Prevalence of hepatitis E virus infection among blood donors in mainland China: a meta‐analysis

BACKGROUND The risk of hepatitis E virus (HEV) infection from blood transfusion has raised increasing concern in many countries. Several transfusion‐transmitted cases have been described in the United Kingdom and Japan. The objective was to investigate the prevalence of HEV infection among Chinese blood donors and analyze the potential risk of HEV infection through blood transfusion in China. STUDY DESIGN AND METHODS Major English and Chinese research databases were used as background research for the study of locations, years, and the number of HEV infections among blood donors in China. The pooled, estimated rate of HEV infection was calculated. Subgroup analyses, for age, sex, and alanine aminotransferase (ALT) levels were performed using software for comprehensive meta‐analysis. RESULTS The pooled rates of anti‐HEV IgM– and anti‐HEV IgG–positive donations were 1.09% (95% confidence interval [CI], 0.95%‐1.26%) and 30% (95% CI, 25%‐34%), respectively. The prevalence of anti‐HEV IgM was significantly higher in donors with elevated ALT (4.34%) compared with the rate in donors with normal ALT (1.35%; χ 2 = 39.66, p < 0.01). The anti‐HEV IgM and IgG rates were higher in the Southwest region (1.58 and 41%, respectively) compared to the rates in other regions of China (chi‐square test, p < 0.05). The anti‐HEV IgG rate was also significantly higher in donors 30 years and older compared with donors between 18 and 29 years of age (39% vs. 22%, respectively; χ 2 = 1457.10, p < 0.01). Genetic analysis of HEV from RNA‐positive donors indicated that the majority of HEV infections were Genotype 1 (19/33 = 58%), while the remaining 14 isolates were Genotype 4 (14/33 = 42%; χ 2 = 0.758, p > 0.05). CONCLUSION Qualified donations after routine blood donor screening still carry a potential risk for transmitting HEV. The major genotypes in Chinese donors in this study were Genotypes 1 and 4.