four cases of transfusion-trasmitted Hepatitis E virus infection. Is time to introduce donor screening in Italy

Hepatitis E virus (HEV), a positive-sense single-stranded RNA virus, is a leading cause of acute viral hepatitis worldwide. In Europe, hepatitis E virus (HEV) infection is mainly a food-borne zoonosis, is spread across endemic and non-endemic areas by travel and zoonosis, but it can also be transmitted by blood transfusion [[1]]. It is usually a mild and self-limited infection. However, immunocompromised persons, who are also those more likely to undergo blood transfusions, may develop chronic hepatitis, cirrhosis, and even liver failure, especially if chronic hepatitis E is not recognised and treated in time [[2]]. Biological qualification of blood donations according to current regulations in Italy include serological tests for HBV, HCV, HIV and Syphilis and NAT Test for HBV, HCV and HIV. Plasma product manufacturers, according to European Pharmacopeia Chapter 8.3, perform additional tests for HAV, HEV and parvovirus B19 in pharmaceutical-grade plasma production because HEV, a non-enveloped virus, is resistant to solvent-detergent treatment methods; in case of positive tests, donor blood banks receive result notifications by plasma industry [[3]]. In the period between May 2020 and May 2021, our blood bank received from Plasma product manufacturer three notifications of HEV RNA positive plasma units collected from three first-time donors.