Hepatitis E Virus in the Countries of the Middle East and North Africa Region: An Awareness of an Infectious Threat to Blood Safety

Abstract

BACKGROUND AND OBJECTIVE: Hepatitis E virus (HEV) is mainly transmitted through contaminated water supplies which make the virus endemic in developing countries including countries of the Middle East and North Africa (MENA) region. HEV is now considered as the leading cause of enterically transmitted non-A hepatitis worldwide. Recent reports suggest potential risk of HEV transmission via blood transfusion in endemic areas. The objective of this study was to look at what has been published on HEV infection in the countries of the MENA region over the past 14 years (January 2000 - August 2014) and to see whether the transfusion-transmission route of HEV has been critically evaluated. MATERIALS AND METHODS: Related articles were collected, by searching through the countries of the MENA region using Pubmed, Medline and Google Scholar. The search was conducted using predefined combination of keywords: 'Hepatitis E Virus', 'Hepatitis E', 'Hepatitis E Infection', 'blood donors' in combination with all the names of the MENA region countries which cover a population of over 380 million people. One hundred articles were reviewed, of which 25 articles were excluded; the excluded papers were written in non-English Language or had uninterpretable data. RESULTS: Published data confirm the endemicity of HEV in the MENA region. Except for Egypt (anti-HEV IgG reaches 100% in certain populations), the seroprevalence of HEV in the general population ranged from 2.3-37.5% and was higher in males than in females. Prevalence increased with age, but exposure seems to be in early life in Egypt as high prevalence was detected in young children. There were only 8 articles published on blood donors and seroprevalence of HEV in blood donors was similar to that in the general population. Only one study was a prospective one and HEV infection would be documented in transfusion recipients. Infections were traced to infected donor samples (HEV-RNA-positive). CONCLUSION: Data on the possible transmission of HEV by blood transfusion in non-endemic countries (e.g. Japan, Germany) is still controversial. In the MENA region however, the role of HEV as infectious threat to blood safety is still seriously under-investigated. More data is needed to quantify the risk of transmission. This at least requires surveillance screening of donors and recipients for markers of recent or active HEV infection using reliable and currently available simple serological test. At the present time however, serious consideration should be given to selective screening for certain groups of patients (e.g. immunocompromised, pregnant women and others) who commonly require blood transfusion and are at high risk of hepatic failure or chronicity from HEV infection.