Transfusion-Transmitted Hepatitis E Virus Infection in France

• Published in: Transfusion medicine reviews Vol. 33; no. 3; pp. 146 - 153
• Main Authors: Gallian, Pierre, Pouchol, Elodie, Djoudi, Rachid, Lhomme, Sébastien, Mouna, Lina, Gross, Sylvie, Bierling, Philippe, Assal, Azzedine, Kamar, Nassim, Mallet, Vincent, Roque-Afonso, Anne-Marie, Izopet, Jacques, Tiberghien, Pierre
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2019; WB Saunders
• Subjects: Acute Disease; Adolescent; Adult; Aged, 80 and over; Blood Donors / statistics & numerical data; Blood Safety / statistics & numerical data; Child; Chronic Disease; Female; France / epidemiology; Hepatitis E; Hepatitis E / diagnosis; Hepatitis E / epidemiology; Hepatitis E / transmission; Hepatitis E virus; Humans; Life Sciences; Male; Microbiology and Parasitology; Middle Aged; Retrospective Studies; Risk Factors; Santé publique et épidémiologie; Severity of Illness Index; Transfusion Reaction / diagnosis; Transfusion Reaction / epidemiology; Transfusion-transmitted infection; Virology; Young Adult; Transfusion-transmitted infection; Hepatitis E; Hepatitis E virus
• ISSN: 0887-7963; 1532-9496
• DOI: 10.1016/j.tmrv.2019.06.001

There is growing concern regarding the risk of transfusion- transmitted (TT) hepatitis E. Since the first described case in 2006, several TT hepatitis E have been reported to the French hemovigilance network. We performed a retrospective analysis of all cases of TT hepatitis E reported between 2006 and 2016. Transfusion-transmitted hepatitis E with high imputability according to phylogenetic analysis occurred in 23 patients aged 8 to 88 years and involved mostly solid organ recipients (n = 9) or patients with malignant hematological diseases (n = 9, including 4 hematopoietic allograft recipients). Involved blood products were plasma (n = 7), among which 6 had undergone pathogen reduction with solvent/detergent (n = 4) or amotosalen + ultra-violet A (UVA) (n = 2 from 1 donation) treatments, red blood concentrates (n = 7), apheresis platelets concentrates (n = 3) and whole blood pooled platelets concentrates (n = 6), among which one had underwent amotosalen + UVA treatment. Median hepatitis E virus (HEV) RNA dose infused was 5.79 [4.36–10.10] log IU. HEV infection progressed to chronic hepatitis E in 14 (61%) immunocompromised patients, 2 of whom had advanced liver fibrosis at diagnosis. Chronic hepatitis E patients cleared HEV with ribavirin treatment (n = 10), after immunosuppressive drug reduction (n = 3), or spontaneously (n = 1). One additional organ transplant recipient with associated co-morbidities died with ongoing HEV infection and multiple organ failure. The other 8 (34.8%) patients with TT hepatitis E cleared HEV within 6 months with ribavirin treatment (n = 3), reduced immunosuppression (n = 1) or spontaneously (n = 4). Red cells, platelets, and plasma transfusions may be associated with TT hepatitis E that can evolve to chronic hepatitis E in immunocompromised patients. Hepatitis E virus has emerged in France as a clinically significant TT infection risk.
•Hepatitis E virus (HEV) has emerged in France as well as elsewhere in Europe as a significant transfusion risk.•Such transfusion-transmitted (TT) HEV infections occur with red cells, platelets and fresh-frozen plasma.•Current pathogen inactivation technologies for blood products are unable to prevent TT HEV infection.•Transfusion-transmitted HEV infection can result in chronic severe hepatitis in immunosuppressed patient.•Where HEV is endemic, enhanced clinical awareness as well as blood donation screening will mitigate the risk associated with TT HEV infection.