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Adverse Occurrence type:
Infrequently described, reports provided as reference.
Time to detection:
46 days (recipient #1); 38 days (recipient #2).
Alerting signals, symptoms, evidence of occurrence:
Platelet apheresis donor reported diagnosis of hepatitis A 18 days post donation; donor developed jaundice and tested positive for HAV IgM. A 6 year old boy with Burkitt's lymphoma had received 3 units of platelets from this donor and became symptomatic (pale stools, abdominal pain, jaundice, elevated liver function tests) 1 month later. Another recipient, a 65 year old female patient with acute leukaemia, tested positive for HAV IgM 38 days post-transfusion and had mild elevation of transaminases but no clinical signs or symptoms. Other close contacts of the 6 year old boy also developed HAV infection.
Demonstration of imputability or root cause:
Events indicate TT-HAV but it must be noted that the imputability is supported but not proven through the sequence analysis over the portion of the genome analysed (VP1). Altough the strains in this cluster showed no differences, that was also the case when comparison to unrelated strains was made (see phylogenetic tree) as this is the virus circulating in Hungary since 2012.
Suggest new keywords:
transfusion transmitted Hepatitis A, HAV, Hepatitis A,
jaundice, VP1, sequence
- Hettmann A, et al. Phylogenetic analysis of a transfusion-transmitted hepatitis A outbreak. Virus Genes. 2017 Feb;53(1):15-20 - Gowland, D., Fontana, S., Niederhauser, C. and Taleghani, B.M. (2004). Molecular and serologic tracing of a transfusion-transmitted hepatitis A virus. Transfusion 44(11): 1555-61. - da Silva, SG, et al. A Rare Case of Transfusion Transmission of Hepatitis A Virus to Two Patients with Haematological Disease. - Ishikawa K, et al. A case of posttransfusion hepatitis A.
Expert comments for publication:
Pathogen inactivation technologies do not remove virulence of this non-enveloped virus. There have been several clusters of HAV transmission amongst the MSM community, with repeated outbreaks described in Europe and the US. With this increased activity, there is always the possibility of transmission outside this particular risk group. Blood establishments need to observe the evolving HAV epidemiology in their communities and consider necessary blood safety measures as and if required. In a recent food-related outbreak in Scotland, precautionary measures were put in place and a temporary restriction on donations from donors living in certain post code areas was implemented (https://nhsnss.org/blog-news/articles/blood-service-response-to-hepatitis-a-outbreak/).