Héma-Québec, Montréal, Québec, Canada.
Canadian Blood Services, Toronto and Ottawa, Ontario, Canada.
Transfus Med Rev. 2019 Jul;33(3):139-145. doi: 10.1016/j.tmrv.2019.05.017. Epub 2019 Jun 20.
Hepatitis E virus (HEV) is the most common cause of acute hepatitis worldwide including large water-borne outbreaks, zoonotic infections and transfusion transmissions. Several countries have initiated or are considering blood donor screening in response to high HEV-RNA donation prevalence leading to transfusion-transmission risk. Because HEV transmission is more common through food sources, the efficacy of blood donor screening alone may be limited. HEV-nucleic acids in 101 489 blood donations in the United States and Canada were studied. A risk-based decision-making framework was used to evaluate the quantitative risks and cost-benefit of HEV-blood donation screening in Canada comparing three scenarios: no screening, screening blood for all transfused patients or screening blood for only those at greatest risk. HEV-RNA prevalence in the United States was one per 16 908 (95% confidence interval [CI], 1:5786-1:81987), whereas Canadian HEV-RNA prevalence was one per 4615 (95% CI, 1:2579-1:9244). Although 4-fold greater, Canadian HEV-RNA prevalence was not significantly higher than in the United States. Viral loads ranged from 20 to 3080 international units per mL; all successfully typed infections were genotype 3. No HEV-RNA false-positive donations were identified for 100 percent specificity. Without donation screening, heart and lung transplant recipients had the greatest HEV-infection risk (1:366962) versus kidney transplant recipients with the lowest (1:2.8 million) at costs of $225 546 to $561 810 per quality-adjusted life-year (QALY) gained for partial or universal screening, respectively. Higher cost per QALY would be expected in the United States. Thus, HEV prevalence in North America is lower than in countries performing blood donation screening, and if implemented, is projected to be costly under any scenario.
戊型肝炎病毒 (HEV) 是世界范围内引起急性肝炎的最常见原因，包括大规模水源性暴发、人畜共患感染和输血传播。由于高 HEV-RNA 供体流行率导致输血传播风险，一些国家已经启动或正在考虑对献血者进行筛查。由于 HEV 传播更常见于食物来源，仅通过献血者筛查可能效果有限。本研究对美国和加拿大的 101489 份献血样本进行了 HEV-核酸检测。采用基于风险的决策框架，通过比较三种情况，即不进行筛查、对所有接受输血的患者进行筛查或仅对高危患者进行筛查，评估加拿大进行 HEV-献血筛查的定量风险和成本效益：仅对所有接受输血的患者进行筛查；仅对高危患者进行筛查。美国的 HEV-RNA 流行率为每 16908 人中有 1 人（95%置信区间 [CI]，1:5786-1:81987），而加拿大的 HEV-RNA 流行率为每 4615 人中有 1 人（95% CI，1:2579-1:9244）。尽管加拿大的 HEV-RNA 流行率高 4 倍，但与美国相比并不显著更高。病毒载量范围为 20 至 3080 国际单位/毫升；所有成功分型的感染均为基因型 3。对于 100%特异性，没有发现 HEV-RNA 假阳性献血。不进行献血筛查，心脏和肺移植受者的 HEV 感染风险最大（1:366962），而肾移植受者的风险最低（1:280 万），部分或全面筛查的成本效益比为每获得 1 个质量调整生命年（QALY）分别为 225546 美元至 561810 美元。预计美国的成本效益比会更高。因此，北美地区的 HEV 流行率低于开展献血筛查的国家，如果实施，在任何情况下预计成本都很高。
