Hepatitis E Virus Infection in Ghanaian Blood Donors - the Importance of Immunoassay Selection and Confirmation

Background And Objectives: Hepatitis E virus (HEV) infection is emerging as a potential new threat to blood safety after several cases of transfusion-transmission were reported from non-epidemic countries. On the basis of seroprevalence data, HEV is endemic in Ghana where poor sanitary conditions and regular flooding are prevalent. However, no data are available for HEV prevalence in blood donors.

Materials And Methods: Plasma samples from 239 Ghanaian blood donors were tested for anti-HEV IgG and IgM by ELISA (two and three assays, respectively) and Western blot (recomLine) and for HEV-RNA by RT-qPCR.

Results: All donors were RNA negative. Results from the different serological assays were discrepant: reactivity in two of the three IgM assays was correlated with elevated IgM levels, but the discrepancies between IgG assays were unrelated to the donors' IgG levels and more likely related to assay sensitivity. Fourteen samples (5·9%) were anti-HEV IgM reactive and 11 samples (4·6%) anti-HEV IgG reactive in at least two serological assays from different manufacturers.

Conclusions: (a) In the absence of accepted confirmatory assays, it is crucial to confirm anti-HEV reactive samples with an alternative assay, especially when the population tested carries high levels of immunoglobulin M. (b) Although asymptomatic HEV infections are common in Ghanaian blood donors, currently, it does not seem to be a major risk to blood safety.