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Adverse Occurrence type:
Prospective study of 225,000 blood donors in the South of England between October 2012 and September 2013 revealed asymptomatic, acute infection in donors at a rate of 1:2800, with 42% transmission rate of HEV to recipients of blood components.
Alerting signals, symptoms, evidence of occurrence:
As most recipients of blood components were immunocompromised haemato-oncology or post transplant patients, symptomatic hepatitic illness was not seen. One surgical patient developed mild hepatitis 5 weeks post transfusion. Exact timing of first detectable RNA cannot be quoted as samples were available at different time points, but viraemia could become detectable some months post transfusion and the study group elected to follow up recipients up to 16 weeks post- transfusion to exclude transmission. At the point of viral RNA clearance, transient transaminitis could be occasionally detected. Length of viraemia was prolonged and directly correlated with increased level of immunosuppression.
Demonstration of imputability or root cause:
Seroconversion detected in recipients and sequencing of ORF 2 to establish donor and recipient link. They were all HEV Genotype 3 viruses.
Patricia E Hewitt, Samreen Ijaz, Su R Brailsford, Rachel Brett, Steven Dicks, Becky Haywood, Iain T R Kennedy, Alan Kitchen, Poorvi Patel, John Poh, Katherine Russell, Kate I Tettmar, Joanne Tossell, Ines Ushiro-Lumb, Richard S Tedder (2014). Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. Lancet 384(9956):1766-73.