Blood-borne HEV transmission: A one year experience with routine HEV screening at a tertiary center

Background:

Routine hepatitis E virus (HEV) testing of blood products has recently been implemented in Great-Britain and the Netherlands. The relevance of blood-borne HEV-transmission in Germany is still under debate and requires further investigations.

Methods:

Starting in October 2016 all blood donors at the University Hospital Hamburg-Eppendorf were routinely screened for HEV RNA. Pools of 24 donations were tested using the new Roche cobas 6800® HEV PCR assay (LLOD single: 19 IU/ml, 24 pool: 456 IU/ml), reactive pools were tested individually to identify HEV RNA positive donors. HEV RNA positive blood products were not transfused. HEV-PCR positive donors and a control cohort (n = 256) were asked to answer a questionnaire.

Results:

30/28981 HEV-RNA-positive donors were identified (0.103%). Median viral load was 960 IU/ml. Only 3 of the positive donors (10%) presented with elevated transaminases at time of donation (ALT: 83 U/l, 192 U/l and 101 U/l). The questionnaire revealed that HEV-viraemic donors significantly more often consumed raw pork meat (12/19; 63%) than controls (89/256, 35%, p < 0.013). In two donors undercooked pork liver dishes were identified as the source of infection.

Conclusions:

Incidence of HEV RNA in asymptomatic blood donors in our cohort is higher than reported before although most donors have low viral load. Since prolonged viremia (more than 3 months) can be observed, a single HEV-positive blood donor can cause HEV infections in several patients with possible fatal clinical outcome. Uncooked or undercooked pork meat might be a relevant risk factor for HEV infection.