Background/Aims: A higher prevalence of anti-hepatitis E virus (HEV) in non-endemic viral hepatitis such as in Germany has been reported in our previous study. The aim of this study was to assess the seroepidemiology of HEV among haemodialysis (HD) patients in Shin-Kong Hospital, Taiwan, and to evaluate whether there was an increased risk of infection and exposure to HEV even in an area of endemic viral hepatitis. Methods: Serum samples obtained from 400 Taiwanese patients on chronic HD (group 1), 400 sex- and age-matched healthy subjects (group 2) and hospital patients (group 3) were tested for the IgG anti-HEV. Results: The prevalence of anti-HEV among the HD patients and the healthy controls were 31 and 8.9%, respectively. The difference (22%) was statistically significant (p < 0.01). In comparison, the anti-HEV in hospital patients was 16%. Conclusion: The study indicated a significantly higher risk of HEV infection among patients on chronic HD in endemic regions of viral hepatitis such as Taiwan. Mostly because of anaemia, HD patients usually received packed transfusion (red blood cells) if their haemoglobin was low. It is possible that HEV infection may be transmitted through blood transfusions in an endemic area. In such areas, appropriate strategies should be adopted to prevent the risk of HEV among HD patients.

Keywords:
Hepatitis E virus infection, Haemodialysis, Blood transfusion
1.
Bradley DW: Hepatitis E: Epidemiology, etiology and molecular biology. Rev Med Virol 1992;2:19–28.
2.
Reyes GR, Purdy MA, Kim JP: Isolation of a cDNA from the virus responsible for enterically transmitted non-A, non-B hepatitis. Science 1990;247:1335–1339.
3.
Wang CH, Flehmig B, Moeckli R: Transmission of hepatitis E virus by transfusion. Lancet 1993;341:825–826.
4.
Matsubayashi K, Nagaoka Y, Sakata H, Sato S, Fukai K, Kato T, Takahashi K, Mishiro S, Imai M, Takeda N, Ikeda H: Transfusion-transmitted hepatitis E caused by apparently indigenous hepatitis E virus strain in Hokkaido, Japan. Transfusion 2004;44:934–940.
5.
Halfon P, Ouzan D, Chanas M: High prevalence of hepatitis E virus antibody in haemodialysis patients (letter). Lancet 1994;344:746.
6.
Dalekos GN, Zervou E, Elisaf M, Germanos N, Galanakis E, Bourantas K, Siamopoulos KC, Tsianos EV: Antibodies to hepatitis E virus among several populations in Greece: Increased prevalence in an hemodialysis unit. Transfusion 1998;38:589–595.
7.
Wang CH, Tschen SY, Schalasta G, Pillot J, Iahn G, Flehmig B: Anti-hepatitis E virus markers in hemodialysis patients. Nephron 1996;72:343–345.
8.
Fabrizi F, Lunghi G, Bacchini G, Corti M, Pagano A, Locatelli F: Hepatitis E virus infection in haemodialysis patients: A seroepidemiological survey. Nephrol Dial Transplant 1997;12:133–136.
9.
Gessoni G, Manoni F: Hepatitis E virus infection in north-east Italy: Serological study in the open population and groups at risk. J Viral Hepat 1996;3:197–202.
10.
Wang CH: Hepatitis E virus infection in Taiwan: Prevalence of neutralising anti-HEV- positive serum. Epidemiol Bull 2001;17:301–326.
11.
Normann A, Jung C, Vallbracht A, Flehmig B: Time course of hepatitis A viremia and viral load in the blood of human hepatitis A patients. J Med Virol 2004;72:10–16.
12.
Xia NS, Zhang J, Zheng YJ, Ge SX, Ye XZ, Ou SH: Transfusion of plasma from a blood donor induced hepatitis E in rhesus monkey. Vox Sang 2004;86:45–47.
13.
Renato MB, Roman PI, Taylor RP, Goodkin DA, LaBrecque J, Powers KL, Bolton WK: Prospective study of the immune effects of normalizing the hemoglobin concentration in hemodialysis patients who receive recombinant human erythropoietin. J Am Soc Nephrol 2004;15:1339–1346.
14.
Foley RN, Parfrey PS, Moprgen J: Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomegaly. Kidney Int 2000;58:1325–1335.
15.
Yount S, Lai JS, Cella D: Methods and progress in assessing the quality of life effects of supportive care with erythropoietin therapy. Curr Opin Hematol 2002;9:234–240.
16.
Ramachandran J, Eapen CE, Kang G, Abraham P, Hubert DD, Kurian G, Hephzibah J, Mukhopadhya A, Chandy GM: Hepatitis E superinfection produces severe decompensation in patients with chronic liver disease. J Gastroenterol Hepatol 2004;19:134–138.
17.
Hwang SJ, Yang WC and the Dialysis Surveillance Committee: 1999 National dialysis surveillance in Taiwan. Acta Nephrol 2000;14:139–228.
18.
Ding X, Li TC, Hayashi S, Masaki N, Tran TH, Hirano M, Yamaguchi M, Usui M, Takeda N, Abe K: Present state of hepatitis E virus epidemiology in Tokyo, Japan. Hepatol Res 2003;27:169–173.
19.
Wang CH, Flehmig B, Jahn G, Tschen SY: Hepatitis E virus in haemodialysis. Vox Sang 1997;73:54–55.
20.
Khuroo MS, Kamili S, Yattoo GN: Hepatitis E virus infection may be transmitted through blood transfusion in an endemic area. J Gastroenterol Hepatol 2004;19:778–784.
21.
Woolf B: On estimating the relation between blood group and diseases. Ann Hum Genet 1955;19:251–253.
22.
Thrusfield M, Ortega C, de Blas I, Noordhuizen JP, Frankena K: WIN EPISCOPE 2.0: Improved epidemiological software for veterinary medicine. Vet Rec 2001;148:567–572.
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2005
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