TY - JOUR T1 - Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. JF - Lancet//Lancet Y1 - 2014 A1 - Hewitt, Patricia E A1 - Ijaz, Samreen A1 - Brailsford, Su R A1 - Brett, Rachel A1 - Dicks, Steven A1 - Haywood, Becky A1 - Kennedy, Iain T R A1 - Kitchen, Alan A1 - Patel, Poorvi A1 - Poh, John A1 - Russell, Katherine A1 - Tettmar, Kate I A1 - Tossell, Joanne A1 - Ushiro-Lumb, Ines A1 - Tedder, Richard S KW - *Blood Component Transfusion/ae [Adverse Effects] KW - *Communicable Disease Control/mt [Methods] KW - *Disease Transmission, Infectious/sn [Statistics & Numerical Data] KW - *Hepatitis E virus/ge [Genetics] KW - *Hepatitis E/ep [Epidemiology] KW - *Hepatitis E/tm [Transmission] KW - Adult KW - Age Distribution KW - Aged KW - Blood Component Transfusion/mt [Methods] KW - Blood Transfusion/ae [Adverse Effects] KW - Cohort Studies KW - England/ep [Epidemiology] KW - Female KW - Genotype KW - Hepatitis E virus/im [Immunology] KW - Hepatitis E/im [Immunology] KW - Hepatitis E/pc [Prevention & Control] KW - Humans KW - Male KW - Middle Aged KW - Prevalence KW - Retrospective Studies KW - Risk Assessment KW - Sex Distribution AB - BACKGROUND: The prevalence of hepatitis E virus (HEV) genotype 3 infections in the English population (including blood donors) is unknown, but is probably widespread, and the virus has been detected in pooled plasma products. HEV-infected donors have been retrospectively identified through investigation of reported cases of possible transfusion-transmitted hepatitis E. The frequency of HEV transmission by transfusion and its outcome remains unknown. We report the prevalence of HEV RNA in blood donations, the transmission of the virus through a range of blood components, and describe the resulting morbidity in the recipients., METHODS: From Oct 8, 2012, to Sept 30, 2013, 225,000 blood donations that were collected in southeast England were screened retrospectively for HEV RNA. Donations containing HEV were characterised by use of serology and genomic phylogeny. Recipients, who received any blood components from these donations, were identified and the outcome of exposure was ascertained., FINDINGS: 79 donors were viraemic with genotype 3 HEV, giving an RNA prevalence of one in 2848. Most viraemic donors were seronegative at the time of donation. The 79 donations had been used to prepare 129 blood components, 62 of which had been transfused before identification of the infected donation. Follow-up of 43 recipients showed 18 (42%) had evidence of infection. Absence of detectable antibody and high viral load in the donation rendered infection more likely. Recipient immunosuppression delayed or prevented seroconversion and extended the duration of viraemia. Three recipients cleared longstanding infection after intervention with ribavirin or alteration in immunosuppressive therapy. Ten recipients developed prolonged or persistent infection. Transaminitis was common, but short-term morbidity was rare; only one recipient developed apparent but clinically mild post-transfusion hepatitis., INTERPRETATION: Our findings suggest that HEV genotype 3 infections are widespread in the English population and in blood donors. Transfusion-transmitted infections rarely caused acute morbidity, but in some immunosuppressed patients became persistent. Although at present blood donations are not screened, an agreed policy is needed for the identification of patients with persistent HEV infection, irrespective of origin, so that they can be offered antiviral therapy., FUNDING: Public Health England and National Health Service Blood and Transplant.Copyright © 2014 Hewitt et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by Elsevier Ltd. All rights reserved. M1 - 2985213r, l0s, 0053266 PB - Hewitt,Patricia E. Transfusion Microbiology, National Health Service Blood and Transplant, London, UK.Ijaz,Samreen. Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK.Brailsford,Su R. Transfusion M CY - England VL - 384 SN - 1474-547X CP - 9956 N1 - Comment in: Lancet. 2014 Nov 15;384(9956):1729-30; PMID: 25078305 L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=25078306 ID - 4068 ER -