Effect of Hepatitis E Virus RNA Universal Blood Donor Screening, Catalonia, Spain, 2017‒2020

Abstract

Hepatitis E virus (HEV) is the major cause of acute viral hepatitis in several countries in Europe. HEV is acquired mainly by consumption of contaminated pork but can also be transmitted through blood transfusion. HEV infection is usually self-limited but can become persistent in immunocompromised persons. During the first 30 months of HEV RNA universal screening of blood donations in Catalonia, Spain, we identified 151 HEV RNA-positive donations (1/4,341 blood donations). Most infected donors reported consumption of pates and sausages, and 58% were negative for HEV IgM and IgG. All HEV isolates belonged to genotype 3. All infected donors spontaneously resolved the infection, and no neurologic symptoms and reinfections were observed after 1 year of follow-up. Since the implementation of HEV RNA universal screening, no new cases of transfusion-transmitted HEV infection were reported. Our data indicate HEV screening of blood donations provides safer blood for all recipients, especially for immunosuppressed persons.

Keywords: Catalonia; HEV; IgG; IgM; Spain; acquisition route; blood donors; hepatitis E virus; screening; universal blood donor screening; viral load; virus RNA; viruses.

Figure 1

Rate of HEV RNA‒positive donations, Catalonia, Spain, November 2017‒April 2020. A) All donations; B) by age group during the same period. HEV, hepatitis E virus.

Figure 2

Geographic distribution of HEV-infected blood donors, Catalonia, Spain, November 2017‒April 2020. A) All donations (n = 151). B) HEV RNA detection rate (per 10,000 analyzed blood donations), by province (Barcelona, Girona, Lleida, and Tarragona). Maps were created by using Tableau Software (https://www.tableau.com). HEV, hepatitis E virus.

Figure 3

Phylogenetic analysis of HEV isolates from HEV-positive blood donors identified, Catalonia, Spain, November 2017‒April 2020 (n = 91). Evolutionary relationships of taxa. Evolutionary history was inferred by using the neighbor-joining method. Sequence analysis was performed by using MEGA 7 software (https://www.megasoftware.net) and HEV reference sequences described in Smith et al. (15), and additional HEV sequences from GenBank (labeled by accession number). Evolutionary distances were computed by using the maximum composite likelihood method, and the phylogenetic tree was constructed by using the neighbor-joining method. Colored dots indicate the HEV reference sequences used in the analysis (blue, HEV genotype 1; purple, HEV genotype 2; green, HEV genotype 3; gray, HEV genotype 4). Scale bar indicates nucleotide substitutions per site. HEV, hepatitis E virus.