The endemicity of Hepatitis E virus in Malta

Abstract

Hepatitis E Virus detection has substantially increased in developed countries which has led to continuous studies on the prevalence and incidence of hepatitis E Virus globally, in order to determine endemicity and the risk of the infection, in the country of study. To date, no study has been carried out on the epidemiology of hepatitis E Virus in Malta. Based on its zoonotic and food borne illness, humans are most commonly infected by hepatitis E Virus through the consumption of infected, raw or undercooked meat generally from pigs, deer and rabbits. Besides being transmitted via faecal-oral route, hepatitis E Virus can be transmitted through blood and blood products used for transfusion purposes, therefore the results of this project impinge on imperative screening decisions. The aim of this study was to determine the prevalence of hepatitis E virus in Maltese blood donors and the incidence proportion of hepatitis E virus in patients with alanine aminotransferase levels greater than 1,000 IU/L and tested negative for hepatitis A, Band C markers. The results were used in order to assess the feasibility and clinical benefit of the introduction of hepatitis E virus testing at the Molecular Diagnostics Laboratory, Mater Dei Hospital and providing hepatitis E negative blood to at least, vulnerable groups of patients by the implementation of hepatitis E virus screening of blood donations. For this study, 4,032 archived sera retrieved from blood donations between July 2013 and October 2013 were tested using the ELISA method in an effort to determine the prevalence of the hepatitis E virus in Maltese blood donors. The prevalence of hepatitis E virus in Maltese blood donors has been calculated to be 6.41 %, which is considered to be endemic, being similar to most European countries. Patient samples received at the Virology laboratory, Mater Dei Hospital, with alanine aminotransferase levels greater than 1,000 IU/L and tested. negative for Hepatitis A, B or C markers, were tested by Fast Track Diagnostics hepatitis E virus RNA using Real-Time Polymerase Chain Reaction (RT-PCR). A total of 76 patient samples were tested. The incidence proportion was calculated to be 5 in 76 (6.6%) for the selected patient group over a period of 12-months (3rd February 2016 till 3rd February 2017). Based on the prevalence and incidence proportion results obtained for hepatitis E virus in Malta for the present study, it was feasible and reliable to perform a cost benefit analysis. The proposed plan for Malta is to introduce hepatitis E virus testing at the Molecular Diagnostics, Laboratory Mater Dei Hospital on patients presenting with acute Hepatitis negative for Hepatitis A, Band C, and to implement screening for hepatitis E virus RNA of donated blood at the National Blood Transfusion Service (NBTS). For the current proposal, the annual cost of selective screening for hepatitis E virus in Malta for 100 donations per week and annual universal screening of hepatitis E virus in Malta for the 50 donations per day were both calculated. Recommendations and the possibility of follow up studies were put forward in view of these findings.