Epidemiology of hepatitis E virus infection in a cohort of 4023 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

*Corresponding author for this work

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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
Publication statusPublished - Feb 2020



  • Anti-HEV IgG
  • Chronic HEV infection
  • Epidemiology
  • Hepatitis E
  • Immunocompromised
  • Transfusion transmission

Cite this

Harritshøj, L. H., Hother, C. E., Sengeløv, H., Daugaard, G., Sørensen, S. S., Jacobsen, S., Perch, M., Holm, D. K., Sækmose, S. G., Aagaard, B., Erikstrup, C., Hogema, B. M., Lundgren, J. D., & Ullum, H. (2020). Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients. International Journal of Infectious Diseases, 91, 188-195. https://doi.org/10.1016/j.ijid.2019.11.014