Hoad V C, Seed C R, Fryk J J, Harley R, Flower R L P, Hogema B M, Kiely P, Faddy H M
Clinical Services and Research, Australian Red Cross Blood Service, Perth, WA, Australia.
Research and Development, Australian Red Cross Blood Service, Brisbane, QLD, Australia.
Vox Sang. 2017 Oct;112(7):614-621. doi: 10.1111/vox.12559. Epub 2017 Aug 18.
Hepatitis E virus (HEV) is a known transfusion-transmissible agent. HEV infection has increased in prevalence in many developed nations with RNA detection in donors as high as 1 in 600. A high proportion of HEV infections are asymptomatic and therefore not interdicted by donor exclusion criteria. To manage the HEV transfusion-transmission (TT) risk some developed nations have implemented HEV RNA screening. In Australia, HEV is rarely notified; although locally acquired infections have been reported, and the burden of disease is unknown. The purpose of this study was to determine the frequency of HEV infection in Australian donors and associated TT risk.
Plasma samples (n = 74 131) were collected from whole blood donors during 2016 and screened for HEV RNA by transcription-mediated amplification (TMA) in pools of six. Individual TMA reactive samples were confirmed by RT-PCR and, if positive, viral load determined. Prevalence data from the study were used to model the HEV-TT risk.
One sample in 74 131 (95% CI: 1 in 1 481 781 to 1 in 15 031) was confirmed positive for HEV RNA, with an estimated viral load of 180 IU/ml, which is below that typically associated with TT. Using a transmission-risk model, we estimated the risk of an adverse outcome associated with TT-HEV of approximately 1 in 3·5 million components transfused.
Hepatitis E virus viremia is rare in Australia and lower than the published RNA prevalence estimates of other developed countries. The risk of TT-HEV adverse outcomes is negligible, and HEV RNA donor screening is not currently indicated.
戊型肝炎病毒（HEV）是一种已知的可经输血传播的病原体。在许多发达国家，HEV感染的患病率有所上升，献血者中RNA检测阳性率高达1/600。相当一部分HEV感染是无症状的，因此未被献血者排除标准所阻断。为了管理HEV输血传播（TT）风险，一些发达国家已实施HEV RNA筛查。在澳大利亚，HEV感染报告很少；尽管有本地获得性感染的报告，但疾病负担尚不清楚。本研究的目的是确定澳大利亚献血者中HEV感染的频率以及相关的TT风险。
2016年从全血献血者中采集血浆样本（n = 74131），通过转录介导扩增（TMA）以6份样本为一组进行HEV RNA筛查。TMA反应性单个样本通过逆转录聚合酶链反应（RT-PCR）进行确认，如呈阳性，则测定病毒载量。该研究的患病率数据用于模拟HEV-TT风险。
74131份样本中有1份（95%可信区间：1/1481781至1/15031）HEV RNA确认呈阳性，估计病毒载量为180 IU/ml，低于通常与TT相关的水平。使用传播风险模型，我们估计与TT-HEV相关的不良后果风险约为每350万份输注成分中有1例。
戊型肝炎病毒血症在澳大利亚很少见，低于其他发达国家公布的RNA患病率估计值。TT-HEV不良后果的风险可忽略不计，目前不建议对献血者进行HEV RNA筛查。
