Sero-molecular Epidemiology of Hepatitis E Virus in Blood Donors, Gezira State, Sudan: A Cross-sectional Study
Abstract
Background: Hepatitis E virus (HEV) is a hepatotropic pathogen that causes significant
morbidity and mortality in humans. It is an important causative agent of viral hepatitis
outbreaks. This study investigates the serological and molecular prevalence of HEV
in blood donors attending the Central Blood Bank in Wad Medani City in Gezira State,
Sudan.
Methods: The study adopted a cross-sectional descriptive design. A structured
questionnaire was used to collect data concerning demographic information and risk
factors associated with HEV transmission. All enrolled participants (N = 300) were
screened for HEV IgG antibodies using commercial ELISA kits, then strong positive
samples (N = 84) were selected and rescreened for HEV IgM and HEV RNA by RT
PCR. SPSS version 24.0 was used for analysis.
Results: Out of 300 male participants, 36.3% (109/300) were positive for HEV IgG.
However, only one participant was IgM positive, while the HEV RNA was negative.
The highest prevalence rates of the virus were 42 (44.6%) among the age group
of 31–40 years, 20 (48.8%) in those who consumed food from outside, 13 (50%) in
three to four multiple blood donations, and 5 (62.5%) in those who consumed water
from the river source. A significant association of HEV IgG prevalence concerning the
occupation of the participants being students or farmers was detected using univariate
and multivariate analysis (P-value = 0.007).
Conclusion: High prevalence of HEV IgG was demonstrated among the healthy
blood donors in this study. Given the possibility of HEV transmission by transfusion
from donors to recipients, we recommend that routine screening for HEV should
be adopted by blood banks in Sudan.
References
S. (2004). Hepevirus. Virus Taxonomy, 853–857.
[2] Modrow, S., Falke, D., Truyen, U., & Schätzl, H. (2013). Viruses with single-stranded,
segmented, negative-sense RNA genomes. Molecular Virology. Springer.
[3] Smith, D. B., Simmonds, P., Jameel, S., Emerson, S. U., Harrison, T. J., Meng, X. J.,
Okamoto, H., Van der Poel, W. H. M., Purdy, M. A., & the Members Of The International
Committee On The Taxonomy Of Viruses Study Group. (2014). Consensus proposals
for classification of the family Hepeviridae. The Journal of General Virology, 95(Pt
10), 2223–2232. https://doi.org/10.1099/vir.0.068429-0
[4] Abdel Hady, S. I., El-Din, M. S., & El-Din, M. E. (1998). A high hepatitis E virus (HEV)
seroprevalence among unpaid blood donors and haemodialysis patients in Egypt.
The Journal of the Egyptian Public Health Association, 73(3–4), 165–179.
[5] Houcine, N., Jacques, R., Salma, F., Anne-Gaëlle, D., Amin, S., Mohsen, H.,
Hamadi, B., Christophe, R., Patrice, A., Mahjoub, A., & Caroline, S. (2012).
Seroprevalence of hepatitis E virus infection in rural and urban populations, Tunisia.
Clinical Microbiology and Infection, 18(5), E119–E121. https://doi.org/10.1111/j.1469-
0691.2012.03793.x
[6] Ben Halima, M., Arrouji, Z., Slim, A., Lakhoua, R., & Ben Redjeb, S. (1998).
[Epidemiology of hepatitis E in Tunisia]. La Tunisie Medicale, 76(5), 129–131.
[7] Traoré, K. A., Rouamba, H., Nébié, Y., Sanou, M., Traoré, A. S., Barro, N., & Roques, P.
(2012). Seroprevalence of fecal-oral transmitted hepatitis A and E virus antibodies in
Burkina Faso. PLoS One, 7(10), e48125. https://doi.org/10.1371/journal.pone.0048125
[8] Adjei, A. A., Tettey, Y., Aviyase, J. T., Adu-Gyamfi, C., Obed, S., Mingle, J. A.,
Ayeh-Kumi, P. F., & Adiku, T. K. (2009). Hepatitis E virus infection is highly
prevalent among pregnant women in Accra, Ghana. Virology Journal, 6(1), 108.
https://doi.org/10.1186/1743-422X-6-108
[9] Slot, E., Hogema, B. M., Riezebos-Brilman, A., Kok, T. M., Molier, M., & Zaaijer, H. L.
(2013). Silent hepatitis E virus infection in Dutch blood donors, 2011 to 2012. Eurosurveillance, 18(31), 20550. https://doi.org/10.2807/1560-7917.ES2013.18.31.20550
[10] Faber, M. S., Wenzel, J. J., Jilg, W., Thamm, M., Höhle, M., & Stark, K. (2012). Hepatitis
E virus seroprevalence among adults, Germany. Emerging Infectious Diseases, 18(10),
1654–1657. https://doi.org/10.3201/eid1810.111756
[11] Huzly, D., Umhau, M., Bettinger, D., Cathomen, T., Emmerich, F., Hasselblatt,
P., Hengel, H., Herzog, R., Kappert, O., Maassen, S., Schorb, E., Schulz-Huotari,
C., Thimme, R., Unmüssig, R., Wenzel, J. J., & Panning, M. (2014). Transfusiontransmitted hepatitis E in Germany, 2013. Eurosurveillance, 19(21), 208–212.
https://doi.org/10.2807/1560-7917.ES2014.19.21.20812
[12] Mitsui, T., Tsukamoto, Y., Suzuki, S., Yamazaki, C., Masuko, K., Tsuda, F., Takahashi,
M., Tsatsralt-Od, B., Nishizawa, T., & Okamoto, H. (2005). Serological and molecular
studies on subclinical hepatitis E virus infection using periodic serum samples
obtained from healthy individuals. Journal of Medical Virology, 76(4), 526–533.
https://doi.org/10.1002/jmv.20393
[13] Tamura, A., Shimizu, Y. K., Tanaka, T., Kuroda, K., Arakawa, Y., Takahashi, K., Mishiro,
S., Shimizu, K., & Moriyama, M. (2007). Persistent infection of hepatitis E virus
transmitted by blood transfusion in a patient with T-cell lymphoma. Hepatology
Research, 37(2), 113–120. https://doi.org/10.1111/j.1872-034X.2007.00024.x
[14] Colson, P., Coze, C., Gallian, P., Henry, M., De Micco, P., & Tamalet, C. (2007).
Transfusion-associated hepatitis E, France. Emerging Infectious Diseases, 13(4),
648–649. https://doi.org/10.3201/eid1304.061387
[15] Féray, C., Pawlotsky, J. M., Roque-Afonso, A. M., Samuel, D., & Dhumeaux, D. (2014).
Should we screen blood products for hepatitis E virus RNA? Lancet, 383(9913), 218.
https://doi.org/10.1016/S0140-6736(14)60072-6
[16] Arankalle, V. A., & Chobe, L. P. (1999). Hepatitis E virus: Can it be transmitted
parenterally? Journal of Viral Hepatitis, 6(2), 161–164. https://doi.org/10.1046/j.1365-
2893.1999.00141.x
[17] Khuroo, M. S., Kamili, S., & Yattoo, G. N. (2004). Hepatitis E virus infection
may be transmitted through blood transfusions in an endemic area. Journal
of Gastroenterology and Hepatology, 19(7), 778–784. https://doi.org/10.1111/j.1440-
1746.2004.03437.x
[18] Ibrahim, E., Abdelwahab, S., Nady, S., Hashem, M., Galal, G., Sobhy, M., Saleh, A.
S., & Shata, M. T. Prevalence of anti-HEV IgM among blood donors in Egypt. (2010).
The Egyptian Journal of Immunology/Egyptian Association of Immunologists, 18(2),
47–58.
[19] Meldal, B. H., Sarkodie, F., Owusu-Ofori, S., & Allain, J. P. (2013). Hepatitis E
virus infection in Ghanaian blood donors – The importance of immunoassay
selection and confirmation. Vox Sanguinis, 104(1), 30–36. https://doi.org/10.1111/j.1423-
0410.2012.01637.x
[20] Baylis, S. A., Gärtner, T., Nick, S., Ovemyr, J., & Blümel, J. (2012). Occurrence of
hepatitis E virus RNA in plasma donations from Sweden, Germany and the United
States. Vox Sanguinis, 103(1), 89–90. https://doi.org/10.1111/j.1423-0410.2011.01583.x
[21] Guo, Q. S., Yan, Q., Xiong, J. H., Ge, S. X., Shih, J. W., Ng, M. H., Zhang, J., & Xia, N.
S. (2010). Prevalence of hepatitis E virus in Chinese blood donors. Journal of Clinical
Microbiology, 48(1), 317–318. https://doi.org/10.1128/JCM.01466-09
[22] Fischer, C., Hofmann, M., Danzer, M., Hofer, K., Kaar, J., & Gabriel, C. (2015).
Seroprevalence and Incidence of hepatitis E in blood donors in Upper Austria. PLoS
One, 10(3), e0119576. https://doi.org/10.1371/journal.pone.0119576
[23] Babiker, N. A., Abakar, A. D., Taha, M. A., & Mohamed, N. T. (2019). Sero-Molecular
Epidemiology of Hepatitis E Virus among Hemodialysis. Jouf University Medical
Journal, 6(3), 9–16.
[24] Naeimi, B., Kalimani, F. M., & Pourfatolah, A. A. (2015). Hepatitis E virus
seroprevalence among blood donors in Bushehr, South of Iran. Hepa Month, 15(11).
[25] Ahmed, A. B., & Hamedelnil, Y. F. (2015). Seroprevalence of hepatitis E virus
among blood donors in Omdurman locality, Sudan. American Journal of Research
Communication, 3(5), 252–258.
