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HEV in Dutch Blood and Patients
1. HEV in Holland
part 1:
HEV in Dutch blood donors
ECDC, Stockholm, Nov. 28-29th, 2018.
prof.dr. Hans L. Zaaijer, MD PhD, medical microbiologist
Sanquin Blood Supply Foundation &
Amsterdam University Medical Centers
2. - HEV PCR on pools of 24 donations.
- July 3rd 2017 – Nov 4th 2018: 565.207 donations , avg. 8074 / week.
- 231 / 565.207 confirmed HEV+ , 1 : 2447 donations.
Yield of HEV PCR donorscreening in NL,
as started on July 3rd 2017.
3. Yield of screening of NL plasmadonations,
in pools of 96, as of Oct. 2012
- HEV PCR screening of 2000 - 3000 plasmadonations / month, in pools of 96.
- Record high medio 2014:
approx. 1:600 persons viremic on any given day (= incidence of 1% / year).
(previous slide)
4. Distribution of HEV viral loads
in 231 PCR positive blood donors.
(July 3rd 2017 – Nov 4th 2018)
7. Estimation of HEV in the Netherlands:
61,000 HEV infections per year; 85 via transfusion (= only 1:700 !).
HEV donor screening (in pools of 24) :
79 HEV transmissions prevented, 6 HEV infections slip through.
1722 Organ- and bone marrow transplant patients per year:
via food: 5.5 chronic cases of hepatitis E / year.
via transfusion: 2.2 chronic cases of hepatitis E / year.
HEV donor screening prevents 79 of 85 transfusion transmissions, and
2.0 of the 2.2 transfusion associated chronic hep E cases annually.
1.4 M€ testing costs/year; ~ € 700,000 per prevented chronic case.
How many HEV infections were prevented?
we applied our previous model, correcting for the lower incidence of HEV:
9. part 2:
HEV in NL: clinical impact
(including: failure to cure chronic hep E in a Dutch patient)
ECDC, Stockholm, Nov. 28-29th, 2018.
prof.dr. Hans L. Zaaijer, MD PhD, medical microbiologist
Sanquin Blood Supply Foundation &
Amsterdam University Medical Centers
10. "hepatitis E" = 2 distinct diseases
tropical & travellers hep E
by HEV genotypes 1,2
zoonotic (pig) hep E
by HEV genotype 3
pregnant women 20% fatality no disease
children acute hepatitis no disease
adults acute hepatitis ‘no disease’
middle aged, elderly acute hepatitis acute hepatitis (mild)
extra hepatic: ? - sporadic: neuralgic amyotrophy
- Guilain Barré Syndrome ?
organ- and stem cell
transplant patients*
? chronic hepatitis*, cirrhosis*
* in immuno-suppressed patients HEV IgM and IgG
often remain negative. Please do HEV PCR.
11. adapted from: WHM vd Poel - Current Opinion in Virology 2014, 4:91–96
How do we acquire HEV genotype 3?
12. Clinical impact of hep E in Holland
for example:
Overview of diagnostic HEV PCR testing at Academic Medical Centre (AMC),
Amsterdam, 2011-2018
HEV PCR testing at
AMC Amsterdam
2011 – 2018
HEV PCR
outcome
hospital
of origin
1759 samples submitted
for HEV RNA PCR
248 positive 62 patients:
35 AMC
24 VUmc
1511 negative 3 other