Molecular Epidemiology of Hepatitis E Virus Genotypes in Blood Donors in Peshawar, Khyber Pakhtunkhwa

Main Article Content

Muhammad Adeel
Nihad Bahadur
Raja Hamza Ishtiaq
Hammad Hussain Anjum
Zain Ali
Obaid Ullah
Aamer Ali Khattak


Background: Hepatitis E virus (HEV), an RNA virus, poses a significant global health threat, affecting 2.3 billion people annually, causing 70,000 deaths, over 50% of acute viral hepatitis cases. In Pakistan, HEV prevalence is high among pregnant women (26%), with a mortality rate of 26 to 30%. Blood transmission is a leading source of sporadic HEV infection.

Methodology: The blood specimens were investigated with HEV to detect anti- IgM and IgG antibodies. Anti HEV IgM positive specimens confirmed the incidence of viral RNA by Polymerase chain reactions. The positive cases containing viral RNA were subjected to sequencing of ORF2.

Result: A total of 3480 blood specimens were screened serologically by ELISA for the existence of anti HEV IgM and anti-HEV IgG antibodies. Of these 3480 samples, 170 (4.9%) were confirmed positive when screened for HEV antibodies among study population, there was a statistically significant difference observed between males and females (p=0.00001).  From 170 positive samples, 60 (1.72 %) were positive for having anti-HEV IgM antibodies in plasma, whereas 110 (3.16 %) were found with anti-HEV IgG antibodies. Among 60 (1.72 %) IgM-positive samples, 18 (0.51 %) were confirmed positive by PCR for the presence of HEV-RNA. Genotype 1 was observed in all 18 HEV RNA-positive samples.  

Conclusion: The findings of this study underscore the urgency of implementing HEV screening protocols before blood donation. The risk of transmission through blood products is evident, with 4.9% of screened blood specimens exhibiting HEV antibodies. Therefore, the National Blood Transfusion Regulatory Authority must incorporate HEV screening as a routine procedure in Pakistan.

Article Details

How to Cite
Adeel, M., Bahadur, N., Ishtiaq, R. H., Anjum, H. H., Ali, Z., Ullah, O., & Khattak, A. A. (2024). Molecular Epidemiology of Hepatitis E Virus Genotypes in Blood Donors in Peshawar, Khyber Pakhtunkhwa. Journal of Health and Rehabilitation Research, 4(1), 1574–1580.
Author Biographies

Muhammad Adeel, Riphah International University Islamabad Pakistan.

Faculty of Rehabilitation and Allied Health Sciences (FRAHS), Riphah International University, Islamabad, Pakistan.

Nihad Bahadur, Riphah International University Islamabad Pakistan.

MLT Department, Riphah International University, Islamabad, Pakistan.

Raja Hamza Ishtiaq, Riphah International University Islamabad Pakistan.

MLT Department, Riphah International University, Islamabad, Pakistan.

Hammad Hussain Anjum, Riphah International University Islamabad Pakistan.

MLT Department, Riphah International University, Islamabad, Pakistan.

Zain Ali, National University of Medical Sciences Rawalpindi Pakistan.

National University of Medical Sciences, Rawalpindi, Pakistan.

Obaid Ullah, National Institute of Health Islamabad Pakistan.

Health Research Institute, National Institute of Health, Islamabad, Pakistan.

Aamer Ali Khattak, The University of Haripur-Haripur Khyber Pakhtunkhwa Pakistan.

Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan.


Goel A, Vijay HJ, Katiyar H, Aggarwal R. Prevalence of hepatitis E viraemia among blood donors: a systematic review. Vox Sanguinis. 2020;115(3):120-32.

Denner J. Hepatitis E virus (HEV)—The future. Viruses. 2019;11(3):251.

Ahmad T, Haroon H, Ahmad K, Shah SM, Shah MW, Hussain A, et al. Hepatitis E vaccines: a mini review. Biomedical Research and Therapy. 2021;8(9):4514-24.

Aggarwal A, Perumpail RB, Tummala S, Ahmed A. Hepatitis E virus infection in the liver transplant recipients: clinical presentation and management. World Journal of Hepatology. 2016;8(2):117.

Nan Y, Wu C, Zhao Q, Zhou E-M. Zoonotic hepatitis E virus: an ignored risk for public health. Frontiers in microbiology. 2017;8:2396.

Hriskova K, Marosevic D, Belting A, Wenzel J, Carl A, Katz K. Epidemiology of hepatitis E in 2017 in Bavaria, Germany. Food and environmental virology. 2021;13(3):337-46.

Sangthang S, Shastry S, Sudheesh N, Chawla K, Madiyal M, Kandasamy D. Seroepidemiology of Hepatitis E virus among the voluntary blood donors in the coastal region of Karnataka, India. F1000Research. 2023;12(266):266.

Domanović D, Tedder R, Blümel J, Zaaijer H, Gallian P, Niederhauser C, et al. Hepatitis E and blood donation safety in selected European countries: a shift to screening? Eurosurveillance. 2017;22(16):30514.

Grigas J, Simkute E, Simanavicius M, Pautienius A, Streimikyte-Mockeliune Z, Razukevicius D, et al. Hepatitis E genotype 3 virus isolate from wild boar is capable of replication in non-human primate and swine kidney cells and mouse neuroblastoma cells. BMC veterinary research. 2020;16:1-11.

Jupattanasin S, Chainuvati S, Chotiyaputta W, Chanmanee T, Supapueng O, Charoonruangrit U, et al. A nationwide survey of the seroprevalence of hepatitis E virus infections among blood donors in Thailand. Viral Immunology. 2019;32(7):302-7.

Jothikumar N, Cromeans TL, Robertson BH, Meng X, Hill VR. A broadly reactive one-step real-time RT-PCR assay for rapid and sensitive detection of hepatitis E virus. Journal of virological methods. 2006;131(1):65-71.

Namsai A, Louisirirotchanakul S, Wongchinda N, Siripanyaphinyo U, Virulhakul P, Puthavathana P, et al. Surveillance of hepatitis A and E viruses contamination in shellfish in Thailand. Letters in applied microbiology. 2011;53(6):608-13.

Siripanyaphinyo U, Laohasinnarong D, Siripanee J, Kaeoket K, Kameoka M, Ikuta K, et al. Full‐length sequence of genotype 3 hepatitis E virus derived from a pig in Thailand. Journal of medical virology. 2009;81(4):657-64.

Tripathy AS, Puranik S, Sharma M, Chakraborty S, Devakate UR. Hepatitis E virus seroprevalence among blood donors in Pune, India. Journal of Medical Virology. 2019;91(5):813-9.

Gajjar MD, Bhatnagar NM, Sonani RV, Gupta S, Patel T. Hepatitis E seroprevalence among blood donors: A pilot study from Western India. Asian journal of transfusion science. 2014;8(1):29.

Boukhrissa H, Mechakra S, Mahnane A, Boussouf N, Gasmi A, Lacheheb A. Seroprevalence of hepatitis E virus among blood donors in eastern Algeria. Tropical Doctor. 2022;52(4):479-83.

da Silva CM, Oliveira JM, Mendoza-Sassi RA, Figueiredo AS, da Mota LD, Nader MM, et al. Detection and characterization of hepatitis E virus genotype 3 in HIV-infected patients and blood donors from southern Brazil. International Journal of Infectious Diseases. 2019;86:114-21.

Marcantonio C, Pezzotti P, Bruni R, Taliani G, Chionne P, Madonna E, et al. Incidence of hepatitis E virus infection among blood donors in a high endemic area of Central Italy. Journal of Viral Hepatitis. 2019;26(4):506-12.

Grabarczyk P, Sulkowska E, Gdowska J, Kopacz A, Liszewski G, Kubicka‐Russel D, et al. Molecular and serological infection marker screening in blood donors indicates high endemicity of hepatitis E virus in Poland. Transfusion. 2018;58(5):1245-53.

Rasche A, Saqib M, Liljander AM, Bornstein S, Zohaib A, Renneker S, et al. Hepatitis E virus infection in dromedaries, north and east Africa, United Arab Emirates, and Pakistan, 1983–2015. Emerging infectious diseases. 2016;22(7):1249.

Farooqi HMU. Liver-on-Chip Development for Pathophysiological Emulation and Drug Toxicity Testing: 제주대학교 대학원; 2022.

Alhatlani BY, Aljabr WA, Almarzouqi MS, Alhatlani SM, Alzunaydi RN, Alsaykhan AS, et al. Seroprevalence of the hepatitis E virus antibodies among blood donors in the Qassim region, Saudi Arabia. Future Virology. 2021;16(6):383-8.

Hewitt PE, Ijaz S, Brailsford SR, Brett R, Dicks S, Haywood B, et al. Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. The Lancet. 2014;384(9956):1766-73.

Picchi G, Ricciardi A, Marola L, Madonna E, Chionne P, Villano U, et al. SAT-211-HEV infection in Italy: Beyond the hepatic disease. Journal of Hepatology. 2019;70(1):e723.

De Sabato L, Di Bartolo I, Montomoli E, Trombetta C, Ruggeri F, Ostanello F. Retrospective study evaluating seroprevalence of hepatitis E virus in blood donors and in swine veterinarians in Italy (2004). Zoonoses and public health. 2017;64(4):308-12.

Cordes AK, Goudeva L, Lütgehetmann M, Wenzel JJ, Behrendt P, Wedemeyer H, et al. Risk of transfusion-transmitted hepatitis E virus infection from pool-tested platelets and plasma. Journal of Hepatology. 2022;76(1):46-52.

Katiyar H, Goel A, Sonker A, Yadav V, Sapun S, Chaudhary R, et al. Prevalence of hepatitis E virus viremia and antibodies among healthy blood donors in India. Indian journal of gastroenterology. 2018;37:342-6.

Navaneethan U, Al Mohajer M, Shata MT. Hepatitis E and pregnancy: understanding the pathogenesis. Liver international. 2008;28(9):1190-9.

Chen X, Gong P, Wagner AL, Li Y, Wang G, Lu Y. Identification of hepatitis E virus subtype 4f in blood donors in Shanghai, China. Virus research. 2019;265:30-3.

Ren F, Zhao C, Wang L, Wang Z, Gong X, Song M, et al. Hepatitis E virus seroprevalence and molecular study among blood donors in C hina. Transfusion. 2014;54(3pt2):910-7.

Tsoi WC, Zhu X, To APC, Holmberg J. Hepatitis E virus infection in Hong Kong blood donors. Vox Sanguinis. 2020;115(1):11-7.

Kevorkyan A, Golkocheva-Markova E, Raycheva R, Rangelova V, Komitova R, Atanasova M, et al. Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria. Pathogens. 2023;12(10):1208.

Abebe M, Ali I, Ayele S, Overbo J, Aseffa A, Mihret A. Seroprevalence and risk factors of Hepatitis E Virus infection among pregnant women in Addis Ababa, Ethiopia. PloS one. 2017;12(6):e0180078.

Mishra KK, Patel K, Trivedi A, Patel P, Ghosh K, Bharadva S. Risk of hepatitis‐E virus infections among blood donors in a regional blood transfusion centre in western India. Transfusion Medicine. 2021;31(3):193-9.

Bes M, Costafreda MI, Riveiro-Barciela M, Piron M, Rico A, Quer J, et al. Effect of Hepatitis E Virus RNA Universal Blood Donor Screening, Catalonia, Spain, 2017‒2020. Emerging Infectious Diseases. 2022;28(1):157.

Eder M, Strassl R, Beinhardt S, Stättermayer AF, Kozbial K, Lagler H, et al. High seroprevalence of anti‐hepatitis E antibodies in Austrian patients with autoimmune hepatitis. Liver International. 2019;39(4):640-5.

Jing W, Liu J, Liu M. The global trends and regional differences in incidence of HEV infection from 1990 to 2017 and implications for HEV prevention. Liver International. 2021;41(1):58-69.

Parsa R, Adibzadeh S, Behbahani AB, Farhadi A, Yaghobi R, Dehbidi GRR, et al. Detection of hepatitis E virus genotype 1 among blood donors from Southwest of Iran. Hepatitis Monthly. 2016;16(6).

Schemmerer M, Wenzel JJ, Stark K, Faber M. Molecular epidemiology and genotype-specific disease severity of hepatitis E virus infections in Germany, 2010–2019. Emerging Microbes & Infections. 2022;11(1):1754-63.

Siripanyaphinyo U, Boon‐Long J, Louisirirotchanakul S, Takeda N, Chanmanee T, Srimee B, et al. Occurrence of hepatitis E virus infection in acute hepatitis in Thailand. Journal of Medical Virology. 2014;86(10):1730-5.

Most read articles by the same author(s)