Original ResearchTransfusion-Transmitted Hepatitis E Virus Infection in France
Section snippets
Blood Products in France
In France, collection, qualification, preparation and distribution of labile blood products for civilians are under the exclusive responsibility of a national transfusion public service: Etablissement Français du Sang (EFS).
During the study period (2006—2016), approximately three million labile blood products were transfused annually in France including 2.4 million of red blood cells concentrates (RBC), ~300 000 platelets concentrates including~ 50 to 60% whole blood-derived pooled platelets
Patients
In 2006, the first case of TT HEV was reported in France in a 8 year-old child treated for a kidney tumor (#1, Table 1) [15]. Up to December 2016, 78 suspected cases of possible HEV-TT were reported to the French hemovigilance network.
In 22 of these 78 cases, TT HEV was excluded based on negative HEV NAT of all blood products transfused to the patients. Imputability was deemed non-evaluable in 4 cases. In 29 cases, absence of evaluable recipient viral genome or inconclusive phylogenetic
Discussion
With 23 reported cases of transfusion-transmitted infections of high imputability between 2006 and 2016 in France, including 14 with chronic hepatitis, HEV has emerged as a significant infectious transfusion risk. These cases highlight the clinical burden associated with TT-HEV, while most probably only representing a fraction of the current occurrences. Indeed, and despite recent progress, hepatitis E may be misdiagnosed. HEV infection is often asymptomatic in immunocompetent patients. Chronic
Author's contributions
PG, RD and PT designed the study; all authors contributed data; PG, EP, RD and PT wrote the first draft; JI, AMRA, NK and VM further contributed to the writing of the manuscript; all authors reviewed and approved the final version of the manuscript.
Conflict of Interest
PG, EP, RD, SG, PB, AA and PT are employed by the French transfusion public service (Etablissement Français du Sang) in charge of blood products manufacturing and issuing in France.
Acknowledgments
The authors express their thanks to the French hemovigilance network members for the careful reporting of these cases.
References (50)
- et al.
Acute hepatitis E in south-West France over a 5-year period
J Clin Virol
(2009) - et al.
Transfusion-transmitted hepatitis E in a misleading context of autoimmunity and drug-induced toxicity
J Hepatol
(2012) - et al.
Hepatitis E transmission by transfusion of intercept blood system-treated plasma
Blood
(2014) - et al.
Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants
Gastroenterology
(2011) - et al.
Chronic hepatitis E virus infection and treatment
J Clin Exp Hepatol
(2013) - et al.
Hepatitis E virus in blood components: a prevalence and transmission study in Southeast England
Lancet
(2014 Nov 15) - et al.
B. et al. characterization of the lipid envelope of exosome encapsulated HEV particles protected from the immune response
Biochimie
(2017) - et al.
Hepatitis E virus infection
Nat Rev Dis Primers
(2017) - et al.
Hepatitis E virus infection
Clin Microbiol Rev
(2014) - et al.
A nationwide survey of hepatitis E viral infection in French blood donors
Hepatology
(2016)
Hepatitis E virus and chronic hepatitis in organ-transplant recipients
N Engl J Med
Hepatitis E virus reinfections in solid-organ-transplant recipients can evolve into chronic infections
J Infect Dis
Hepatitis E virus in Scottish blood donors
Vox Sang
S, et al. Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011
Euro Surveill
Hepatitis E Vox Sang
Transfusion-transmitted hepatitis E caused by apparently indigenous hepatitis E virus strain in Hokkaido
Japan Transfusion
Transfusion-transmitted hepatitis E in a 'nonhyperendemic' country
Transfus Med
Red blood cell transfusion-transmitted acute hepatitis E in an immunocompetent subject in Europe: a case report
Transfusion
Transfusion-associated hepatitis E, France
Emerg Infect Dis
Genotype 3 diversity and quantification of hepatitis E virus RNA
J Clin Microbiol
Hepatitis E virus genotype 3 diversity in France
Emerg Infect Dis
Posttransplantation hepatitis E: transfusion-transmitted hepatitis rising from the ashes
Transplantation
Transfusion-acquired hepatitis E infection misdiagnosed as severe critical illness polyneuromyopathy in a heart transplant patient
Transpl Infect Dis
Cited by (47)
Chronic hepatitis E: Advancing research and patient care
2022, Journal of HepatologyCitation Excerpt :Transfusion-transmitted acute HEV infection was first indicated in Japanese studies in 2004,47 and chronic HEV infection acquired via blood transfusion was reported later in Japanese liver transplant recipients.48 Subsequently, a series of cases were reported in Europe, particularly in immunocompromised patients, several of whom developed chronic infection.49,50 These cases have been associated with the transfusion of various blood components including fresh frozen plasma, red blood cell samples, platelet preparations and pooled granulocytes.51
Assuring Pathogen Safety of the Starting Material for Plasma-Derived Products
2022, Encyclopedia of Infection and ImmunityRisk of transfusion-transmitted hepatitis E virus infection from pool-tested platelets and plasma
2022, Journal of HepatologyCitation Excerpt :As early as 2006, transfusion-transmitted (tt) hepatitis E in a transplant recipient was described.5 Since then, multiple tt HEV infections were detected in immunocompromised patients, several of whom had chronic hepatitis.6 As HEV-infected blood donors (BDs) are viremic but asymptomatic and usually show no elevation in transaminases or antibodies directed against HEV, screening of blood donors for HEV RNA is the only option to control tt hepatitis E.7
Hepatitis E Virus: An emerging enigmatic and underestimated pathogen
2022, Saudi Journal of Biological SciencesCitation Excerpt :Parenteral transmission of HEV is also a possibility. There have been reports of nosocomial HEV infections following whole blood transfusion and transfusion of blood products (Gallian, 2019). Other sources of parenteral transmission include organ transplant (Denner, 2019), intravenous drug abuse (Kuznetsova, 2018), and haemodialysis (Eini et al., 2015).
- 1
Contributed equally.
- 2
Current affiliation: Direction Générale de la Santé, Ministère de la Santé, Paris, France.