Transfusion-transmitted hepatitis E caused by apparently indigenous hepatitis E virus strain in Hokkaido, Japan.
BACKGROUND
In industrialized countries, sporadic cases of hepatitis E have been reported in individuals who have never been in an endemic area. Hepatitis E virus (HEV) infection commonly occurs via the fecal-oral route but a potential risk of transfusion transmission route has been suggested.


METHODS
A 67-year-old Japanese male patient who had never been abroad received a transfusion of blood from 23 voluntary donors and developed acute hepatitis with unknown etiology after transfusion. His blood samples were tested for viral markers of hepatitis viruses.


RESULTS
HAV, HBV, HCV, CMV, and EBV were ruled out as causative agents in this case. The patient's blood sample in the acute phase contained HEV RNA as well as IgM and IgG anti-HEV. HEV RNA was also detected in one of the FFP units transfused. The donor had no history of traveling abroad and had a normal ALT level at the time of donation. The PCR products from the patient and the donor showed complete identity for two distinct regions of HEV within open reading frame 1.


CONCLUSIONS
The patient was infected with HEV via transfused blood from a volunteer donor. A potential risk of posttransfusion hepatitis E should be considered even in nonendemic countries.
Matsubayashi
Keiji
K
Hokkaido Red Cross Blood Center, Sapporo, Japan. kmatsu@hokkaido.bc.jrc.or.jp
Nagaoka
Yasuhiro
Y
Sakata
Hidekatsu
H
Sato
Shinichiro
S
Fukai
Kanji
K
Kato
Toshiaki
T
Takahashi
Kazuaki
K
Mishiro
Shunji
S
Imai
Mitsunobu
M
Takeda
Naokazu
N
Ikeda
Hisami
H
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001782:Blood Donors; D016063:Blood Loss, Surgical; D006348:Cardiac Surgical Procedures; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000201:enzymology / Q000635:transmission* / Q000821:virology; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D011183:Postoperative Complications / Q000209:etiology / Q000821:virology; D012367:RNA, Viral / Q000235:genetics; D065227:Transfusion Reaction
D006508:Hepatitis Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase