Hepatitis E in blood donors: investigation of the natural course of asymptomatic infection, Germany, 2011.
Asymptomatic hepatitis E virus (HEV) infections have been found in blood donors from various European countries, but the natural course is rarely specified. Here, we compared the progression of HEV viraemia, serostatus and liver-specific enzymes in 10 blood donors with clinically asymptomatic genotype 3 HEV infection, measuring HEV RNA concentrations, plasma concentrations of alanine/aspartate aminotransferase, glutamate dehydrogenase and bilirubin and anti-HEV IgA, IgM and IgG antibodies. RNA concentrations ranged from 77.2 to 2.19×10(5) IU/mL, with viraemia lasting from less than 10 to 52 days. Donors showed a typical progression of a recent HEV infection but differed in the first detection of anti-HEV IgA, IgM and IgG and seropositivity of the antibody classes. The diagnostic window between HEV RNA detection and first occurrence of anti-HEV antibodies ranged from eight to 48 days, depending on the serological assay used. The progression of laboratory parameters of asymptomatic HEV infection was largely comparable to the progression of symptomatic HEV infection, but only four of 10 donors showed elevated liver-specific parameters. Our results help elucidate the risk of transfusion-associated HEV infection and provide a basis for development of screening strategies. The diagnostic window illustrates that infectious blood donors can be efficiently identified only by RNA screening.
Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein- Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Tanja
T
Vollmer
Juergen
J
Diekmann
Matthias
M
Eberhardt
Cornelius
C
Knabbe
Jens
J
Dreier
D000410:Alanine Transaminase / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood*; D058345:Asymptomatic Infections; D001769:Blood / Q000821:virology*; D001782:Blood Donors; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005838:Genotype; D005858:Germany; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D012367:RNA, Viral / Q000235:genetics; D017422:Sequence Analysis, DNA
D000914:Antibodies, Viral; D006508:Hepatitis Antibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral; D000410:Alanine Transaminase
Hepatitis E virus; anti-HEV IgA; anti-HEV IgG; anti-HEV IgM; progression; seroconversion