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• Created by Lydia Foeken, last modified on  26 April, 2024, 17.15

Table of Contents

Acute infection (= HEV-RNA detectable, not IgG-positivity)

At recruitment (only if donor reports, no test required):

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• If entirely free of symptoms, re-evaluation is possible after 2 months. Consult with TC.
• If lasting hepatitis-like symptoms like fatigue, elevated liver enzymes, chronic HEV infection should be excluded (defined as persisting viremia >3 months)
• Testing available to TC

At collection day / in the product (if test required by local regulations, or if medically appropriate, e g recent travel history; results will typically be available only after donation)

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• INFORM transplant centre immediately, if positive result.
• Do not discard the product, but leave the decision to transfuse to the transplant centre
• As transplant centres might not be familiar with HEV, communicate that it might be acceptable to use the product after risk/benefit assessment, especially if the recipient has already been exposed to HEV.  

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Chronic infection

DEFER donor until documented healingclearance of virus and recovery of donor.

Background:

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis world-wide. Over the last 10 years, human hepatitis E cases have been increasingly reported in Europe where genotype 3 (HEV-3) is common. The main reservoir of HEV in Europe are pigs and wild boar. The majority of the infections are asymptomatic or mild. In acute cases the disease is a self-limiting hepatitis affecting mostly male adults above 60 years of age; on rare occasions the infection can result in a severe, fulminant hepatitis with acute liver failure. [1]Only 5-20% of infected individuals develop symptoms of a hepatitis. Most people with acute infection recover completely within one to five weeks

In several countries, where all blood products must be tested for HEV-RNA.[1]https://, it is recommended to follow local guidelines / regulation^{2 -5}

References

1. 1. Facts about hepatitis E. European Centre for Disease Prevention and Control. https/www.ecdc.europa.eu/en/hepatitis-e/facts.
2. A.S. de Vos et al. Cost Effectiveness of the screening of blood donations for hepatitis E virus in the Netherlands. Transfusion Vol 57, February 2017.
3. JK Mah et al. Hepatitis E virus seropositivity in an ethnically diverse community blood donor population. Vox Sanguinis. 2023;1–7.
4. R S Tedder et al. Hepatitis E risks: pigs or blood—that is the question. Volume 57, February 2017 Transfusion
5. E Spada et al. A nationwide retrospective study on prevalence of hepatitis E virus infection in Italian blood donors. Blood Transfusion 2018; 16: 413-21 DOI 10.2450/2018.0033-18

6. Domanović D et al. Hepatitis E and blood donation safety in selected European countries: a shift to screening? Euro Surveill. 2017 Apr 20;22(16):30514. doi: 10.2807/1560-7917.ES.2017.22.16.30514. PMID: 28449730; PMCID: PMC5404480.

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