Hepatitis E virus (HEV)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
The frequency of transfusion-associated HEV transmission cannot be ascertained from these reports as the fate of all blood components is not described.
Time to detection: 
10 - 22 days
Alerting signals, symptoms, evidence of occurrence: 
2014 publication: A Japanese man underwent re-thoracotomy following coronary artery bypass surgery, followed by platelet transfusion. The blood donor became symptomatic after donation and was found to be HEV infected. The donated blood was retrospectively found to contain HEV RNA. Vireamia in the recipient was observed on day 10 post-transfusion, followed by a gradual increase in the HEV load that reached a peak after 45 days. On day 54, the patient showed an elevated serum ALT level of 109 IU/L and AST of 70 IU/L and he remained asymptomatic. The aminotransferase levels reached 704 IU/L for AST and 972 IU/L for ALT on day 65 post-transfusion and returned to normal levels by day 85. Despite positive IgG and IgM, HEV RNA was still detectable until day 85. 2009 publication: Description of a look back following illness and diagnosis of acute HEV in a platelet donor, who had consumed contaminated pork products 23 days before blood donation. The HEV strain was of genotype 4. The recipient was a stem cell transplant recipient who developed significant elevation of aminotransferases and eventually mounted serological response and controlled HEV viraemia.
Demonstration of imputability or root cause: 
Sequence analysis of the HEV genotype 3 strains from donor and recipient showed an identical match for 326 nucleotides in ORF1, and clustered separately from other Japanese genotype 3 sequences. In the transmission of HEV G4, full length sequence was identical in donor and recipient.
Imputability grade: 
3 Definite/Certain/Proven
Suggest new keywords: 
hepatitis E
red blood cells
stem cell recipient
Suggest references: 
Matsubayashi K, Kang JH, Sakata H, Takahashi K, Shindo M, Kato M, et al. A case of transfusion-transmitted hepatitis E caused by blood from a donor infected with hepatitis E virus via zoonotic food-borne route. Transfusion. 2008;48(7):1368-75. Matsubayashi K, Nagaoka Y, Sakata H, Sato S, Fukai K, Kato T, et al. Transfusion-transmitted hepatitis E caused by apparently indigenous hepatitis E virus strain in Hokkaido, Japan. Transfusion. 2004;44(6):934-40. Matsui T, Kang JH, Matsubayashi K, Yamazaki H, Nagai K, Sakata H, et al. Rare case of transfusion-transmitted hepatitis E from the blood of a donor infected with the hepatitis E virus genotype 3 indigenous to Japan: Viral dynamics from onset to recovery. Hepatology research : the official journal of the Japan Society of Hepatology. 2014