Long-term HEV carriers without antibody seroconversion among eligible immunocompetent blood donors

Abstract

Hepatitis E virus (HEV) is emerging as a potential threat to the safety of blood transfusions. In many countries and regions endemic for HEV, such as China, blood donors are not routinely tested for HEV infection. In this study, 11747 eligible blood donors were screened for anti-HEV immunoglobulin M (IgM)/immunoglobulin G (IgG) and HEV RNA and antigen in China. Twenty-four donors who were positive for both HEV antigen and RNA were followed for ≥ 70 days, and none of these donors reported clinical hepatitis or illness. At least 1 follow-up sample was provided by 17 donors, including 10 with viremia and/or antigenemia for ≥ 70 days and 3 with antigen and RNA positivity for >90 days. Fourteen of the 17 donors did not present with an obvious serologic response during the follow-up period. These results differed from previous reports, in which viremia lasted for 68 days and elicited an antibody response. These donors showed atypical HEV infection progression that differed from that of hepatitis E patients. The presence of these donors presents a challenge for transfusion transmission screening.

These authors contributed equally: Gui-Ping Wen, Chang-Rong Chen, Xiu-Yu Song

These authors contributed equally: Gui-Ping Wen, Chang-Rong Chen, Xiu-Yu Song

Acknowledgements

This work was supported by the Natural Science Foundation of Fujian Province, China (grant number 2016J05201), the National Natural Science Foundation of China (grant number 81701576), the China Postdoctoral Science Fund (grant number 2017M622083), the Principal Funds from Xiamen University (grant number 20720150137), and the Medical Innovation Program of Fujian province (grant number 2015-CXB-51).

Authors' Contributions

Conceived and designed the experiments: Z-Z.Z., S-H.O. and N-S.X.; performed the experiments: G-P.W., Z-M.T., W-F.J., S-L.W., and K.Z; analyzed the data: G.-P.W., C-R.C., X-Y.S., J.Z, Z-Z.Z. and N-S.X.; wrote the paper: G-P.W., and Z-Z.Z.

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Supplementary Information accompanies this paper at (10.1038/s41426-018-0125-y).