Epidemiology of Hepatitis E Virus Infection in a Cohort of 4,023 Immunocompromised Patients

Lene H Harritshøj, Christoffer E Hother, Henrik Sengeløv, Gedske Daugaard, Søren S Sørensen, Søren Jacobsen, Michael Perch, Dorte K Holm, Susanne G Sækmose, Bitten Aagaard, Christian Erikstrup, Boris M Hogema, Jens D Lundgren, Henrik Ullum

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Objectives: The prevalence of active, chronic, and former hepatitis E virus (HEV) infections was investigated in a cohort of immunocompromised patients. The association with transfusion transmitted HEV was evaluated, and the HEV seroprevalence was compared with that in healthy blood donors. Study design and methods: Serum samples from 4023 immunocompromised patients at Rigshospitalet, Denmark were retrospectively tested for HEV RNA and anti-HEV IgG. HEV RNA-positive patients were followed up by HEV testing, clinical symptoms, and transfusion history. Factors associated with anti-HEV were explored by multivariable logistic regression analysis. Samples from 1226 blood donors were retrospectively tested for anti-HEV IgG. Results: HEV RNA was detected in six patients (0.15%) with no indications of chronic HEV infection. HEV RNA prevalence rates among recipients of allogeneic haematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT) were 0.58% and 0.21%, respectively. Transfusion transmitted infections were refuted, and transfusion history was not associated with anti-HEV positivity. The difference in HEV seroprevalence between patients (22.0%) and blood donors (10.9%) decreased when adjusting for age and sex (odds ratio 1.20, 95% confidence interval 0.97–1.48). Conclusions: HEV viremia among allo-HSCT and SOT recipients suggests that clinicians should be aware of this diagnosis. The lack of association of blood transfusion with anti-HEV positivity supports food-borne transmission as the main transmission route of HEV common to both patients and blood donors.

Original languageEnglish
JournalInternational Journal of Infectious Diseases
Pages (from-to)188-195
Number of pages8
Publication statusPublished - Feb 2020

Bibliographical note

Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.


  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Donors
  • Cross-Sectional Studies
  • Denmark/epidemiology
  • Female
  • Hepatitis Antibodies/blood
  • Hepatitis E virus/genetics
  • Hepatitis E/blood
  • Humans
  • Immunocompromised Host
  • Male
  • Middle Aged
  • Prevalence
  • RNA, Viral/genetics
  • Retrospective Studies
  • Seroepidemiologic Studies
  • Viremia/epidemiology
  • Young Adult


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