Hepatitis E virus (HEV) is the most common cause of acute hepatitis worldwide including large water-borne outbreaks, zoonotic infections and transfusion transmissions. Several countries have initiated or are considering blood donor screening in response to high HEV-RNA donation prevalence leading to transfusion-transmission risk. Because HEV transmission is more common through food sources, the efficacy of blood donor screening alone may be limited. HEV-nucleic acids in 101 489 blood donations in the United States and Canada were studied. A risk-based decision-making framework was used to evaluate the quantitative risks and cost–benefit of HEV-blood donation screening in Canada comparing three scenarios: no screening, screening blood for all transfused patients or screening blood for only those at greatest risk. HEV-RNA prevalence in the United States was one per 16 908 (95% confidence interval [CI], 1:5786–1:81987), whereas Canadian HEV-RNA prevalence was one per 4615 (95% CI, 1:2579–1:9244). Although 4-fold greater, Canadian HEV-RNA prevalence was not significantly higher than in the United States. Viral loads ranged from 20 to 3080 international units per mL; all successfully typed infections were genotype 3. No HEV-RNA false-positive donations were identified for 100 percent specificity. Without donation screening, heart and lung transplant recipients had the greatest HEV-infection risk (1:366962) versus kidney transplant recipients with the lowest (1:2.8 million) at costs of $225 546 to $561 810 per quality-adjusted life-year (QALY) gained for partial or universal screening, respectively. Higher cost per QALY would be expected in the United States. Thus, HEV prevalence in North America is lower than in countries performing blood donation screening, and if implemented, is projected to be costly under any scenario.

戊型肝炎病毒（HEV）是全世界急性肝炎的最常见病因，包括大规模的水传播疾病，人畜共患病感染和输血传播。几个国家已经开始或正在考虑对献血者进行高比例的HEV-RNA捐赠，以筛查献血者，从而导致输血传播风险。由于戊型肝炎病毒通过食物来源传播更为普遍，因此仅对献血者进行筛查的有效性可能受到限制。在美国和加拿大，对101 489次献血中的戊型肝炎病毒核酸进行了研究。在加拿大，使用基于风险的决策框架来评估HEV血液捐赠筛查的定量风险和成本效益，并比较三种情况：不筛查，为所有输血患者筛查血液或仅对最大风险的患者筛查血液。在美国，HEV-RNA患病率为每16 908个（95％置信区间[CI]，1：5786-1：81987），而加拿大HEV-RNA患病率为每4615个（95％CI，1：2579- 1：9244）。尽管加拿大HEV-RNA的患病率高4倍，但并未明显高于美国。病毒载量范围为每毫升20至3080国际单位；所有成功分型的感染均为基因型3。未鉴定出HEV-RNA假阳性捐赠物具有100％的特异性。如果不进行捐赠筛查，则心脏和肺移植接受者的HEV感染风险最高（1：366962），肾移植接受者的最低HEV感染风险（1：280万），每质量调整生命年的费用为225 546美元至561 810美元（ QALY）分别用于部分或通用筛选。在美国，每QALY的成本预计会更高。