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One-third of chronic hepatitis E cases transmitted through blood products

PARIS — Blood products were linked to 36% of chronic hepatitis E cases among a group of immunosuppressed patients, according to a study presented at the International Liver Congress 2018.

“We are propagating screening of blood donations because an infected blood product given to an immunocompromised patient has serious consequences,” Ansgar Lohse, MD, from the University of Medical Center Hamburg-Eppendorf, Germany, told Healio Gastroenterology and Liver Disease. “Just testing blood products given to immunocompromised patients is almost impossible because you don't know ahead which product will go to which patients.”

According to Dirk Westhölter, MD, from the University Hospital Hamburg-Eppendorf, Germany, in his presentation on the study, routine HEV testing of blood products has recently been implemented in Great Britain and the Netherlands, but the relevance of bloodborne HEV-transmission remains controversially discussed in numerous countries.

The researchers retrospectively analyzed data from all 37 immunosuppressed patients seen at their center between 2011 and 2017 and all blood products given to patients with chronic HEV.

Eleven of the immunosuppressed patients developed chronic HEV. The researchers confirmed that HEV-infected blood products were the source of transmission in four of the 11 patients, including two patients who received heart transplants.

As part of their research into HEV incidence and risk factors, the researchers also conducted a questionnaire among the HEV-infected donors and found that those with HEV were significantly more likely to consume raw pork meat often compared with a set of control participants (63% vs. 35%; P < .01).

“The number of notified transfusion-transmitted HEV infections has so far been relatively low, probably due to under-reporting and under-recognition,” Westhölter, said in a press release. “This study confirms that blood products are an important source of HEV infection for immunosuppressed individuals and it has led us to recommend HEV RNA screening of all blood products destined for transplant or immunosuppressed patients.”

“Both in acute hepatitis of unknown etiology and in raised liver enzymes in immunosuppressed patients, being repeatedly positive, hepatitis E is a differential diagnosis and needs testing,” Lohse said. “People who think they're healthy may carry the virus. Physicians need to think about it.” – by Talitha Bennett

For more information:

Westhölter D, et al. PS-063. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.

Disclosure: Westhölter and Lohse report no relevant financial relationships

Editor's note: This article was updated to reflect a correction to Westhölter's certification.