In this interesting study from China, 11747 eligible blood donors were screened for anti-HEV IgM/IgG and HEV RNA and antigen. Twenty-four donors who were positive for both HEV antigen and RNA were followed for ≥ 70 days, and none of these donors reported clinical hepatitis or illness. At least 1 follow-up sample was provided by 17 donors, including 10 with viremia and/or antigenemia for ≥ 70 days and 3 with antigen and RNA positivity for >90 days. Fourteen of the 17 donors did not present with an obvious serologic response during the follow-up period. These donors showed atypical HEV infection progression that differed from that of hepatitis E patients.
This study challenges our concept that Hepatitis E presents as only acute infections. Not only there was an asymptomatic chronic state with viremia, this was also not associated with antibody response as well. These patients are going to pose particular challenge during pre blood donation screening. A compelling evidence that hepatotropic viruses produce multifaceted disease with variable immunological response and clinical disease.