness of routine HEV blood donor screening, and to determine whether this process should be implemented at blood clinics everywhere."

Blood donations (n=13,441) at the University Hospital Hamburg-Eppendorf were tested from October 2016. Pools of 24 donations were screened using an HEV PCR assay, with reactive pools tested individually to identify HEV RNA positive donors.

Out of 15 HEV RNA positive donors identified, 14 were healthy and asymptomatic and one presented with acute self-limiting hepatitis. Of the asymptomatic donors, one had been HEV RNA positive for over three months and had donated blood products prior to this screening, which had then been transfused into nine immunocompromised patients. Interestingly, eight of these patients did not go on to develop Hepatitis E, and only one patient had detectable serum HEV RNA before death due to acute-on-chronic liver failure complicated by pseudomonas sepsis.

"The proportion of HEV RNA positive donors found in this study is higher than previously reported and quite worrisome. Given the suboptimal, inconsistent sensitivity of commercially available anti-HEV antibody assays, and in view of the serious consequences that may occur in immunocompromised recipients, screening for HEV RNA of blood donor minipools should be discussed promptly," said Prof Francesco Negro, Divisions of Gastroenterology and Hepatology of Clinical Pathology, University Hospital of Geneva, Switzerland and EASL Governing Board Member.

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About The International Liver Congress™

This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2017 will take place from April 19 – 23, at the RAI Amsterdam, Amsterdam, The Netherlands.

About The European Association for the Study of the Liver (EASL)

Since its foundation in 1966, this not-for-profit organisation has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European Association with international influence, with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.

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Onsite location reference

Session title: Parallel session: Challenges in hepatitis B and E
Time, date and location of session: 16:00 – 18:00, Friday 21 April, Forum
Presenter: Dirk Westhölter, Germany
Abstract: Blood-borne HEV transmission: first experience with global HEV screening at a tertiary center (PS110), 17:45 – 18:00

Author disclosures

None.

References

1 World Health Organization. Hepatitis E Factsheet. July 2016. Available from: http://www.who.int/mediacentre/factsheets/fs280/en/. Last accessed: April 2017.

2 Debing Y, et al. Update on hepatitis E virology: implications for clinical practice. J Hepatol. 2016;65(1):200-212.

3 Pischke S, et al. Hepatitis E virus; infection beyond the liver? J Hepatol. 2017; Article in press.

4 Krain LJ, et al. Host immune status and response to hepatitis E virus infection. Clin Microbiol Rev. 2014;27(1):139-165.

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https://ilc-congress.eu/wp-content/uploads/2017/04/PS110-Westh%C3%B6lter.pdf

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