Hepatitis e virus in blood components: A prevalence and transmission study in southeast England

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*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

427 Citations (Scopus)


Findings 79 donors were viraemic with genotype 3 HEV, giving an RNA prevalence of one in 2848. Most viraemic donors were seronegative at the time of donation. The 79 donations had been used to prepare 129 blood components, 62 of which had been transfused before identification of the infected donation. Follow-up of 43 recipients showed 18 (42%) had evidence of infection. Absence of detectable antibody and high viral load in the donation rendered infection more likely. Recipient immunosuppression delayed or prevented seroconversion and extended the duration of viraemia. Three recipients cleared longstanding infection after intervention with ribavirin or alteration in immunosuppressive therapy. Ten recipients developed prolonged or persistent infection. Transaminitis was common, but short-term morbidity was rare; only one recipient developed apparent but clinically mild post-transfusion hepatitis.

Interpretation Our findings suggest that HEV genotype 3 infections are widespread in the English population and in blood donors. Transfusion-transmitted infections rarely caused acute morbidity, but in some immunosuppressed patients became persistent. Although at present blood donations are not screened, an agreed policy is needed for the identification of patients with persistent HEV infection, irrespective of origin, so that they can be offered antiviral therapy. Funding Public Health England and National Health Service Blood and Transplant.

Methods From Oct 8, 2012, to Sept 30, 2013, 225 000 blood donations that were collected in southeast England were screened retrospectively for HEV RNA. Donations containing HEV were characterised by use of serology and genomic phylogeny. Recipients, who received any blood components from these donations, were identified and the outcome of exposure was ascertained.

Background The prevalence of hepatitis E virus (HEV) genotype 3 infections in the English population (including blood donors) is unknown, but is probably widespread, and the virus has been detected in pooled plasma products. HEV-infected donors have been retrospectively identified through investigation of reported cases of possible transfusion-transmitted hepatitis E. The frequency of HEV transmission by transfusion and its outcome remains unknown. We report the prevalence of HEV RNA in blood donations, the transmission of the virus through a range of blood components, and describe the resulting morbidity in the recipients.

Original languageEnglish
Pages (from-to)1766-1773
Number of pages8
JournalThe Lancet
Issue number9956
Publication statusPublished - 15 Nov 2014

Bibliographical note

Funding Information:
This study was jointly funded internally by Public Health England and the NHSBT. We thank the members of National Transfusion Microbiology Office and Transfusion Microbiology Surveillance, particularly Gill Rayfield and Raji Salker; members of the National Transfusion Microbiology Reference Laboratory including Alex Boateng, Ruwanika Kothalawala, and Nazow Azim; Sam Lattimore at the Centre for Infectious Disease Surveillance and Control, Public Health England for valuable statistical advice; colleagues in the joint Blood Borne Virus Unit Public Health England for help in the running of this study and participation in steering group meetings; NHSBT donors for their enthusiastic contribution to the study; NHSBT Filton for collation and dispatch of donor samples to Colindale; National Health Service staff in both trust and community services for their sensitive handling of potentially difficult situations engendered by the Look Back requirement, and the members of the data monitoring committee for their enduring advice.


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