Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis

Annika Wolski; Sven Pischke; Ann-Kathrin Ozga; Marylyn M Addo; Thomas Horvatits

doi:10.3390/pathogens12030425

Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis

Pathogens. 2023 Mar 8;12(3):425. doi: 10.3390/pathogens12030425.

Authors

Annika Wolski¹, Sven Pischke^{1

2}, Ann-Kathrin Ozga³, Marylyn M Addo^{1

2

4}, Thomas Horvatits^{1

5}

Affiliations

¹ Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
² German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner Sites, 20251 Hamburg, Germany.
³ Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
⁴ Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
⁵ Gastromedics Health Center, 7000 Eisenstadt, Austria.

Abstract

Background and aims: The increasing number of diagnosed hepatitis E virus (HEV) infections in Europe has led to the implementation of the testing of blood products in various countries. Many nations have not yet implemented such screening. To assess the need for HEV screening in blood products worldwide, we conducted a systematic review and meta-analysis assessing HEV RNA positivity and anti-HEV seroprevalence in blood donors.

Methods: Studies reporting anti-HEV IgG/IgM or HEV RNA positivity rates among blood donors worldwide were identified via predefined search terms in PubMed and Scopus. Estimates were calculated by pooling study data with multivariable linear mixed-effects metaregression analysis.

Results: A total of 157 (14%) of 1144 studies were included in the final analysis. The estimated HEV PCR positivity rate ranged from 0.01 to 0.14% worldwide, with strikingly higher rates in Asia (0.14%) and Europe (0.10%) in comparison to North America (0.01%). In line with this, anti-HEV IgG seroprevalence in North America (13%) was lower than that in Europe (19%).

Conclusions: Our data demonstrate large regional differences regarding the risk of HEV exposure and blood-borne HEV transmission. Considering the cost-benefit ratio, this supports blood product screening in high endemic areas, such as Europe and Asia, in contrast to low endemic regions, such as the U.S.

Keywords: HEV; blood donors; hepatitis E virus; meta-analysis.

Publication types

Review

Grants and funding

This study has been founded by German Center for Infectious Diseases (DZIF), FKZ 8009701709 (DZIF TI 1.709). We acknowledge financial support from the Open Access Publication Fund of UKE—Universitätsklinikum Hamburg-Eppendorf- and DFG—German Research Foundation.