351
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Transfusion-transmitted hepatitis E in a patient with myelodysplastic syndromes. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:103-6. [PMID: 24120594 DOI: 10.2450/2013.0081-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/17/2013] [Indexed: 01/26/2023]
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352
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Riezebos-Brilman A, Verschuuren EAM, van Son WJ, van Imhoff GW, Brügemann J, Blokzijl H, Niesters HGM. The clinical course of hepatitis E virus infection in patients of a tertiary Dutch hospital over a 5-year period. J Clin Virol 2013; 58:509-14. [PMID: 24055152 DOI: 10.1016/j.jcv.2013.08.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) has long been known as a major cause of acute hepatitis in developing countries with occasional travel-related cases in developed countries, most of them belonging to genotype 1. Currently, genotype 3 HEV is recognized as an emerging public health issue in developed countries and can cause a chronic hepatitis in immunocompromised patients. OBJECTIVES The aim of this study was to get an overview of the clinical course of HEV infection, from July 2007 to December 2012, and further characterize HEV in patients of the University Medical Center Groningen (UMCG) over a 5-year time period. METHODS Since the second half of 2007, patients in the UMCG with unexplained hepatitis were screened for HEV and clinical data were collected. HEV was characterized by sequencing of the ORF1 and ORF2 regions. RESULTS In total, 34 patients of the 1129 tested patients showed HEV viremia. The majority of the infected patients were immunocompromised; 18 were solid organ transplant (SOT) patients and 9 were patients immunocompromised for other reasons. Seven patients diagnosed with HEV were immunocompetent. Viral genotyping revealed genotype 3 isolates, mostly genotype 3c. CONCLUSION Non-travel related HEV hepatitis is an important diagnosis. In immunocompromised patients HEV infection often has major clinical impact, necessitating medical intervention including antiviral treatment. In immunocompetent patients, the detection could expand our understanding about the route of transmission and the relation with the zoonotic origin. Therefore, besides an increasing awareness for HEV among clinicians and medical microbiologists, diagnostics should be routinely incorporated into standard patients care.
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Affiliation(s)
- Annelies Riezebos-Brilman
- Department of Medical Microbiology, Division of Clinical Virology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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353
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Santos L, Mesquita JR, Rocha Pereira N, Lima-Alves C, Serrão R, Figueiredo P, Reis J, Simões J, Nascimento M, Sarmento A. Acute hepatitis E complicated by Guillain-Barre syndrome in Portugal, December 2012--a case report. ACTA ACUST UNITED AC 2013; 18. [PMID: 23987830 DOI: 10.2807/1560-7917.es2013.18.34.20563] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Autochthonous hepatitis E virus (HEV) infection has been increasingly reported in Europe and the United States, mostly arising from genotype 3 and less frequently genotype 4. We report here on a patient with HEV genotype 3a infection complicated by Guillain-Barré syndrome in Portugal in December 2012. We draw attention to the diagnosis of autochthonous HEV infection and to its rare, but important, neurological complications.
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Affiliation(s)
- L Santos
- Infectious Disease Service, Intensive Care Unit; Nephrology Research and Development Unit (FCT-725) and Faculty of Medicine of University of Porto, Sao Joao Hospital Centre, Alameda Professor Hernani Monteiro, Porto, Portugal.
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354
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Maddukuri VC, Russo MW, Ahrens WA, Emerson SU, Engle RE, Purcell RH, Thompson EB, Bonkovsky HL. Chronic hepatitis E with neurologic manifestations and rapid progression of liver fibrosis in a liver transplant recipient. Dig Dis Sci 2013; 58:2413-6. [PMID: 23512404 DOI: 10.1007/s10620-013-2628-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/26/2013] [Indexed: 01/11/2023]
Affiliation(s)
- Vinaya C Maddukuri
- The Liver-Biliary-Pancreatic Center and Liver Transplant Center, Carolinas Medical Center, 1540 Garden Terrace, Research Office Bldg, 5th Floor, WS 7, Charlotte, NC 28203, USA.
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355
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Debing Y, Winton J, Neyts J, Dallmeier K. Cutthroat trout virus as a surrogate in vitro infection model for testing inhibitors of hepatitis E virus replication. Antiviral Res 2013; 100:98-101. [PMID: 23916729 DOI: 10.1016/j.antiviral.2013.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/03/2013] [Accepted: 07/22/2013] [Indexed: 11/18/2022]
Abstract
Hepatitis E virus (HEV) is one of the most important causes of acute hepatitis worldwide. Although most infections are self-limiting, mortality is particularly high in pregnant women. Chronic infections can occur in transplant and other immune-compromised patients. Successful treatment of chronic hepatitis E has been reported with ribavirin and pegylated interferon-alpha, however severe side effects were observed. We employed the cutthroat trout virus (CTV), a non-pathogenic fish virus with remarkable similarities to HEV, as a potential surrogate for HEV and established an antiviral assay against this virus using the Chinook salmon embryo (CHSE-214) cell line. Ribavirin and the respective trout interferon were found to efficiently inhibit CTV replication. Other known broad-spectrum inhibitors of RNA virus replication such as the nucleoside analog 2'-C-methylcytidine resulted only in a moderate antiviral activity. In its natural fish host, CTV levels largely fluctuate during the reproductive cycle with the virus detected mainly during spawning. We wondered whether this aspect of CTV infection may serve as a surrogate model for the peculiar pathogenesis of HEV in pregnant women. To that end the effect of three sex steroids on in vitro CTV replication was evaluated. Whereas progesterone resulted in marked inhibition of virus replication, testosterone and 17β-estradiol stimulated viral growth. Our data thus indicate that CTV may serve as a surrogate model for HEV, both for antiviral experiments and studies on the replication biology of the Hepeviridae.
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Affiliation(s)
- Yannick Debing
- Rega Institute for Medical Research, Department of Microbiology and Immunology, Minderbroedersstraat 10, 3000 Leuven, Belgium
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356
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Geurtsvankessel CH, Islam Z, Mohammad QD, Jacobs BC, Endtz HP, Osterhaus ADME. Hepatitis E and Guillain-Barre syndrome. Clin Infect Dis 2013; 57:1369-70. [PMID: 23899686 DOI: 10.1093/cid/cit512] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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357
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Zhou X, de Man RA, de Knegt RJ, Metselaar HJ, Peppelenbosch MP, Pan Q. Epidemiology and management of chronic hepatitis E infection in solid organ transplantation: a comprehensive literature review. Rev Med Virol 2013; 23:295-304. [PMID: 23813631 DOI: 10.1002/rmv.1751] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 12/14/2022]
Abstract
Hepatitis E virus (HEV) infection has emerged as a global public health issue. Although it often causes an acute and self-limiting infection with low mortality rates in the western world, it bears a high risk of developing chronic hepatitis in immunocompromised patients with substantial mortality rates. Organ transplant recipients who receive immunosuppressive medication to prevent rejection are thought to be the main population at risk for chronic hepatitis E. Therefore, there is an urgent need to properly evaluate the clinical impact of HEV in these patients. This article aims to review the prevalence, infection course, and management of HEV infection after solid organ transplantation by performing a comprehensive literature review. In addition, an in-depth emphasis of this clinical issue and a discussion of future development are also presented.
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Affiliation(s)
- Xinying Zhou
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands
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358
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Naini BV, Lassman CR. Liver Transplant Pathology: Review of Challenging Diagnostic Situations. Surg Pathol Clin 2013; 6:277-93. [PMID: 26838975 DOI: 10.1016/j.path.2013.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Histopathologic assessment of allograft liver biopsies has an important role in managing patients who have undergone liver transplantation. In this review, several topics are discussed that create diagnostic problems in transplant pathology, with emphasis on pathologic features and differential diagnosis. The topics discussed are acute cellular rejection, late acute rejection (centrizonal/parenchymal rejection), chronic rejection, plasma cell hepatitis, idiopathic posttransplant chronic hepatitis, fibrosing cholestatic hepatitis, selected viral infections (cytomegalovirus, Epstein-Barr virus, and hepatitis E), and acute antibody-mediated rejection.
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Affiliation(s)
- Bita V Naini
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 1P-172 CHS, Los Angeles, CA 90095-1732, USA.
| | - Charles R Lassman
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, 13-145 CHS, Los Angeles, CA 90095-1732, USA
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359
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Mesquita JR, Conceição-Neto N, Valente-Gomes G, Gonçalves G, Nascimento MSJ. Antibodies to hepatitis E in Portuguese mothers and their newborns. J Med Virol 2013; 85:1377-8. [PMID: 23722441 DOI: 10.1002/jmv.23619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 11/08/2022]
Abstract
The high mortality of pregnant women is one of the main features of hepatitis E virus (HEV) infection in endemic countries. With the emergence of genotype 3 HEV in industrialized countries, attention should be given to pregnant women from these regions since the effect of genotype 3 HEV in pregnancy is not yet known. In this study, archived sera dating from 1993 from mothers with no history of traveling to HEV endemic countries and their newborns were tested for anti-HEV IgG antibodies. Four of the 12 maternal sera were positive for IgG anti-HEV, indicating exposure to this virus. Their newborns were also positive, showing higher anti-HEV IgG levels. Overall, these findings demonstrate not only an efficient transplacental transport of anti-HEV IgG, but also circulation of autochthonous HEV in Portugal in the early 1990s.
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Affiliation(s)
- J R Mesquita
- Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy of University of Porto. Rua Jorge Viterbo Ferreira, Porto, Portugal.
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360
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Abstract
PURPOSE OF REVIEW The spectrum of hepatitis E virus (HEV) infection has changed over the past 2 years, especially in the developed world. Herein, we review the progress made in studying the epidemiology, hepatic, and extrahepatic manifestations, and the treatment of HEV infection, over the past 2 years. RECENT FINDINGS HEV infection is an underdiagnosed disease because of the use of low-sensitivity serological assays. In addition to the four known genotypes, other new genotypes have also been recently described. HEV infection is not only a self-limiting disease but it can also evolve to chronic hepatitis and cirrhosis in organ transplant patients, hematological patients receiving chemotherapy, and HIV patients. HEV can also cause extrahepatic manifestations, such as neurological symptoms, kidney injury, and hematological disorders. Pegylated interferon and ribavirin have been found to effectively treat HEV infection. SUMMARY HEV is a worldwide disease that can cause hepatic and extrahepatic manifestations.
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361
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Drug-Induced Liver Injury Throughout the Drug Development Life Cycle: Where We Have Been, Where We are Now, and Where We are Headed. Perspectives of a Clinical Hepatologist. Pharmaceut Med 2013. [DOI: 10.1007/s40290-013-0015-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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362
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Neukam K, Barreiro P, Macías J, Avellón A, Cifuentes C, Martín-Carbonero L, Echevarría JM, Vargas J, Soriano V, Pineda JA. Chronic hepatitis E in HIV patients: rapid progression to cirrhosis and response to oral ribavirin. Clin Infect Dis 2013; 57:465-8. [PMID: 23575198 DOI: 10.1093/cid/cit224] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic hepatitis E virus infection with rapid progression to cirrhosis is reported in 2 human immunodeficiency virus (HIV)-infected patients with severe immunosuppression. Monotherapy with ribavirin led to temporary viral response and marked improvement of liver damage. Chronic hepatitis E should be regarded as another opportunistic event within HIV infection.
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Affiliation(s)
- Karin Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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363
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Performance of two commercial assays for detecting hepatitis E virus RNA in acute or chronic infections. J Clin Microbiol 2013; 51:1913-6. [PMID: 23515544 DOI: 10.1128/jcm.00661-13] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We assessed the performance of the Ceeram and Altona assays, the first two commercially available hepatitis E virus (HEV) RNA assays, using serial dilutions of 4 HEV-positive reference samples (genotypes 3a, 3c, 3e, and 3f). Both assays provided good analytical sensitivity and high reproducibility for detecting genotype 3 HEV RNA.
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364
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Vikrant S, Kumar S. Severe hyperbilirubinemia and acute renal failure associated with hepatitis E in a patient whose glucose-6-phosphate dehydrogenase levels were normal. Clin Exp Nephrol 2013; 17:596-7. [PMID: 23494297 DOI: 10.1007/s10157-013-0795-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/01/2013] [Indexed: 10/27/2022]
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365
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Pathobiology of hepatitis E: lessons learned from primate models. Emerg Microbes Infect 2013; 2:e9. [PMID: 26038457 PMCID: PMC3630954 DOI: 10.1038/emi.2013.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 12/12/2022]
Abstract
Like the other hepatitis viruses, hepatitis E virus (HEV) has been difficult to study because of limitations in cell culture systems and small animal models. Much of what we know has come from epidemiological studies in developing countries and, more recently, in industrialized countries. However, the epidemiology is very different in these two settings: hepatitis E in developing countries is epidemic as well as sporadic, principally water-borne, most likely to cause disease in older children and young adults and relatively severe, especially in pregnant women; in industrialized countries the disease is sporadic, principally food-borne, most common in the elderly and probably associated with mostly inapparent infections. These differences are believed to be genotypically determined. To examine the biological parameters of hepatitis E, we have studied HEV infections in nonhuman primates, which are surrogates of man. Infections with HEV genotypes 1-3 were compared in rhesus and cynomolgus macaques and chimpanzees. In general, the biological characteristics of the different HEV genotypes mirrored their epidemiological characteristics.
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366
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Lhomme S, Dubois M, Abravanel F, Top S, Bertagnoli S, Guerin JL, Izopet J. Risk of zoonotic transmission of HEV from rabbits. J Clin Virol 2013; 58:357-62. [PMID: 23474012 PMCID: PMC7172140 DOI: 10.1016/j.jcv.2013.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/14/2013] [Accepted: 02/08/2013] [Indexed: 12/17/2022]
Abstract
Hepatitis E virus strains from rabbits indicate that these mammals may be a reservoir for HEVs that cause infection in humans. Further issues remain to be clarified, including whether the genotype of rabbit HEV differs from human and swine HEV genotype 3 and whether rabbit HEV can infect human and other animals. HEV was found in farmed rabbits in several geographic areas of China, in USA and more recently in France. The prevalence of antibodies against HEV was 36%, 57% and 55% in rabbits from Virginia (USA), Gansu Province and Beijing (China), respectively. HEV RNA was detected in 16.5% of serum samples from farmed rabbits in Virginia, 7.5% in Gansu Province and 7.0% in Beijing. HEV RNA was detected in 7% of bile samples from farmed rabbits and in 23% of liver samples from wild rabbits in France. The full-length genomic sequences analysis indicates that all the rabbit strains belong to the same clade. Nucleotide sequences were 72.2-78.2% identical to HEV genotypes 1-4. Comparison with HEV sequences of human strains circulating in France and reference sequences identified a human strain closely related to rabbit HEV. A 93-nucleotide insertion in the X domain of the ORF1 of the human strain and in all the rabbit HEV strains was found. Moreover, the ability of rabbit HEV to cause cross-species infection in a pig model has recently been demonstrated. Rabbit HEV can replicate efficiently in human cell lines. Collectively, these data support the possibility of zoonotic transmission of HEV from rabbits.
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Affiliation(s)
- Sébastien Lhomme
- INSERM, UMR 1043, F-31300 Toulouse, France; Laboratoire de Virologie, CHU Purpan, 330 Avenue de Grande Bretagne, F-31300 Toulouse, France
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367
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Juhl D, Baylis SA, Blümel J, Görg S, Hennig H. Seroprevalence and incidence of hepatitis E virus infection in German blood donors. Transfusion 2013; 54:49-56. [PMID: 23441647 DOI: 10.1111/trf.12121] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 11/29/2012] [Accepted: 12/15/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hepatitis E virus (HEV) is transmissible by transfusion. More data are needed about seroprevalence, incidence, and viremia in blood donors for the assessment of risk of transfusion-transmitted (TT)-HEV infections. STUDY DESIGN AND METHODS Samples from 1019 whole blood donors were tested for anti-HEV immunoglobulin (Ig)G by enzyme-linked immunosorbent assay and Western blot. The incidence of HEV and presence of HEV RNA in donors who seroconverted were determined by testing archive samples and recipients of viremic donations were traced. Anti-HEV IgM and alanine transaminase (ALT) testing were also performed to assess the value of such measures in the prevention of TT-HEV infections. RESULTS A total of 69 of 1019 donors tested positive for anti-HEV IgG (6.8% seroprevalence), and seroconversion for anti-HEV IgG occurred in seven of 69 donors within 2 years (incidence, 0.35%/year). Three of seven (42.8%) seroconverting donors provided an archive sample in which HEV RNA was detectable. One recipient of these donations was traceable; anti-HEV IgG, IgM, and HEV RNA testing were negative 41 days after transfusion. Neither ALT levels nor anti-HEV IgM detection correlated with the presence of HEV RNA. CONCLUSIONS The seroprevalence of HEV was 6.8%, and the annual incidence 0.35%. HEV RNA was detectable in several seroconverting donors, without evidence for HEV transmission in the only traceable recipient. Since neither ALT nor anti-HEV IgM testing correlate with the presence of HEV RNA, HEV nucleic acid testing currently provides the only method for the prevention of TT-HEV infection. However, before implementation, more data about clinical relevance of TT-HEV infections and infectious dose of HEV are required.
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Affiliation(s)
- David Juhl
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck/Kiel, Germany; Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
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