{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:25:58Z","timestamp":1784129158266,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Thalassemia is an inherited hematological disorder characterized by a decrease in the synthesis of or absence of one or more globin chains. Hepatitis E virus (HEV) is a major cause of acute viral hepatitis, constituting a major global health burden and emerging as a critical public health concern. HEV infection is mainly transmitted via the fecal\u2013oral route; however, parenteral transmission through blood components has been reported in both developing and developed countries. Although HEV infection is typically self-limiting, immunocompromised individuals, patients with chronic liver disease, and thalassemic patients are at a heightened risk of contracting the infection and may develop chronic hepatitis and life-threatening complications that require treatment. The reported prevalence rates of HEV in thalassemia patients vary significantly by country. Age, gender, residential area, and the cumulative amount of blood transfusions received have been identified as associated risk factors for HEV infection. In order to enhance blood safety and ensure the protection of vulnerable patient populations, such as thalassemia patients, several countries have introduced universal or targeted HEV screening policies in blood donations. Other preventive measures include vigilant monitoring of thalassemic patients and screening for anti-HEV antibodies. The aim of this review is to explore the prevalence, risk factors, clinical impact and management of HEV infection in patients with thalassemia.<\/jats:p>","DOI":"10.3390\/pathogens13121058","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T05:43:43Z","timestamp":1733118223000},"page":"1058","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["HEV Infection in Beta-Thalassemia Patients"],"prefix":"10.3390","volume":"13","author":[{"given":"Despoina","family":"Papageorgiou","sequence":"first","affiliation":[{"name":"Medical School, University of Patras, Rio, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3152-4777","authenticated-orcid":false,"given":"Anne-Lise","family":"de Lastic","sequence":"additional","affiliation":[{"name":"Laboratory of Immunohematology, Medical School, University of Patras, Rio, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6503-0284","authenticated-orcid":false,"given":"Olga","family":"Tsachouridou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simeon","family":"Metallidis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4289-9494","authenticated-orcid":false,"given":"Karolina","family":"Akinosoglou","sequence":"additional","affiliation":[{"name":"Medical School, University of Patras, Rio, 26504 Patras, Greece"},{"name":"Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, Rio, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1788","DOI":"10.1002\/mgg3.1788","article-title":"Current Status of Beta-Thalassemia and Its Treatment Strategies","volume":"9","author":"Ali","year":"2021","journal-title":"Mol. Genet. Genom. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1007\/s40265-020-01341-9","article-title":"Beta Thalassemia: New Therapeutic Options Beyond Transfusion and Iron Chelation","volume":"80","author":"Motta","year":"2020","journal-title":"Drugs"},{"key":"ref_3","unstructured":"Needs, T., Gonzalez-Mosquera, L.F., and Lynch, D.T. (2023). Beta Thalassemia, StatPearls."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1038\/gim.2016.173","article-title":"\u03b2-Thalassemia","volume":"19","author":"Origa","year":"2017","journal-title":"Genet. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s12185-018-2411-9","article-title":"\u03b2-Thalassemia Intermedia: A Comprehensive Overview and Novel Approaches","volume":"108","author":"Asadov","year":"2018","journal-title":"Int. J. Hematol."},{"key":"ref_6","unstructured":"(2024, June 30). Hepatitis E. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-e."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1111\/liv.14468","article-title":"The Global Epidemiology of Hepatitis E Virus Infection: A Systematic Review and Meta-Analysis","volume":"40","author":"Li","year":"2020","journal-title":"Liver Int."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Clemente-Casares, P., Ramos-Romero, C., Ramirez-Gonzalez, E., and Mas, A. (2016). Hepatitis E Virus in Industrialized Countries: The Silent Threat. BioMed Res. Int., 2016.","DOI":"10.1155\/2016\/9838041"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.sjbs.2021.09.003","article-title":"Hepatitis E Virus: An Emerging Enigmatic and Underestimated Pathogen","volume":"29","author":"Raji","year":"2022","journal-title":"Saudi J. Biol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wolski, A., Pischke, S., Ozga, A.-K., Addo, M.M., and Horvatits, T. (2023). Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis. Pathogens, 12.","DOI":"10.3390\/pathogens12030425"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Songtanin, B., Molehin, A.J., Brittan, K., Manatsathit, W., and Nugent, K. (2023). Hepatitis E Virus Infections: Epidemiology, Genetic Diversity, and Clinical Considerations. Viruses, 15.","DOI":"10.20944\/preprints202306.0456.v1"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3748\/wjg.v28.i1.47","article-title":"Transfusion-Transmitted Hepatitis E: What We Know so Far?","volume":"28","author":"Cheung","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lhomme, S., Marion, O., Abravanel, F., Izopet, J., and Kamar, N. (2020). Clinical Manifestations, Pathogenesis and Treatment of Hepatitis E Virus Infections. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020331"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5543","DOI":"10.3748\/wjg.v26.i37.5543","article-title":"Hepatitis E Virus: Epidemiology, Diagnosis, Clinical Manifestations, and Treatment","volume":"26","author":"Aslan","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Thakur, V., Ratho, R.K., Kumar, S., Saxena, S.K., Bora, I., and Thakur, P. (2020). Viral Hepatitis E and Chronicity: A Growing Public Health Concern. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.577339"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.2147\/IDR.S449221","article-title":"Hepatitis E Virus (HEV) Infection Among Immunocompromised Individuals: A Brief Narrative Review","volume":"17","author":"Alexandrova","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e732","DOI":"10.1097\/HS9.0000000000000732","article-title":"2021 Thalassaemia International Federation Guidelines for the Management of Transfusion-Dependent Thalassemia","volume":"6","author":"Farmakis","year":"2022","journal-title":"HemaSphere"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gluba-Brz\u00f3zka, A., Franczyk, B., Rysz-G\u00f3rzy\u0144ska, M., Rokicki, R., Koziarska-Ro\u015bciszewska, M., and Rysz, J. (2021). Pathomechanisms of Immunological Disturbances in \u03b2-Thalassemia. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22189677"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Mancinelli, R., Rosa, L., Cutone, A., Lepanto, M.S., Franchitto, A., Onori, P., Gaudio, E., and Valenti, P. (2020). Viral Hepatitis and Iron Dysregulation: Molecular Pathways and the Role of Lactoferrin. Molecules, 25.","DOI":"10.3390\/molecules25081997"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.bjid.2019.01.007","article-title":"Hepatitis E Virus Prevalence in Egyptian Children with Transfusion-Dependent Thalassemia","volume":"23","author":"Abdelmawla","year":"2019","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1080\/15321819.2022.2046602","article-title":"Prevalence and Risk Factors of Hepatitis E Virus Infection among Patients with \u03b2-Thalassemia Major in South of Iran","volume":"43","author":"Farshadpour","year":"2022","journal-title":"J. Immunoass. Immunochem."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e101784","DOI":"10.5812\/mejrh.101784","article-title":"Hepatitis E Virus Infection Among Iranian Patients with Beta-Thalassemia","volume":"7","author":"Bineshian","year":"2020","journal-title":"Middle East J. Rehabil. Health Stud."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Dalvand, N., Dalvand, A., Sharifi, Z., and Hosseini, S.M. (2019). Prevalence of Hepatitis E Virus in Thalassemia Patients with Hepatitis C in Tehran, Iran. Iran. J. Microbiol., 11.","DOI":"10.18502\/ijm.v11i6.2226"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"14180","DOI":"10.5812\/iji.14180","article-title":"Comparison Between the Frequency of Hepatitis E Virus Among Major Thalassemia Patients With Control Group in Mashhad, North East of Iran","volume":"4","author":"Golshan","year":"2017","journal-title":"Int. J. Infect."},{"key":"ref_25","first-page":"53885","article-title":"Sero-Epidemiological Study of Hepatitis E Virus among Thalassemia as High Risk Patients: A Cross-Sectional Survey in Jahrom, Southern, Iran","volume":"8","author":"Jahromi","year":"2016","journal-title":"Glob. J. Health Sci."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Elizee, P.K., Alavian, S.M., Miri, S.M., Behnava, B., Alavian, S.H., Keshvari, M., Fesharaki, M.G., Salimi, S., Mehrnoush, L., and Shafiei, M. (2013). The Seroprevalence of Entrically Transmitted Viral Hepatitis in HCV Infected Thalassemia and Hemophilia Patients in Iran. Jundishapur J. Microbiol., 6.","DOI":"10.5812\/jjm.9091"},{"key":"ref_27","first-page":"183","article-title":"Spectrum of Viral Hepatitis in Thalassemic Children Receiving Multiple Blood Transfusions","volume":"21","author":"Irshad","year":"2002","journal-title":"Indian J. Gastroenterol. Off. J. Indian Soc. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1046\/j.1537-2995.1998.38698326339.x","article-title":"Antibodies to Hepatitis E Virus among Several Populations in Greece: Increased Prevalence in an Hemodialysis Unit","volume":"38","author":"Dalekos","year":"1998","journal-title":"Transfusion"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"443","DOI":"10.3109\/00365549609037936","article-title":"Hepatitis E Virus Infection in Individuals at High Risk of Transmission of Non-A, Non-B Hepatitis and Sexually Transmitted Diseases","volume":"28","author":"Psichogiou","year":"1996","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1111\/vox.12572","article-title":"Hepatitis E in Transfusion-Dependent Thalassaemia Patients, in Greece: A Single Centre Experience","volume":"112","author":"Klonizakis","year":"2017","journal-title":"Vox Sang."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/j.1365-2893.1996.tb00096.x","article-title":"Hepatitis E Virus Infection in Patients from Saudi Arabia with Sickle Cell Anaemia and \u03b2-Thalassemia Major: Possible Transmission by Blood Transfusion","volume":"3","author":"Ramia","year":"1996","journal-title":"J. Viral Hepat."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1002\/jmv.25498","article-title":"Prevalence of Hepatitis E Virus Infection in Multiple Transfused Brazilian Patients with Thalassemia and Sickle Cell Disease","volume":"91","author":"Slavov","year":"2019","journal-title":"J. Med. Virol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s13337-020-00589-9","article-title":"The Seropervelance of Infectious Hepatitis Viruses (HBV, HCV and HEV) among Blood Donors and Their Correlation to Risk Factors in Qena Governorate, Upper Egypt","volume":"31","author":"Ahmed","year":"2020","journal-title":"VirusDisease"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Martino, B.D., Profio, F.D., Palombieri, A., Sayed, I.M., and Abdelwahab, S.F. (2022). Is Hepatitis E Virus a Neglected or Emerging Pathogen in Egypt?. Pathogens, 11.","DOI":"10.3390\/pathogens11111337"},{"key":"ref_35","first-page":"47","article-title":"Prevalence of Anti-HEV IgM among Blood Donors in Egypt","volume":"18","author":"Ibrahim","year":"2011","journal-title":"Egypt. J. Immunol.\/Egypt. Assoc. Immunol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40249-018-0514-4","article-title":"Seroprevalence of Hepatitis e in Adults in Brazil: A Systematic Review and Meta-Analysis","volume":"8","author":"Tengan","year":"2019","journal-title":"Infect. Dis. Poverty"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"102350","DOI":"10.1016\/j.bjid.2022.102350","article-title":"Seroprevalence of Hepatitis E Virus Infection among Volunteer Blood Donors in Central Brazil","volume":"26","author":"Granato","year":"2022","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Costa, M.B., Gouv\u00eaa, M.S.G., Chuffi, S., Dellavia, G.H., Ornel, F., Von Diemen, L., Kessler, F., Pinho, J.R.R., and \u00c1lvares-da-Silva, M.R. (2021). Seroprevalence of Hepatitis E Virus in Risk Populations and Blood Donors in a Referral Hospital in the South of Brazil. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-85365-5"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ijid.2019.06.027","article-title":"Detection and Characterization of Hepatitis E Virus Genotype 3 in HIV-Infected Patients and Blood Donors from Southern Brazil","volume":"86","author":"Oliveira","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1007\/s42770-022-00816-z","article-title":"Analysis of Seroprevalence and Risk Factors for Hepatitis E Virus (HEV) in Donation Candidates and Blood Donors in Northeast Brazil","volume":"53","author":"Cunha","year":"2022","journal-title":"Braz. J. Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/BF02937946","article-title":"Epidemiology of Hepatitis E Virus in Male Blood Donors in Jeddah, Saudi Arabia","volume":"167","author":"Abdelaal","year":"1998","journal-title":"Ir. J. Med. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/vox.12122","article-title":"Seroprevalence of Hepatitis E Virus in Blood Donors in Greece","volume":"106","author":"Pittaras","year":"2014","journal-title":"Vox Sang."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Antonopoulou, N., Schinas, G., Kotsiri, Z., Tsachouridou, O., Protopapas, K., Petrakis, V., Petrakis, E.C., Papageorgiou, D., Tzimotoudis, D., and Metallidis, S. (2024). Testing Hepatitis E Seroprevalence among HIV-Infected Patients in Greece: THE SHIP Study. Pathogens, 13.","DOI":"10.3390\/pathogens13070536"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5143","DOI":"10.3748\/wjg.v22.i22.5143","article-title":"Epidemiology of Hepatitis E Virus in Iran","volume":"22","author":"Taherkhani","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.jhep.2022.05.006","article-title":"Chronic Hepatitis E: Advancing Research and Patient Care","volume":"77","author":"Ma","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.tracli.2017.06.012","article-title":"HEV and Transfusion-Recipient Risk","volume":"24","author":"Izopet","year":"2017","journal-title":"Transfus. Clin. Biol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"482","DOI":"10.4254\/wjh.v14.i3.482","article-title":"Hepatitis E in Immunocompromised Individuals","volume":"14","author":"Damiris","year":"2022","journal-title":"World J. Hepatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"E50","DOI":"10.1002\/ajh.23905","article-title":"Hepatitis E Infection in a Patient with Transfusion-Dependent \u03b2 Thalassemia","volume":"90","author":"Sayani","year":"2015","journal-title":"Am. J. Hematol."},{"key":"ref_49","first-page":"103","article-title":"Hepatitis E with Intravascular Hemolysis in Beta Thalassemia Trait: A Rare Association or Coincidence","volume":"66","author":"Shah","year":"2018","journal-title":"J. Assoc. Physicians India"},{"key":"ref_50","unstructured":"Koskinas, J., Tampaki, M., Dusheiko, G., and Porter, J. (2023). Liver Disease. 2021 Guidelines: For the Management of Transfusion Dependent Thalassaemia (TDT), Thalassaemia International Federation."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1159\/000499121","article-title":"Blood Donor Screening for Hepatitis E Virus in the European Union","volume":"46","author":"Boland","year":"2019","journal-title":"Transfus. Med. Hemotherapy"},{"key":"ref_52","unstructured":"EASL (2019). Screening of Blood Donations for Hepatitis E Virus (HEV), The European Association for the Study of the Liver."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1111\/vox.12559","article-title":"Hepatitis E Virus RNA in Australian Blood Donors: Prevalence and Risk Assessment","volume":"112","author":"Hoad","year":"2017","journal-title":"Vox Sang."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/12\/1058\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:44:08Z","timestamp":1760114648000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/12\/1058"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":53,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["pathogens13121058"],"URL":"https:\/\/doi.org\/10.3390\/pathogens13121058","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}