|LETTERS TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 233
Hepatitis E virus RNA in Pakistani blood donors: An emerging transfusion transmitted infection
Noore Saba1, Usman Waheed2, Iqbal Mohammad3, Akhlaaq Wazeer4
1 Department of Health, Peshawar Regional Blood Centre, Khyber Pakhtunkhwa; Department of Health, Khyber Pakhtunkhwa Blood Transfusion Authority, Peshawar, Pakistan
2 Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
3 Department of Health, Peshawar Regional Blood Centre, Khyber Pakhtunkhwa, Peshawar, Pakistan
4 Department of Pathology and Transfusion Medicine, Divisional Headquarters Teaching Hospital, Mirpur, AJK, Pakistan
|Date of Submission||04-Aug-2020|
|Date of Decision||03-Sep-2020|
|Date of Acceptance||14-Sep-2020|
|Date of Web Publication||13-Nov-2020|
Department of Health, Peshawar Regional Blood Centre, Khyber Pakhtunkhwa; Department of Health, Khyber Pakhtunkhwa Blood Transfusion Authority, Peshawar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Saba N, Waheed U, Mohammad I, Wazeer A. Hepatitis E virus RNA in Pakistani blood donors: An emerging transfusion transmitted infection. Glob J Transfus Med 2020;5:233
|How to cite this URL:|
Saba N, Waheed U, Mohammad I, Wazeer A. Hepatitis E virus RNA in Pakistani blood donors: An emerging transfusion transmitted infection. Glob J Transfus Med [serial online] 2020 [cited 2020 Nov 27];5:233. Available from: https://www.gjtmonline.com/text.asp?2020/5/2/233/300641
Hepatitis E virus (HEV) is an emerging infection that can be transmitted by blood transfusion. In the last two decades, numerous countries have reported the HEV transmission through blood transfusion.
In Pakistan, HEV is largely endemic; however, the epidemiological data on HEV incidence in blood donors are absent. In the present pilot study, we estimated the prevalence of HEV in blood donors over a period of six months at the Regional Blood Centre located in Peshawar, Pakistan. The molecular analysis was performed at the Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan. The study was approved by the Ethics Committee of the Regional Blood Centre. A total of 5230 blood donors who donated blood from January to June 2020 were made part of the study after informed consent. The donors were considered eligible for the donation if they fulfilled the criteria as per national standards and guidelines.
The blood samples were tested for the presence of antibodies to HEV (anti-HEV IgM and IgG) through enzyme-linked immunosorbent assay kits (Wantai Biological Co., China). Testing was carried out following standard instructions from the manufacturer. Only anti-HEV IgM positive plasma samples were tested for HEV RNA. For molecular analysis, the viral RNA was extracted from plasma using a commercially available kit (QIAamp viral RNA kit, QIAGEN), and amplification was done by quantitative reverse transcription-polymerase chain reaction (RT-qPCR). The testing was performed by the use of primers, probe, and thermocycling conditions, as described previously. HEV titer of reactive samples was quantified using the first WHO international standard (code 6329/10) for HEV RNA for NAT-based assays (Paul Ehrlich Institute, Langen, Germany). The quantification's linear range was from 25 to 10E + 7 IU/mL. The screening data were entered into Microsoft Excel 2013 database.
Of the 5230 blood samples serologically screened for HEV, 107 (2.04%) were reactive for anti-HEV IgM, while 183 (3.49%) were reactive for anti-HEV IgG. Only 27 of the anti-HEV IgM reactive samples were also anti-HEV IgG reactive. The RT-qPCR testing showed that 37 of the 107 anti-HEV IgM reactive samples were positive for HEV RNA. The viral load of HEV RNA samples ranged from 20 to 34,220 IU/ml. Hence, the overall positivity of HEV RNA was 0.70% (37/5230). The demographic data of RT-qPCR reactive donors indicated that they were primarily males (88.57%), with a mean age of 29.4 years.
To the best of our knowledge, this is the first study to identify the presence of HEV in the blood donor population of Pakistan. When compared with studies from developed countries, such as England, and Scotland, our results showed a higher prevalence of HEV. In contrast, our results were on the lower side when compared with countries like India, and Nepal. These variations may be credited to the sensitivity and specificity of the assays used and the variation in the epidemiology of HEV in different regions of the world. Further studies on genotype analysis of HEV RNA positive samples are ongoing, and results will soon be available.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hewitt PE, Ijaz S, Brailsford SR, Brett R, Dicks S, Haywood B, et al
. Hepatitis E virus in blood components: A prevalence and transmission study in Southeast England. Lancet 2014;384:1766-73.
Baylis SA, Blümel J, Mizusawa S, Matsubayashi K, Sakata H, Okada Y, et al
. World Health Organization International Standard to harmonize assays for detection of hepatitis E virus RNA. Emerg Infect Dis 2013;19:729-35.
Beale MA, Tettmar K, Szypulska R, Tedder RS, Ijaz S. Is there evidence of recent hepatitis E virus infection in English and north welsh blood donors? Vox Sang 2011;100:340-2.
Cleland A, Smith L, Crossan C, Blatchford O, Dalton HR, Scobie L, et al
. Hepatitis E virus in Scottish blood donors. Vox Sang 2013;105:283-9.
Katiyar H, Goel A, Sonker A, Yadav V, SapunS, Chaudhary R, et al
. Prevalence of hepatitis E virus viremia and antibodies among healthy blood donors in India. Indian J Gastroenterol 2018;37:342-6.
Shrestha AC, Flower RL, Seed CR, Rajkarnikar M, Shrestha SK, Thapa U, et al
. Hepatitis E virus seroepidemiology: A post-earthquake study among blood donors in Nepal. BMC Infect Dis 2016;16:707.