Hepatitis E virus RNA in Australian blood donors: prevalence and risk assessment

Background and Objectives Hepatitis E virus (HEV) is a known transfusion‐transmissible agent. HEV infection has increased in prevalence in many developed nations with RNA detection in donors as high as 1 in 600. A high proportion of HEV infections are asymptomatic and therefore not interdicted by do...

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Bibliographic Details
Published in:Vox sanguinis 2017-10, Vol.112 (7), p.614-621
Main Authors: Hoad, V. C., Seed, C. R., Fryk, J. J., Harley, R., Flower, R. L. P., Hogema, B. M., Kiely, P., Faddy, H. M.
Format: Article
Language:English
Subjects:
Australia
blood
Blood & organ donations
Blood Donors
Blood transfusions
Developed countries
emerging infectious disease
Genetic screening
Health risks
Hepatitis
Hepatitis E - blood
Hepatitis E - epidemiology
hepatitis E virus
Hepatitis E virus - genetics
Hepatitis E virus - isolation & purification
Humans
Industrialized nations
Infections
Male
Middle Aged
Polymerase chain reaction
Prevalence
Ribonucleic acid
risk
Risk Assessment
Risk management
RNA
RNA viruses
RNA, Viral - blood
safety
Sampling methods
Screening
Transcription
transfusion
Viremia
Viruses
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Summary:Background and Objectives Hepatitis E virus (HEV) is a known transfusion‐transmissible agent. HEV infection has increased in prevalence in many developed nations with RNA detection in donors as high as 1 in 600. A high proportion of HEV infections are asymptomatic and therefore not interdicted by donor exclusion criteria. To manage the HEV transfusion‐transmission (TT) risk some developed nations have implemented HEV RNA screening. In Australia, HEV is rarely notified; although locally acquired infections have been reported, and the burden of disease is unknown. The purpose of this study was to determine the frequency of HEV infection in Australian donors and associated TT risk. Materials and Methods Plasma samples (n = 74 131) were collected from whole blood donors during 2016 and screened for HEV RNA by transcription‐mediated amplification (TMA) in pools of six. Individual TMA reactive samples were confirmed by RT‐PCR and, if positive, viral load determined. Prevalence data from the study were used to model the HEV‐TT risk. Results One sample in 74 131 (95% CI: 1 in 1 481 781 to 1 in 15 031) was confirmed positive for HEV RNA, with an estimated viral load of 180 IU/ml, which is below that typically associated with TT. Using a transmission‐risk model, we estimated the risk of an adverse outcome associated with TT‐HEV of approximately 1 in 3·5 million components transfused. Conclusion Hepatitis E virus viremia is rare in Australia and lower than the published RNA prevalence estimates of other developed countries. The risk of TT‐HEV adverse outcomes is negligible, and HEV RNA donor screening is not currently indicated.
ISSN:0042-9007
1423-0410
DOI:10.1111/vox.12559