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J Clin Virol. 2018 Aug;105:26-30. doi: 10.1016/j.jcv.2018.05.013. Epub 2018 May 29.

Course of HEV viremia and anti-HEV IgM/IgG response in asymptomatic blood donors.

Author information

1
I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany. Electronic address: c.kraef@uke.de.
2
I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany.
3
Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Germany.
4
I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany; Department for Gastroenterology and Hepatology, Essen University Hospital, Germany.
5
I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany.
6
German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany; Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany.
7
Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany.

Abstract

BACKGROUND:

Globally, an estimated 20 million Hepatitis E infections occur every year. The course of viremia and antibody response has been investigated in patients with symptomatic hepatitis E. However, the majority of HEV infections in industrialized countries take a subclinical course.

OBJECTIVES:

To investigate the course of HEV viremia and epitope specific anti-HEV IgM/IgG response in asymptomatic blood donors in order to understand the immune response and viral clearance in asymptomatic blood donors with HEV infections.

METHODS:

In this study 27 HEV viremic donors were identified by HEV-PCR during routine screening of blood donors and the course of anti-HEV IgM/IgG and HEV-RNA was retrospectively studied using RT-PCR and a commercial immunoblot (Mikrogen®) allowing classification of the antibody response according to HEV epitopes.

RESULTS:

At time of donation, serological testing failed to identify viremic donors as 70.4% had no detectable antibody response. Anti-HEV IgM could be detected in 22.2% of viremic donors while anti-HEV IgG could be found in 7.4%. At least three donors experienced prolonged viremia beyond 100 days. Spontaneous HEV-RNA clearance within a median time span of 57 days was observed in all 27 donors. In all donors anti-HEV IgG specific for the immunogenic viral epitope O2C could be detected in close temporal association with viral clearance.

CONCLUSION:

Serological testing is inappropriate for identifying HEV-viremic blood donors. Acute HEV infection in asymptomatic blood donors can persist for more than 100 days. HEV-RNA clearance coincided with the appearance of anti-HEV IgM/IgG confirming the importance of a B-cell mediated response in clearing acute infections. Anti-HEV IgM and IgG specific for the epitope O2C are associated with the clearance of HEV-viremia.

KEYWORDS:

Bloodborne Hepatitis E virus infection; Hepatitis E virus; Hepatitis E virus blood donor screening; Serological response; Viral course

PMID:
29860111
DOI:
10.1016/j.jcv.2018.05.013
[Indexed for MEDLINE]

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