Transfusion-Transmitted Hepatitis E: Implications for Blood Donation Screening

Abstract

In places with inadequate sanitation, hepatitis E, which is caused by infection with the hepatitis E virus (HEV), is a frequent cause of acute hepatitis. HEV belongs to the Hepeviridae family, genus Orthohepevirus, and is an RNA virus. HEV is a new infectious threat to the safety of blood. Over the past 18 years, cases of HEV acquired by transfusions have been described. Concern over transfusion-transmitted HEV as a new global health issue is increasing. Immunocompromised people who get HEV may develop a persistent infection, increasing their risk of developing liver cirrhosis and even the inevitability of death. At even relatively low blood levels of the virus, HEV is contagious. The usefulness of HEV testing on all blood donors is still up for debate. Some countries have implemented universal screening of HEV after taking risk and resource availability into account. The key approach for prevention is the HEV NAT screening. Alternative approaches, such as NAT testing all or portion of blood donations individually or in a small pool, are being investigated. Future research is required to characterize the incidence of HEV transmission by transfusion as well as its clinical characteristics, prognosis, and consequences. This article reviews the available data on transfusion-transmitted HEV, summarizes the prevalence of HEV infections among blood donors, and discusses the significance of these findings for blood donor screening.