Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis

Background and aims: The increasing number of diagnosed hepatitis E virus (HEV) infections in Europe has led to the implementation of the testing of blood products in various countries. Many nations have not yet implemented such screening. To assess the need for HEV screening in blood products worldwide, we conducted a systematic review and meta-analysis assessing HEV RNA positivity and anti-HEV seroprevalence in blood donors. Methods: Studies reporting anti-HEV IgG/IgM or HEV RNA positivity rates among blood donors worldwide were identified via predefined search terms in PubMed and Scopus. Estimates were calculated by pooling study data with multivariable linear mixed-effects metaregression analysis. Results: A total of 157 (14%) of 1144 studies were included in the final analysis. The estimated HEV PCR positivity rate ranged from 0.01 to 0.14% worldwide, with strikingly higher rates in Asia (0.14%) and Europe (0.10%) in comparison to North America (0.01%). In line with this, anti-HEV IgG seroprevalence in North America (13%) was lower than that in Europe (19%). Conclusions: Our data demonstrate large regional differences regarding the risk of HEV exposure and blood-borne HEV transmission. Considering the cost–benefit ratio, this supports blood product screening in high endemic areas, such as Europe and Asia, in contrast to low endemic regions, such as the U.S.

[1]  S. Mann,et al.  The Old Man and the Meat: On Gender Differences in Meat Consumption across Stages of Human Life , 2021, Foods.

[2]  A. Heim,et al.  Risk of transfusion-transmitted hepatitis E virus infection from pool-tested platelets and plasma. , 2021, Journal of hepatology.

[3]  J. Rahman,et al.  Prevalence of Hepatitis E Virus Infection Among Blood Donors in the Eastern Province of Saudi Arabia , 2021, Journal of multidisciplinary healthcare.

[4]  Tiancheng Li,et al.  Hepatitis E virus prevalence among blood donors in Dali, China , 2021, Virology Journal.

[5]  L. Wong,et al.  The Risk of Transfusion-Transmitted Hepatitis E Virus: Evidence from Seroprevalence Screening of Blood Donations , 2021, Indian Journal of Hematology and Blood Transfusion.

[6]  P. Patel,et al.  Risk of hepatitis‐E virus infections among blood donors in a regional blood transfusion centre in western India , 2021, Transfusion medicine.

[7]  L. von Diemen,et al.  Seroprevalence of hepatitis E virus in risk populations and blood donors in a referral hospital in the south of Brazil , 2021, Scientific Reports.

[8]  I. Tsachev,et al.  Seroprevalence of Hepatitis E Virus Infection among Blood Donors in Bulgaria , 2021, Viruses.

[9]  C. Galli,et al.  Seroprevalence of hepatitis E virus in Argentinean blood donors , 2020, European journal of gastroenterology & hepatology.

[10]  W. Preiser,et al.  Prevalence and risks of hepatitis E virus infection in blood donors from the Western Cape, South Africa , 2020, Vox sanguinis.

[11]  Florencia Cancela,et al.  Serological and molecular prevalence of hepatitis E virus among blood donors from Uruguay , 2020, Journal of medical virology.

[12]  D. Prati,et al.  Prevalence and 9‐year incidence of hepatitis E virus infection among North Italian blood donors: Estimated transfusion risk , 2020, Journal of Viral Hepatitis.

[13]  R. Charrel,et al.  Seroprevalence of hepatitis E virus among blood donors on Corsica, France, 2017 , 2020, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[14]  C. Yurdaydın,et al.  HEV seroprevalence in blood donors in Turkey by two commercial total anti‐HEV Ab ELISA kits , 2019, Journal of medical virology.

[15]  J. Izopet,et al.  The Prevalence of Hepatitis E in a Patient Cohort Presenting With Addictive Injection Behavior , 2019, Front. Psychiatry.

[16]  J. Holmberg,et al.  Hepatitis E virus infection in Hong Kong blood donors , 2019, Vox sanguinis.

[17]  A. Baiker,et al.  A Novel In-House Enzyme-Linked Immunosorbent Assay for Genotype 3 Hepatitis E Virus Reveals High Seroprevalence in Blood Donors in Northern Argentina , 2019, Front. Microbiol..

[18]  R. Bruni,et al.  Hepatitis E virus infection prevalence among men who have sex with men involved in a hepatitis A virus outbreak in Italy. , 2019, Blood transfusion = Trasfusione del sangue.

[19]  R. Charrel,et al.  Seroprevalence Study of Anti-HEV IgG among Different Adult Populations in Corsica, France, 2019 , 2019, Microorganisms.

[20]  P. Meuleman,et al.  Hepatitis E virus prevalence in Flemish blood donors , 2019, Journal of viral hepatitis.

[21]  S. Louisirirotchanakul,et al.  A Nationwide Survey of the Seroprevalence of Hepatitis E Virus Infections Among Blood Donors in Thailand. , 2019, Viral immunology.

[22]  N. Gardinali,et al.  Detection and characterization of hepatitis E virus genotype-3 in HIV-infected patients and blood donors from Southern Brazil. , 2019, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[23]  A. Lohse,et al.  The Clinical Perspective on Hepatitis E , 2019, Viruses.

[24]  T. Vuk,et al.  Estimation of the hepatitis E assay-dependent seroprevalence among Croatian blood donors. , 2019, Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine.

[25]  T. Bergström,et al.  Hepatitis A and E virus infections have different epidemiological patterns in Rwanda. , 2019, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[26]  P. Gallian,et al.  Viral load and clinical manifestations of hepatitis E virus genotype 3 infections , 2019, Journal of viral hepatitis.

[27]  S. Kashima,et al.  Prevalence of hepatitis E virus infection in multiple transfused Brazilian patients with thalassemia and sickle cell disease , 2019, Journal of medical virology.

[28]  A. Tripathy,et al.  Hepatitis E virus seroprevalence among blood donors in Pune, India , 2019, Journal of medical virology.

[29]  S. Pischke,et al.  HEV in pregnancy: Understanding the crucial role of steroid hormones , 2019, Liver international : official journal of the International Association for the Study of the Liver.

[30]  I. Ushiro-Lumb,et al.  Hepatitis E virus in blood donors in England, 2016 to 2017: from selective to universal screening , 2019, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[31]  Yihan Lu,et al.  Identification of hepatitis E virus subtype 4f in blood donors in Shanghai, China. , 2019, Virus research.

[32]  J. Ticehurst,et al.  Probable transmission of hepatitis E virus (HEV) via transfusion in the United States , 2019, Transfusion.

[33]  A. Lohse,et al.  Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study , 2019, Viruses.

[34]  C. Knabbe,et al.  Hepatitis E virus blood donor NAT screening: as much as possible or as much as needed? , 2018, Transfusion.

[35]  A. Theamboonlers,et al.  Hepatitis E virus infection in Thai blood donors , 2018, Transfusion.

[36]  J. Izopet,et al.  Hepatitis E prevalence in French Polynesian blood donors , 2018, PloS one.

[37]  S. Görg,et al.  Lack of evidence for the transmission of hepatitis E virus by coagulation factor concentrates based on seroprevalence data , 2018, Transfusion medicine.

[38]  A. Lohse,et al.  Hepatitis E seroprevalence in the Americas: A systematic review and meta‐analysis , 2018, Liver international (Print).

[39]  H. Wedemeyer,et al.  Risk factors and seroprevalence of hepatitis E evaluated in frozen‐serum samples (2002‐2003) of pregnant women compared with female blood donors in a Southern region of Brazil , 2018, Journal of medical virology.

[40]  S. Fontana,et al.  Current hepatitis E virus seroprevalence in Swiss blood donors and apparent decline from 1997 to 2016 , 2018, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[41]  Gheyath K Nasrallah,et al.  Performance evaluation of five commercial assays in assessing seroprevalence of HEV antibodies among blood donors , 2018, Journal of medical microbiology.

[42]  Zizheng Zheng,et al.  Long-term HEV carriers without antibody seroconversion among eligible immunocompetent blood donors , 2018, Emerging Microbes & Infections.

[43]  R. Aggarwal,et al.  Prevalence of hepatitis E virus viremia and antibodies among healthy blood donors in India , 2018, Indian Journal of Gastroenterology.

[44]  M. Addo,et al.  HEV-positive blood donations represent a relevant infection risk for immunosuppressed recipients. , 2018, Journal of hepatology.

[45]  K. Stark,et al.  Case-control study on risk factors for acute hepatitis E in Germany, 2012 to 2014 , 2018, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[46]  R. Bruni,et al.  A nationwide retrospective study on prevalence of hepatitis E virus infection in Italian blood donors. , 2018, Blood transfusion = Trasfusione del sangue.

[47]  V. Corman,et al.  Molecular and serological infection marker screening in blood donors indicates high endemicity of hepatitis E virus in Poland , 2018, Transfusion.

[48]  W. van Pelt,et al.  Risk factors for hepatitis E virus seropositivity in Dutch blood donors , 2018, BMC Infectious Diseases.

[49]  L. Jarvis,et al.  Hepatitis E virus (HEV) in Scotland: evidence of recent increase in viral circulation in humans , 2018, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[50]  J. Hewitt,et al.  Prevalence of hepatitis E virus antibodies and infection in New Zealand blood donors. , 2018, The New Zealand medical journal.

[51]  M. Michalak,et al.  Comparative Seroprevalence of Hepatitis A And E Viruses in Blood Donors from Wielkopolska Region, West-Central Poland , 2018, Polish journal of microbiology.

[52]  V. Hoad,et al.  Hepatitis E virus RNA in Australian blood donors: prevalence and risk assessment , 2017, Vox sanguinis.

[53]  A. Zanetti,et al.  Seroprevalence of hepatitis E virus among blood donors in northern Italy (Sondrio, Lombardy) determined by three different assays. , 2017, Blood transfusion = Trasfusione del sangue.

[54]  J. Wenzel,et al.  Low hepatitis E virus RNA prevalence in a large‐scale survey of United States source plasma donors , 2017, Transfusion.

[55]  M. Michalak,et al.  Hepatitis E virus IgG seroprevalence in HIV patients and blood donors, west-central Poland. , 2017, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[56]  Gheyath K Nasrallah,et al.  Seroprevalence of hepatitis E virus among blood donors in Qatar (2013‐2016) , 2017, Transfusion.

[57]  M. Michalak,et al.  Hepatitis E virus antibodies in HIV-infected patients and blood donors from western Poland: A preliminary report. , 2017, Advances in clinical and experimental medicine : official organ Wroclaw Medical University.

[58]  C. Granato,et al.  High prevalence of hepatitis E virus antibodies in Sao Paulo, Southeastern Brazil: analysis of a group of blood donors representative of the general population , 2017, The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases.

[59]  I. Di Bartolo,et al.  Retrospective Study Evaluating Seroprevalence of Hepatitis E Virus in Blood Donors and in Swine Veterinarians in Italy (2004) , 2017, Zoonoses and public health.

[60]  A. Andonov,et al.  Hepatitis E in Canadian blood donors , 2017, Transfusion.

[61]  L. C. Kreutz,et al.  In house ELISA based on recombinant ORF2 protein underline high prevalence of IgG anti-hepatitis E virus amongst blood donors in south Brazil , 2017, PloS one.

[62]  E. Slot,et al.  Meat consumption is a major risk factor for hepatitis E virus infection , 2017, PloS one.

[63]  R. Tedder,et al.  Racial differences in seroprevalence of HAV and HEV in blood donors in the Western Cape, South Africa: a clue to the predominant HEV genotype? , 2017, Epidemiology and Infection.

[64]  M. Alvarez,et al.  HEV infection in French HIV-infected patients. , 2017, The Journal of infection.

[65]  K. Nelson,et al.  The association of elevated alanine aminotransferase levels with hepatitis E virus infections among blood donors in China , 2017, Transfusion.

[66]  P. Gallian,et al.  Comparison of hepatitis E virus nucleic acid test screening platforms and RNA prevalence in French blood donors , 2017, Transfusion.

[67]  J. Holmberg,et al.  Hepatitis E virus RNA in Australian blood donations , 2016, Transfusion.

[68]  V. Hoad,et al.  Hepatitis E virus seroepidemiology: a post-earthquake study among blood donors in Nepal , 2016, BMC Infectious Diseases.

[69]  S. Ijaz,et al.  Hepatitis E virus infection in the Irish blood donor population , 2016, Transfusion.

[70]  H. Okamoto,et al.  Hepatitis E virus in donor plasma collected in Japan , 2016, Vox Sanguinis.

[71]  Y. Madec,et al.  Hepatitis E virus antibody prevalence, RNA frequency, and genotype among blood donors in Cambodia (Southeast Asia) , 2016, Transfusion.

[72]  K. Borgen,et al.  Hepatitis E in Norway: seroprevalence in humans and swine , 2016, Epidemiology and Infection.

[73]  H. Ullum,et al.  Low transfusion transmission of hepatitis E among 25,637 single‐donation, nucleic acid‐tested blood donors , 2016, Transfusion.

[74]  B. Sapkota,et al.  First report of hepatitis E virus viremia in healthy blood donors from Nepal , 2016, VirusDisease.

[75]  C. Knabbe,et al.  Monitoring of Anti-Hepatitis E Virus Antibody Seroconversion in Asymptomatically Infected Blood Donors: Systematic Comparison of Nine Commercial Anti-HEV IgM and IgG Assays , 2016, Viruses.

[76]  A. Lohse,et al.  Hepatitis E Seroprevalence in Europe: A Meta-Analysis , 2016, Viruses.

[77]  J. Neyts,et al.  Update on hepatitis E virology: Implications for clinical practice. , 2016, Journal of hepatology.

[78]  A. Farhadi,et al.  Detection of Hepatitis E Virus Genotype 1 Among Blood Donors From Southwest of Iran , 2016, Hepatitis monthly.

[79]  P. Messa,et al.  New immunoassays for total, IgA and IgM antibodies against hepatitis E virus: Prevalence in Italian blood donors and patients with chronic liver or kidney diseases. , 2016, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[80]  P. Gallian,et al.  A nationwide survey of hepatitis E viral infection in French blood donors , 2016, Hepatology.

[81]  P. Roques,et al.  Hepatitis E Virus Prevalence among Blood Donors, Ouagadougou, Burkina Faso , 2016, Emerging infectious diseases.

[82]  G. Foster,et al.  Hepatitis E virus: seroprevalence and frequency of viral RNA detection among US blood donors , 2016, Transfusion.

[83]  C. Spada,et al.  High prevalence of hepatitis E virus antibodies among blood donors in Southern Brazil , 2016, Journal of medical virology.

[84]  S. Alavian,et al.  Hepatitis A Virus and Hepatitis E Virus Seroprevalence Among Blood Donors in Tehran, Iran , 2016, Hepatitis monthly.

[85]  A. Osterhaus,et al.  Hepatitis E virus infection among blood donors in the South Caribbean: is screening warranted? , 2016, The Netherlands journal of medicine.

[86]  A. Lasson,et al.  Diagnostic Performance of Five Assays for Anti-Hepatitis E Virus IgG and IgM in a Large Cohort Study , 2015, Journal of Clinical Microbiology.

[87]  S. Akbarzadeh,et al.  Hepatitis E Virus Seroprevalence Among Blood Donors in Bushehr, South of Iran , 2015, Hepatitis monthly.

[88]  R. Purcell,et al.  An Epidemiologic Investigation of a Case of Acute Hepatitis E , 2015, Journal of Clinical Microbiology.

[89]  A. De Luca,et al.  Seroprevalence of hepatitis E virus (HEV) infection in blood donors and renal transplant recipients: a retrospective study from central Italy. , 2015, Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive.

[90]  C. Mengelle,et al.  Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011. , 2015, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[91]  S. Sauleda,et al.  Seroprevalence of hepatitis E virus (HEV) and detection of HEV RNA with a transcription‐mediated amplification assay in blood donors from Catalonia (Spain) , 2015, Transfusion.

[92]  M. Danzer,et al.  Seroprevalence and Incidence of hepatitis E in Blood Donors in Upper Austria , 2015, PloS one.

[93]  O. Bahri,et al.  Hepatitis E virus seroprevalence among hemodialysis and hemophiliac patients in Tunisia (North Africa) , 2015, Journal of medical virology.

[94]  R. Purcell,et al.  Declining prevalence of hepatitis E antibodies among Danish blood donors , 2014, Transfusion.

[95]  I. Ushiro-Lumb,et al.  Hepatitis E virus in blood components: a prevalence and transmission study in southeast England , 2014, The Lancet.

[96]  J. Holmberg,et al.  Hepatitis E Virus and Implications for Blood Supply Safety, Australia , 2014, Emerging infectious diseases.

[97]  J. Saiz,et al.  Prevalence of hepatitis E virus (HEV) antibodies in Serbian blood donors. , 2014, Journal of infection in developing countries.

[98]  W. Zhuang,et al.  Hepatitis E virus seroprevalence among blood donors in Jiangsu Province, East China. , 2014, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[99]  M. Buti,et al.  Cirrhosis, Liver Transplantation and HIV Infection Are Risk Factors Associated with Hepatitis E Virus Infection , 2014, PloS one.

[100]  E. Slot,et al.  Past and present of hepatitis E in the Netherlands , 2014, Transfusion.

[101]  T. Cathomen,et al.  Transfusion-transmitted hepatitis E in Germany, 2013. , 2014, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[102]  A. Tsakris,et al.  Seroprevalence of hepatitis E virus in blood donors in Greece , 2014, Vox sanguinis.

[103]  K. Nelson,et al.  Hepatitis E virus seroprevalence and molecular study among blood donors in China , 2014, Transfusion.

[104]  S. Görg,et al.  Seroprevalence and incidence of hepatitis E virus infection in German blood donors , 2014, Transfusion.

[105]  N. Bhatnagar,et al.  Hepatitis E seroprevalence among blood donors: A pilot study from Western India , 2014, Asian journal of transfusion science.

[106]  A. Cleland,et al.  Hepatitis E virus in Scottish blood donors , 2013, Vox sanguinis.

[107]  M. Pourahmad,et al.  Hepatitis E virus and serum level aminotransferases in blood donors. , 2013, Reports of biochemistry & molecular biology.

[108]  N. Xia,et al.  An assessment of hepatitis E virus (HEV) in US blood donors and recipients: no detectable HEV RNA in 1939 donors tested and no evidence for HEV transmission to 362 prospectively followed recipients , 2013, Transfusion.

[109]  E. Slot,et al.  Silent hepatitis E virus infection in Dutch blood donors, 2011 to 2012. , 2013, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[110]  H. Keyvani,et al.  Hepatitis E virus infection in patients infected with human immunodeficiency virus in an endemic area in Iran , 2013, International journal of STD & AIDS.

[111]  A. Eslamifar,et al.  Seroprevalence of Hepatitis E Virus infection among volunteer blood donors in central province of Iran in 2012 , 2013, Iranian journal of microbiology.

[112]  R. Prato,et al.  Epidemiological and clinical features of HEV infection: a survey in the district of Foggia (Apulia, Southern Italy) , 2013, Epidemiology and Infection.

[113]  Saeed M Kabrah,et al.  Anti hepatitis E virus seropositivity in a group of male blood donors in Makkah, Saudi Arabia. , 2013, JPMA. The Journal of the Pakistan Medical Association.

[114]  F. Sarkodie,et al.  Hepatitis E virus infection in Ghanaian blood donors – the importance of immunoassay selection and confirmation , 2013, Vox sanguinis.

[115]  N. M. Utba,et al.  The prevalence of hepatitis E virus in Al-Sadr City - Baghdad. , 2013, Clinical laboratory.

[116]  A. Roque-Afonso,et al.  Transfusion-transmitted hepatitis E in a misleading context of autoimmunity and drug-induced toxicity. , 2012, Journal of hepatology.

[117]  P. Roques,et al.  Seroprevalence of Fecal-Oral Transmitted Hepatitis A and E Virus Antibodies in Burkina Faso , 2012, PloS one.

[118]  J. Izopet,et al.  Hepatitis E , 2012, The Lancet.

[119]  R. Johne,et al.  Novel Approach for Detection of Hepatitis E Virus Infection in German Blood Donors , 2012, Journal of Clinical Microbiology.

[120]  A. Mahjoub,et al.  Seroprevalence of hepatitis E virus infection in rural and urban populations, Tunisia. , 2012, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[121]  M. Manns,et al.  Pathogenesis and treatment of hepatitis e virus infection. , 2012, Gastroenterology.

[122]  F. Souto,et al.  Prevalence of hepatitis E virus antibodies in individuals exposed to swine in Mato Grosso, Brazil. , 2012, Memorias do Instituto Oswaldo Cruz.

[123]  Gretchen A. Stevens,et al.  The global burden of hepatitis E virus genotypes 1 and 2 in 2005 , 2012, Hepatology.

[124]  G. Wang,et al.  Serological and molecular study of hepatitis E virus among illegal blood donors. , 2012, World journal of gastroenterology.

[125]  M. Walther,et al.  Prevalence of hepatitis E virus-specific antibodies in humans with occupational exposure to pigs , 2012, Medical Microbiology and Immunology.

[126]  M. Groschup,et al.  Seroprevalence study in forestry workers from eastern Germany using novel genotype 3- and rat hepatitis E virus-specific immunoglobulin G ELISAs , 2012, Medical Microbiology and Immunology.

[127]  J. Izopet,et al.  Hepatitis E Virus Antibodies in Blood Donors, France , 2011, Emerging infectious diseases.

[128]  G. Glass,et al.  Restricted Enzooticity of Hepatitis E Virus Genotypes 1 to 4 in the United States , 2011, Journal of Clinical Microbiology.

[129]  M. Cavassini,et al.  Hepatitis E Virus Seroprevalence among Blood Donors in Southwest Switzerland , 2011, PloS one.

[130]  R. Tedder,et al.  Is there evidence of recent hepatitis E virus infection in English and North Welsh blood donors? , 2011, Vox sanguinis.

[131]  M. Hashem,et al.  Prevalence of anti-HEV IgM among blood donors in Egypt. , 2011, The Egyptian journal of immunology.

[132]  K. Tadokoro,et al.  A nationwide survey for prevalence of hepatitis E virus antibody in qualified blood donors in Japan , 2010, Vox sanguinis.

[133]  G. Orrù,et al.  Evidence of hepatitis E virus (HEV) infection in human and pigs in Sardinia, Italy. , 2009, Journal of preventive medicine and hygiene.

[134]  N. Xia,et al.  Prevalence of Hepatitis E Virus in Chinese Blood Donors , 2009, Journal of Clinical Microbiology.

[135]  R. Purcell,et al.  Time trend of the prevalence of hepatitis E antibodies among farmers and blood donors: a potential zoonosis in Denmark. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[136]  Jonathan K. Mitchell,et al.  Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease , 2008, European journal of gastroenterology & hepatology.

[137]  M. Assarehzadegan,et al.  Seroprevalence of hepatitis E virus in blood donors in Khuzestan Province, southwest Iran. , 2008, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[138]  J. Izopet,et al.  High prevalence of anti‐hepatitis E virus antibodies in blood donors from South West France , 2008, Journal of medical virology.

[139]  E. Gane,et al.  Hepatitis E in New Zealand , 2007, Journal of gastroenterology and hepatology.

[140]  N. Pavio,et al.  Prevalence of Anti-Hepatitis E Virus Antibodies in French Blood Donors , 2007, Journal of Clinical Microbiology.

[141]  H. Vennema,et al.  Swine‐like hepatitis E viruses are a cause of unexplained hepatitis in the Netherlands , 2007, Journal of viral hepatitis.

[142]  M. Khoshbaten,et al.  Prevalence of antibodies to hepatitis E virus among male blood donors in Tabriz, Islamic Republic of Iran. , 2007, Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit.

[143]  T. Matsuo,et al.  Seroprevalence for hepatitis E virus (HEV) infection among volunteer blood donors of the Regional Blood Bank of Londrina, State of Paraná , Brazil. , 2006, Revista do Instituto de Medicina Tropical de Sao Paulo.

[144]  G. Piédrola,et al.  Seroepidemiological study of hepatitis E virus in different population groups , 1995, European Journal of Clinical Microbiology and Infectious Diseases.

[145]  T. Nishizawa,et al.  Prevalence of antibodies to hepatitis E virus among Japanese blood donors: Identification of three blood donors infected with a genotype 3 hepatitis E virus , 2004, Journal of medical virology.

[146]  M. Khuroo,et al.  Hepatitis E virus infection may be transmitted through blood transfusions in an endemic area , 2004, Journal of gastroenterology and hepatology.

[147]  S. Emerson,et al.  Hepatitis E Virus (HEV) Capsid Antigens Derived from Viruses of Human and Swine Origin Are Equally Efficient for Detecting Anti-HEV by Enzyme Immunoassay , 2002, Journal of Clinical Microbiology.

[148]  D. Kiesslich,et al.  Prevalence of hepatitis E virus antibodies among different groups in the Amazonian basin. , 2002, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[149]  S. Emerson,et al.  Prevalence of Antibodies to Hepatitis E Virus in Veterinarians Working with Swine and in Normal Blood Donors in the United States and Other Countries , 2002, Journal of Clinical Microbiology.

[150]  V. D. de Paula,et al.  Hepatitis E virus infection in selected Brazilian populations. , 2001, Memorias do Instituto Oswaldo Cruz.

[151]  S. Hayashi,et al.  Seroprevalence of Antibody to Hepatitis E Virus in Voluntary Blood Donors in Northern Thailand , 2000 .

[152]  A. Spina,et al.  Hepatitis E Virus Immunoglobulin G Antibodies in Different Populations in Campinas, Brazil , 2000, Clinical Diagnostic Laboratory Immunology.

[153]  S. Jameel,et al.  Hepatitis E virus in Cuba. , 2000, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[154]  J. Mak,et al.  Seroprevalence of antibodies to hepatitis E virus in the normal blood donor population and two aboriginal communities in Malaysia , 1999, Journal of medical virology.

[155]  N. Konomi,et al.  Epidemiology of Hepatitis B, C, E, and G Virus Infections and Molecular Analysis of Hepatitis G Virus Isolates in Bolivia , 1999, Journal of Clinical Microbiology.

[156]  M. Gilchrist,et al.  Hepatitis E virus infection prevalence among selected populations in Iowa. , 1999, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[157]  V. Arankalle,et al.  Hepatitis E virus: can it be transmitted parenterally? , 1999, Journal of viral hepatitis.

[158]  F. Baquero,et al.  Hepatitis E Virus: Relevance in Blood Donors and Risk Groups , 1998, Vox Sanguinis.

[159]  M. Elisaf,et al.  Antibodies to hepatitis E virus among several populations in Greece: increased prevalence in an hemodialysis unit , 1998, Transfusion.

[160]  C. Gilpin,et al.  Epidemiology of hepatitis E virus in male blood donors in Jeddah, Saudi Arabia , 1998, Irish journal of medical science.

[161]  I. Angelillo,et al.  Prevalence of hepatitis E antibodies in healthy persons in southern Italy , 1998, Infection.

[162]  F. Monteiro,et al.  Hepatitis E in Portuguese haemophiliacs and blood donors , 1997, Haemophilia : the official journal of the World Federation of Hemophilia.

[163]  I. K. Kuramoto,et al.  Prevalence of and risk factors for antibody to hepatitis E virus seroreactivity among blood donors in Northern California. , 1997, The Journal of infectious diseases.

[164]  Rey,et al.  Prevalence of IgG Anti-HEV in Buenos Aires, a Nonendemic Area for Hepatitis E. , 1997, Journal of travel medicine.

[165]  D. Vlahov,et al.  Seroreactivity to hepatitis E virus in areas where the disease is not endemic , 1997, Journal of clinical microbiology.

[166]  P. Komolmit,et al.  Prevalence of hepatitis E virus infection in Thailand. , 1996, Annals of tropical medicine and parasitology.

[167]  M. Carl,et al.  Prevalence of Antibody to Hepatitis E Virus among Healthy Individuals in Southern Taiwan , 1995, Microbiology and immunology.

[168]  H. M. van den Berg,et al.  Hepatitis E virus antibodies among patients with hemophilia, blood donors, and hepatitis patients , 1995, Journal of medical virology.

[169]  S. Locarnini,et al.  Seroepidemiology of hepatitis E in selected Australian populations , 1995, Journal of medical virology.

[170]  D. Lavanchy,et al.  Seroprevalence of hepatitis E virus in Switzerland , 1994, The Lancet.

[171]  A. Zanetti,et al.  Hepatitis type E in Italy: A seroepidemiological survey , 1994, Journal of medical virology.