hepatitis e virus screening england and wales up to april 2017 · hepatitis e virus screening...
TRANSCRIPT
Hepatitis E Virus screening England and
Wales up to April 2017
Richard Tedder for the
Joint PHE/NHSBT Blood Borne Virus Unit
Colindale
Presentation title - edit in Header and Footer
SaBTO (Advisory Committee on the Safety of Blood, Tissues and
Organs) formed a working group
2016 - recommendation for the implementation of selective screening
• Donations given to SOT and SCT patients
• NHSBT extended this to neonates <1 year
2017- recommendation extended to universal screening
• Blood donations
• Tissues/organs/stem cells
NB: blood screening will only reduce exposure as risk from diet still
exists
HEV and Blood Safety
Drivers were Penrose report, 45% transmission and persistence
2016 - recommendation was considered proportionate
• Donations only to be given to SOT and SCT patients
• NHSBT extended this to neonates <1 year
• Estimated need 300-400,000 donations to serve
2017- recommendation extended to universal screening
• Utilisation actually >700,000 donors in practice
• Double inventory expenses and complexity
• Increased wastage, risks and uncertainty
• Universal no more expensive than costs above for selective screening
HEV and Blood Safety
Following universal screening the service response included
Donor confirmation
• All pick up were confirmed PCR +ve
• Sequencing
Donor return
• Component donors as required, RNA neg plus strong IgG
• WB donors retested for anti-HEV, so far all seropositive
Information given and invitation to participate in a web based survey
HEV and Blood Safety
HEV RNA testing of blood & apheresis
donations at NHSBT 2016
0,00
0,10
0,20
0,30
0,40
0,50
0,60
0,70
0,80
0,90
0
10000
20000
30000
40000
50000
60000
70000
Pe
r 1
00
0 d
on
ati
on
s
Nu
mb
er
of
do
nati
on
s t
es
ted
Month of donation225 viraemic donors
Data supplied by the NHSBT/PHE Epidemiology Unit
Total singles tested
Per 1000 donations
HEV RNA percent viraemic by gender
and age group, Feb 2016 to Feb 2017
0,000
0,010
0,020
0,030
0,040
0,050
0,060
0,070
0,080
0,090
0,100
17to24 25to34 35to44 45to54 55to64 65plus
Pe
rce
nt
Age group
Supplied by the NHSBT/PHE Epidemiology Unit
Male Female
Viraemic donations by month
Month
2016/17 Donations tested
Confirmed
RNA positive
Prevalence
rate
% of donations
positive
February 603 1 1 in 603 0.17
March 28491 24 1 in 1187 0.08
April 40305 24 1 in 1679 0.06
May 43443 34 1 in 1277 0.08
June 47232 27 1 in 1749 0.06
July 48329 29 1 in 1666 0.06
August 52672 18 1 in 2926 0.03
September 51784 9 1 in 5753 0.02
October
November
December
January
February
53668
59362
57472
54866
54733 *
11
5
15
10
18 *
1 in 4878
1 in 11872
1 in 3831
1 in 5486
1 in 3040
0.02
0.01
0.03
0.02
0.03
TOTAL 592960 225 1 in 2635 0.04
HEV G3 seqs from cases
England (n=430, 2016)
HEV G3 1.3 Kb seqs from 49 English
donors (2016)
0
10
20
30
40
50
60
0
2
4
6
8
10
12
14
16
18
Log10 VL IU/ml
Fitted Normaldistribution
Nu
mb
er
of
do
no
rs
2016/7
2013/4
Chronic HEV England & Wales 2009-2016 (n=94)
0
5
10
15
20
25
30
35
2009 2010 2011 2012 2013 2014 2015 2016
No
's o
f cases
Year
Audits Routine diagnostics
Patients with chronic HEV (n=76)
Age
0-17 yrs
18-34 yrs
35-59 yrs
>60 yrs
Underlying condition
Solid Organ Transplant
HIV
HSCT
Haemato-oncology
Other immunosuppression
Immunocompetent
Unknown
Management of chronic hepatitis E
15
0
5
10
15
20
25
30
35
40
Ribavirin PEG with/withoutRibavirin
? Reduction in IS
No
's o
f cases
Treatment
Treatment for chronic HEV
48/76 treated, 4 not treated, 24 uncertain
Outcome
Ongoing viraemia
Viral Clearance
Death with viraemia
Relapse
?
13
37
12
7
7
HEV RNA confirmed donations by month
Month
2016/17 Donations tested
Confirmed
RNA positive
Prevalence
rate
% of donations
positive
February 603 1 1 in 603 0.17
March 28491 24 1 in 1187 0.08
April 40305 24 1 in 1679 0.06
May 43443 34 1 in 1277 0.08
June 47232 27 1 in 1749 0.06
July 48329 29 1 in 1666 0.06
August 52672 18 1 in 2926 0.03
September 51784 9 1 in 5753 0.02
October 53668 11 1 in 4878 0.02
November 59362 5 1 in 11872 0.01
December 57472 15 1 in 3831 0.03
January 54866 10 1 in 5486 0.02
February 54183 18 1 in 3010 0.03
March 70303 13 1 in 5408 0.02
April# 109300 32* 1 in 3415 0.03
TOTAL 772013 270 1 in 2859 0.03* Provisional data, this is the number of screen reactives (not confirmed with reference testing)
# Universal screening started on the 10th April 2017
17
AcknowledgementsPublic Health England NTMRL, NHSBT, Colindale
Samreen Ijaz Alan Kitchen
Michael Ankcorn Pat Hewitt
Kate Tettmar Ines Ushiro-Lumb
Nick Andrews
NHSBT/PHE Epidemiology Unit
Su Brailsford
Bengu Said