Hepatitis E Virus Outbreak in an Internally Displaced Population of Afghanistan: Is it a Risk to Transfusion Safety?

Abstract

Objective: The objective of this study was to investigate the Hepatitis E virus (HEV) outbreak in an internally displaced population (IDP) of Afghanistan, specifically in the Jalalabad region near the Torkham border.

Methodology: Blood samples were collected from 544 suspected cases in IDP camps in Jalalabad, Afghanistan, near the Torkham border. The samples were screened for HEV antibodies (IgM and IgG) and alanine aminotransferase (ALT). Subsequently, the samples were transported to the Peshawar Regional Blood Centre in Pakistan for serological and molecular analyses. The data were stored in Microsoft Excel 2013 and analyzed by the IBM Statistical Package for Social Sciences version 24.0 Armonk, NY: IBM Corp. for frequency, percentage, mean, and standard deviation. The Chi-square test was used where appropriate, and a p-value of < 0.05 was considered significant with a 95% confidence level.

Results: Out of the 544 samples serologically screened, 135 (24.81%) tested positive for HEV IgM, while 59 (10.84%) were reactive for HEV IgG. Among these samples, only 41 that were HEV IgM reactive also showed reactivity for HEV IgG. Within the cohort of 135 HEV IgM positive patients, 80 (59.25%) had donated blood for their family or friends at least once in the past three years, and all of them were males. Additionally, among the 135 HEV IgM positive samples, 86 (63.70%) tested positive for HEV RNA. The positivity frequency of HEV RNA was 100% (76/76) for symptomatic cases and 16.94% (10/59) for asymptomatic cases.

Conclusion: Our findings suggest that drinking river water was a potential source of HEV infection in this outbreak. It is prudent to consider hepatitis E as a potential risk to blood safety, especially considering that the majority of the infected cases were males with a history of recent blood donation. Furthermore, it is worth noting that there is currently no screening facility for HEV in any blood establishment.