1
|
Marcantonio C, Pezzotti P, Bruni R, Taliani G, Chionne P, Madonna E, Villano U, Pisani G, Equestre M, Dell'Orso L, Ragone K, Ciccaglione AR, Spada E. Incidence of hepatitis E virus infection among blood donors in a high endemic area of Central Italy. J Viral Hepat 2019; 26:506-512. [PMID: 30548124 DOI: 10.1111/jvh.13049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/13/2018] [Indexed: 12/09/2022]
Abstract
In Europe, autochthonous hepatitis E virus (HEV) infection is mainly a foodborne zoonosis, but it is also transmitted by blood transfusion. Despite the numerous prevalence surveys, only a few studies have investigated HEV incidence. We aimed to determine HEV incidence and risk factors among blood donors in a hyperendemic area in Central Italy. Of 296 blood donors who had tested HEV negative in two previous seroprevalence surveys in L'Aquila, 198 agreed to undergo at least another blood sampling for estimating HEV incidence nearly 2 years after the prevalence surveys. Ten newly acquired infections were detected, yielding an overall incidence of 2.1/100 person-years (95%CI: 1.0-3.9), with an estimated participant's cumulative probability of becoming HEV infected of 6.5% (95%CI: 3.5-12.0) at 4 years after enrolment. Seven newly infected blood donors were IgG positive only, two were IgM positive (one also IgG positive) and one was HEV RNA positive only, harbouring subtype 3c. Incident infection was most strongly associated with eating game meat, raw-dried pork liver sausage and raw-dried wild boar sausage. None of these exposures was statistically significant, even if eating raw-dried wild boar sausage approached significance (P = 0.06). The HEV incidence we found was considerable compared with other similar studies. The nearly significant association of incident infection with wild boar and other game meat consumption was in agreement with the 3c subtype isolation in the viremic donor. However, beyond eating habits, also other exposure sources are likely important in hyperendemic areas, where incidence and risk exposure studies need to be undertaken for effectively preventing HEV transmission.
Collapse
Affiliation(s)
- Cinzia Marcantonio
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Roberto Bruni
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Gloria Taliani
- Department of Infectious and Tropical Diseases, University of Rome "La Sapienza", Rome, Italy
| | - Paola Chionne
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Elisabetta Madonna
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Umbertina Villano
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Giulio Pisani
- National Centre for the Control and Evaluation of Medicines, National Institute of Health, Rome, Italy
| | - Michele Equestre
- Department of Neurosciences, National Institute of Health, Rome, Italy
| | - Luigi Dell'Orso
- Immunohematology and Blood Transfusion Unit, "San Salvatore" Hospital, L'Aquila, Italy
| | - Katia Ragone
- Immunohematology and Blood Transfusion Unit, "San Salvatore" Hospital, L'Aquila, Italy
| | | | - Enea Spada
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| |
Collapse
|
2
|
Lucarelli C, Spada E, Taliani G, Chionne P, Madonna E, Marcantonio C, Pezzotti P, Bruni R, La Rosa G, Pisani G, Dell'Orso L, Ragone K, Tomei C, Ciccaglione AR. High prevalence of anti-hepatitis E virus antibodies among blood donors in central Italy, February to March 2014. Euro Surveill 2016; 21:30299. [DOI: 10.2807/1560-7917.es.2016.21.30.30299] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 02/25/2016] [Indexed: 12/23/2022] Open
Abstract
Prevalence of anti-hepatitis E virus (HEV) antibodies is highly variable in developed countries, which seems partly due to differences in assay sensitivity. Using validated sensitive assays, we tested 313 blood donors attending a hospital transfusion unit in central Italy in January and February 2014 for anti-HEV IgG and IgM and HEV RNA. Data on HEV exposure were collected from all donors. Overall anti-HEV IgG prevalence was 49% (153/313). Eating raw dried pig-liver sausage was the only independent predictor of HEV infection (adjusted prevalence rate ratio = 2.14; 95% confidence interval: 1.23–3.74). Three donors were positive for either anti-HEV IgM (n = 2; 0.6%) or HEV RNA (n = 2; 0.6%); they were completely asymptomatic, without alanine aminotransferase (ALT) abnormalities. Of the two HEV RNA-positive donors (both harbouring genotype 3), one was anti-HEV IgG- and IgM-positive, the other was anti-HEV IgG- and IgM-negative. The third donor was positive for anti-HEV IgG and IgM but HEV RNA-negative. HEV infection is therefore hyperendemic among blood donors (80% men 18–64 years-old) from central Italy and associated with local dietary habits. Nearly 1% of donors have acute or recent infection, implying potential transmission to blood recipients. Neither ALT nor anti-HEV IgM testing seems useful to prevent transfusion-transmitted HEV infection.
Collapse
Affiliation(s)
- Claudia Lucarelli
- European Program for Public Health Microbiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
- These authors contributed equally to this work
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Enea Spada
- These authors contributed equally to this work
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gloria Taliani
- Department of Infectious and Tropical Diseases, University of Rome La Sapienza, Rome, Italy
| | - Paola Chionne
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Elisabetta Madonna
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cinzia Marcantonio
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Bruni
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giuseppina La Rosa
- Environment and Primary Prevention Department, Istituto Superiore di Sanità, Rome, Italy
| | - Giulio Pisani
- National Centre for Immunobiologicals Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Dell'Orso
- Immunohematology and Blood Transfusion Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Katia Ragone
- National Centre for Immunobiologicals Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Carla Tomei
- Blood Collection Centre, Regional Committee of the Italian Red Cross of Abruzzo, L’Aquila, Italy
| | - Anna Rita Ciccaglione
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|