Hepatitis E virus: can it be transmitted parenterally?

Of 200 voluntary blood donors screened for hepatitis E virus (HEV) RNA, employing the reverse transcription-polymerase chain reaction (RT-PCR), three were found to be positive (1.5%). None of the HEV RNA-positive blood donors had any symptoms at the time of blood donation or during subsequent follow-up. One donor was positive for immunoglobulin M (IgM) antibodies to HEV, with a raised serum alanine aminotransferase (ALT) level, whereas the other two donors were negative for both immunoglobulin G (IgG) and IgM antibodies to HEV. Follow-up blood samples collected 2-5 months later from HEV RNA-positive blood donors demonstrated the presence of IgG anti-HEV antibodies. Overall seroprevalence of IgG anti-HEV was 18.6%. Retrospective studies on samples collected from commercial blood donors and haemophiliacs revealed IgG anti-HEV positivity to be 24. 6% (46/191) and 24.4% (22/90) and statistically not different (P>0. 1) from the prevalence among voluntary blood donors and an age-matched normal population, respectively. However, a highly significant proportion of the paid plasma donors, with a high prevalence of IgG antibodies to human immunodeficiency virus and hepatitis C virus, were positive for IgG antibodies to HEV (54/71, 76%, P<0.001), indicating a possible role of blood-derived HEV in the transmission of the virus among plasma donors. These results demonstrate the possible risk of transfusion-associated hepatitis E in hyperendemic areas.