Seroprevalence of hepatitis E virus in blood donors in Greece

Abstract

Hepatitis E virus (HEV) infection, apart from its occurrence in endemic countries, has also drawn attention the past years in industrialized countries. Sporadic cases of HEV in developed countries are linked to a history of travel in endemic regions or to consumption of undercooked pork and wild boar/deer products. Recent studies among healthy blood donors from European countries have reported rates of HEV seroprevalence ranging from 2 6% to 20 6%. In the literature, there are documented cases of transfusion-transmitted hepatitis E infection and the recipient’s predisposition, and immune status determines the clinical outcome [1]. The aim of this study was to determine the seroprevalence of HEV among blood donors in Greece, which is unknown. We analysed blood donor samples collected in the ‘Aretaieion’ Hospital’s Blood Bank, in Athens for the presence of anti-HEV IgG antibodies, using the HEV IgG Kit (EIAgen; Adaltis Inc, Milan, Italy). The study was approved by the hospital’s ethic committee. We tested 265 blood donors, with a mean age of 39 6 years (range 19–61), 216 men and 49 women. Anti-HEV IgG was found in 25 of 265 individuals (9 43%). The seroprevalence was 10 65% (23/216) in men and 4 08% (2/49) in women. The presence of anti-HEV IgG did not differ by age or gender (P > 0 05). All positive donors resided in urban areas, and none reported an occupation related to swineherds handling. Also, none of them had a recent history (past year) of travel in endemic areas, but the possibility that they had travelled outside Greece a long time ago and been exposed to HEV could not be excluded. All positive donors underwent a testing for ALT, AST and bilirubin, and 6/23 donors had abnormal AST values, thus a recent asymptomatic infection could not be excluded. This preliminary study shows that HEV seroprevalence among blood donors in Greece is similar to the one reported from UK (10%) [2], lower to that reported in Northwest France [3], but higher to the one reported from Scottish blood donors recently (5%) [4]. This could be explained either by differences in the sensitivity/specificity of commercial tests used for HEV detection and/or the selection of samples from an urban blood bank [5]. Moreover, practices in meat handling and preparation (well cooked vs. undercooked) vary among countries and this may have contributed to the different seroprevalence rates. Nevertheless, our results demonstrate that HEV circulates in the urban population of Greece. Data regarding HEV prevalence in Greek livestock are lacking and merit exploration. Further studies are necessary to define the clinical and epidemiologic importance of HEV infection in Greece, to identify sources and routes of transmission and assess the possible risk of transfusion-transmitted HEV by assessing HEV-RNA in sero-positive blood donors.