Pojavnost in razširjenost okužbe z virusom hepatitisa E med krvodajalci v Republiki Sloveniji

Primc, Alja (author), Jeras, Matjaž (mentor), Levičnik Stezinar, Snežna (co-mentor)

V razvitem svetu je najpogostejši način okužbe z virusom hepatitisa E (HEV) vnos z okuženo hrano, prenaša pa se lahko tudi s transfuzijo okužene krvi in krvnih pripravkov ter s presaditvijo okuženih organov. Če okuženo kri ali krvni pripravek prejme imunsko oslabel bolnik, je pri njem možnost razvoja kroničnega hepatitisa E zelo velika in lahko vodi v odpoved jetrne funkcije in smrti. Ker v Republiki Sloveniji nimamo rutinskega testiranja na prisotnost HEV v darovanih enotah krvi, nevarnost njegovega prenosa s transfuzijo ni zanemarljiva. Cilj magistrske naloge je bil določiti pojavnost akutne okužbe s HEV ter razširjenost prisotnosti protiteles IgG proti virusu med slovenskimi krvodajalci. Za določitev pojavnosti okužbe smo testirali 9284 vzorcev plazme na prisotnost RNA HEV z metodo specifičnega pomnoževanja virusnih nukleinskih kislin, v 1263 od teh pa smo s serološkim testom določali prisotnost protiteles IgG anti-HEV. Vzorce, ki so vsebovali omenjena protitelesa, smo dodatno testirali še na virusa v reaktivnih vzorcih so izvedli na prisotnost protiteles IgM anti-HEV. Kvantitativno določanje RNA HEV in genotipizacijo Nacionalnem referenčnem centru za hepatitis E v Toulouse-u v Franciji. Izmed 9284 testiranih vzorcev jih je bilo na prisotnost RNA HEV reaktivnih pet, dva med njimi pa sta vsebovala tudi protitelesa IgG in IgM anti-HEV. Vseh pet RNA HEV reaktivnih krvodajalcev smo spremljali vse do aviremije. Genotipizacija virusa je bila uspešna v štirih od petih vzorcev, pri čemer sta bila določena genotip 3a v treh, ter genotip 3f v enem vzorcu. Virusno breme v pozitivnih vzorcih je bilo v razponu od 16 do 18700 IU/mL. Prisotnost protiteles IgG anti-HEV smo potrdili pri vseh petih krvodajalcih, in sicer v obdobju od 0 do 105 dni po prvem darovanju krvi. Izmed 1263 serološko testiranih vzorcev jih je 94 (7,4%) vsebovalo protitelesa IgG anti-HEV. Trije od teh pa so bili hkrati pozitivni tudi na prisotnost protiteles IgM anti-HEV, a so bili obenem RNA HEV nereaktivni. Pojavnost okužbe s HEV je glede na naše rezultate 1:1857, kar pomeni, da je okužena 1 na vsakih 1857 donacij krvi. Ocenjena razširjenost okužbe med slovenskimi krvodajalci je torej 7,4%. Njena pojavnost je primerljiva s tistimi evropskimi državami, za katere so tovrstni podatki na voljo. Glede na trenutno dostopne uradne informacije je razširjenost okužbe s HEV med krvodajalci pri nas med nižjimi v Evropi.

• Language: Slovenian
• Keywords: virus hepatitisa E (HEV), krvodajalci, testiranje NAT, test Procleix HEV
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-120351
• Publication date in RUL: 18.09.2020

Secondary language

• Language: English
• Title: Incidence and seroprevalence of hepatitis E infection among Slovenian blood donors

Abstract

The most common way of Hepatitis E virus (HEV) transmission in developed countries is food-borne zoonosis, but HEV can also be transmitted by transfusion of infected blood and blood products or transplantation of infected organs. In case infected blood or blood products are transfused to immunocompromised patients, there is a high risk of chronic hepatitis E development or even hepatic failure and death. Currently, there is no routine testing of donated blood units for HEV infection in place in Republic of Slovenia, so the risk of HEV transmission with infected blood is significant. The aim of master thesis study was to determine the incidence of acute HEV infection and the seroprevalence of anti-HEV IgG antibodies among Slovenian blood donors. To determine incidence and seroprevalence of HEV infection we tested 9284 blood plasma samples for HEV RNA reactivity using the Transcription Mediated Amplification (TMA) technology, and 1236 out of these were also serologically tested for anti-HEV IgG antibodies. Anti-HEV IgG reactive samples were further tested for anti-HEV IgM antibodies. Genotyping and quantitative NAT of HEV RNA reactive samples was performed by Centre National de Reference Hepatitis E, Toulouse, France. Among 9284 tested samples 5 were reactive to HEV RNA and 2 out of those were also reactive to anti-HEV IgG and IgM antibodies. We followed-up all 5 HEV RNA reactive blood donors until the end of viremic phase. HEV genotype was successfully determined in 4 out of 5 samples (3 cases of 3a and 1 case of 3f genotype). The range of viral load in index blood samples was from 16 to 18,700 IU/mL. The presence of anti-HEV IgG antibodies was confirmed in all five HEV RNA reactive blood donors from 0 to 105 days after the index donation. Among 1263 samples tested for anti-HEV IgG antibodies 94 were reactive (7,4%). Three out of these 94 were anti-HEV IgM reactive as well, but HEV RNA nonreactive. Results show 1:1857 incidence of HEV infection among Slovenian blood donors, which means 1 in every 1857 blood donations is compromised. The seroprevalence of anti-HEV IgG antibodies among Slovenian blood donors is 7,4%. The incidence is comparable to the HEV incidence in other European countries for which data is available. The seroprevalence of HEV infection in Slovenia is among lowest in Europe.

• Keywords: Hepatitis E virus (HEV), blood donors, NAT testing, Procleix HEV assay