21 August 2015 Samreen Ijaz Virus Reference Department Health Protection Agency Indigenous HEV...
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19 April 2023
Samreen Ijaz
Virus Reference Department
Health Protection Agency
Indigenous HEV infection in the UK: a hazard for blood donation?
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HEV Infections in England and Wales (2005 study)
HEV seropositive samples with no travel history identified from 1996-2003 at CPHL
Male
Female
GENDER
50-59 yrs
>60 yrs
AGE
Genotype 3UK strains
Genotype 1& 2Endemicstrains
MOLECULAR ANALYSIS
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0%
5%
10%
15%
20%
25%
30%
35%
40%
1-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79
Age group (years)
Pre
va
len
ce
1991
HEV seroprevalence in England(year 1991)
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0%
5%
10%
15%
20%
25%
30%
35%
40%
1-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79
Age group (years)
Pre
va
len
ce
19912004
HEV prevalence by age-group1991 vs 2004
Temporal shift
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Seroprevalence rates vs clinical disease
• 13% seroprevalence high compared to the low rate of clinically evident disease
• Incidence estimates between 1991 and 2004 indicate that ~62 000 cases of HEV occurred per year
• Mathematical modelling suggests that incidence does not vary with age group
• Shared risk factors common to all age groups
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Indigenous HEV in England and Wales
• Routes of transmission in the non-travellers could not be ascertained from this study
• Specific risk factors for acquiring indigenous HEV infections currently remains undefined
• The detection of HEV Abs and RNA in swine and subsequently in several other animals has led to suggestions of a potential zoonosis with animals acting as reservoirs for HEV infection in humans
• 85% of UK pigs are anti-HEV pos.
• Recommended that indigenous HEV be considered a level 2 zoonosis (potential zoonosis), thus requiring enhanced surveillance in the UK
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Parenteral transmission of HEV?
• Higher HEV Ab levels reported in:
• paid blood donors positive for other blood borne viruses
• repeatedly transfused haemodialysis patients
• Subsequent reports of transfusion transmitted HEV from France, Japan and Saudi Arabia
• Studies from Japan have demonstrated that a small but significant proportion of their blood donors were viraemic and potentially able to cause transfusion-associated HEV
• in the absence of elevated ALT and signs or symptoms of hepatitis
• When characterised, the strains involved in the cases from Japan were shown to be indigenous viruses
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Post transfusion hepatitis in the UK
• UK blood donor:
• 14 days after his donation he became ill with a ‘flu-like’ illness
• 10 days later he became jaundiced
• Blood donor reported illness to the blood service but components of his donation had already been used
• Testing for viral markers
• HAV, HBV, HCV, CMV and EBV negative
• HEV IgM and IgG positive
• HEV RNA positive – genotype 3
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Blood Donation
platelets red cellsPool from 4 donors which is resuspended using plasma from one of the donors(not the HEV pos donor)
Would contain 20-30mlsof the donor’s plasma
Patient 1 Patient 2
UNINFECTED INFECTED
Post transfusion hepatitis in the UK
• HEV infection in the recipient related to dose?
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• Post transfusion hepatitis in the UK is now a relatively rare event with enhanced surveillance through the Serious Hazards of Transfusion (SHOT) reporting system
• Approximately 62 000 cases occur each year
• Suggests that there are a significant number of subclinical HEV infection
• Current screening policy in the UK does not include HEV testing
• Should we worry?
Post-transfusion hepatitis
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Initial studies to look at UK blood donors
HEV IgG testing on:
• 262 samples from ‘ordinary’ blood donors
• 339 samples from donors with a history of jaundice (all anti-HBc negative)
0
5
10
15
20
25
17 - 29 30 - 39 40 - 49 50 - 59 > 60
Age (yrs)
%
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HEV seroprevalence in UK blood donors
• HEV seroprevalence trend similar in blood donors to general population
• Similar seroprevalence rates between ordinary and jaundice history donors
• HEV unlikely to be responsible for donors reporting history of jaundice
• History of jaundice not accurate screening method for excluding at risk donors
• Further HEV IgM & RNA testing carried out on all donors
• 4 HEV IgM pos
• 0 HEV RNA pos
EVIDENCE OF RECENT HEV INFECTION IN DONOR POPULATION
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Further work
Evidence of seroconversion in the blood donor panel
Evidence of HEV RNA in minipools
Concern of post transfusion hepatitis in transplant recipients and the immunosuppressed
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Acknowledgements
• Richard Tedder• Mathew Beale• Kate Tettmar• Roger Eglin
• NHS Blood and Transplant