A case of transfusion-transmitted hepatitis E caused by blood from a donor infected with hepatitis E virus via zoonotic food-borne route

Authors

  • Keiji Matsubayashi,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Jong-Hon Kang,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Hidekatsu Sakata,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Kazuaki Takahashi,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Motohiro Shindo,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Masaru Kato,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Shinichiro Sato,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Toshiaki Kato,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Hiroyuki Nishimori,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Kunihiko Tsuji,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Hiroyuki Maguchi,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Jun-ichi Yoshida,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Hiroshi Maekubo,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Shunji Mishiro,

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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  • Hisami Ikeda

    1. From the Hokkaido Red Cross Blood Center, Sapporo; the Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo; the Department of Medical Sciences, Toshiba General Hospital, Tokyo; the Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa; the Department of Internal Medicine, Kitami Red Cross Hospital, Kitami; and the Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
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Keiji Matsubayashi, Hokkaido Red Cross Blood Center, 2-2 Yamanote, Nishi-ku, Sapporo 063-0002, Japan; e-mail: kmatsu@hokkaido.bc.jrc.or.jp.

Abstract

BACKGROUND: Five cases of transfusion transmission of hepatitis E virus (HEV) have been reported so far. The infection routes of the causative donors remain unclear, however. Also, the progress of virus markers in the entire course of HEV infection has not been well documented.

STUDY DESIGN AND METHODS: Nucleic acid testing was performed by real-time reverse transcription–polymerase chain reaction targeting the open reading frame 2 region of HEV. Full-length nucleotide sequences of HEV RNA were detected by direct sequencing.

RESULTS: Lookback study of a HEV-positive donor revealed that the platelets (PLTs) donated from him 2 weeks previously contained HEV RNA and were transfused to a patient. Thirteen relatives including the donor were ascertained to enjoy grilled pork meats together in a barbecue restaurant 23 days before the donation. Thereafter, his father died of fulminant hepatitis E and the other 6 members showed serum markers of HEV infection. In the recipient, HEV was detected in serum on Day 22 and reached the peak of 7.2 log copies per mL on Day 44 followed by the steep increase of alanine aminotransferase. Immunoglobulin G anti-HEV emerged on Day 67; subsequently, hepatitis was resolved. HEV RNA sequences from the donor and recipient were an identical, Japan-indigenous strain of genotype 4. HEV RNA was detectable up to Day 97 in serum, Day 85 in feces, and Day 71 in saliva.

CONCLUSION: A transfusion-transmitted hepatitis E case by blood from a donor infected via the zoonotic food-borne route and the progress of HEV markers in the entire course are demonstrated. Further studies are needed to clarify the epidemiology and the transfusion-related risks for HEV even in industrialized countries.

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