International Journal of Infectious Diseases (Feb 2020)

Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients

  • Lene H. Harritshøj,
  • Christoffer E. Hother,
  • Henrik Sengeløv,
  • Gedske Daugaard,
  • Søren S. Sørensen,
  • Søren Jacobsen,
  • Michael Perch,
  • Dorte K. Holm,
  • Susanne G. Sækmose,
  • Bitten Aagaard,
  • Christian Erikstrup,
  • Boris M. Hogema,
  • Jens D. Lundgren,
  • Henrik Ullum

Journal volume & issue
Vol. 91
pp. 188 – 195

Abstract

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Objectives: The prevalence of active, chronic, and former hepatitis E virus (HEV) infections was investigated in a cohort of immunocompromised patients. The association with transfusion transmitted HEV was evaluated, and the HEV seroprevalence was compared with that in healthy blood donors. Study design and methods: Serum samples from 4023 immunocompromised patients at Rigshospitalet, Denmark were retrospectively tested for HEV RNA and anti-HEV IgG. HEV RNA-positive patients were followed up by HEV testing, clinical symptoms, and transfusion history. Factors associated with anti-HEV were explored by multivariable logistic regression analysis. Samples from 1226 blood donors were retrospectively tested for anti-HEV IgG. Results: HEV RNA was detected in six patients (0.15%) with no indications of chronic HEV infection. HEV RNA prevalence rates among recipients of allogeneic haematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT) were 0.58% and 0.21%, respectively. Transfusion transmitted infections were refuted, and transfusion history was not associated with anti-HEV positivity. The difference in HEV seroprevalence between patients (22.0%) and blood donors (10.9%) decreased when adjusting for age and sex (odds ratio 1.20, 95% confidence interval 0.97–1.48). Conclusions: HEV viremia among allo-HSCT and SOT recipients suggests that clinicians should be aware of this diagnosis. The lack of association of blood transfusion with anti-HEV positivity supports food-borne transmission as the main transmission route of HEV common to both patients and blood donors. Keywords: Hepatitis E, Epidemiology, Immunocompromised, Transfusion transmission, HEV RNA, Anti-HEV IgG, Chronic HEV infection