51
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Kanayama A, Arima Y, Yamagishi T, Kinoshita H, Sunagawa T, Yahata Y, Matsui T, Ishii K, Wakita T, Oishi K. Epidemiology of domestically acquired hepatitis E virus infection in Japan: assessment of the nationally reported surveillance data, 2007-2013. J Med Microbiol 2015; 64:752-758. [PMID: 25976003 DOI: 10.1099/jmm.0.000084] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In recent years, there has been an increase in the number of reported hepatitis E virus (HEV) infections from developed countries. To describe recent trends in notification and potential risk groups and risk factors in Japan, HEV infection cases and demographic, food consumption, clinical and laboratory data reported during 2007-2013 were analysed. In total, 530 HEV infections were reported during 2007-2013. Amongst 462 domestic cases, the mean age was 56.5 years (sd 13.9) and 80.1 % were male. Forty-three cases (9.3 %) were asymptomatic, amongst which 11 were detected from blood donations. Whilst ∼50 cases were reported annually during 2007-2011, the number of reported cases increased to 121 in 2012 and 126 in 2013. The increase was characterized by a rise in the number of domestic, symptomatic cases (P = 0.05) and cases confirmed by anti-HEV IgA detection (P < 0.01). HEV genotypes G3 and G4 were consistently dominant. The major suspected source of infection was food-borne, and the major suspected foods were pig, wild boar and deer meat. The observed increase during 2012-2013 was most likely due to the coverage of the anti-HEV IgA assay by the National Health Insurance system in Japan in October 2011 and its acceptance for surveillance purposes. However, the increase was not associated with detection of asymptomatic cases. Moreover, males aged 50-69 years remained as the high-risk group, and pork and other meats continued to be the most suspected items. Our findings indicated that HEV infection is an emerging and important public health concern in Japan.
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Affiliation(s)
- Atsuhiro Kanayama
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan.,Department of Global Infectious Diseases and Tropical Medicine, National Defense Medical College, Saitama, Japan
| | - Yuzo Arima
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takuya Yamagishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hitomi Kinoshita
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuichiro Yahata
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tamano Matsui
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koji Ishii
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takaji Wakita
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
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Analysis of complete genome sequences and a V239A substitution in the helicase domain of swine hepatitis E virus strains isolated in Canada. Arch Virol 2015; 160:1767-73. [PMID: 25916609 DOI: 10.1007/s00705-015-2429-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/11/2015] [Indexed: 10/23/2022]
Abstract
Among Canadian swine HEV strains, only one complete genome sequence has been published so far, and there are no data on the virulence of these strains. A collection of 28 Canadian swine HEV strains was used in this study. After RNA extraction, a portion of ORF2, the 3' end of the helicase domain, and two complete genomes were amplified and sequenced. These two new Canadian complete genomes belonged to two different subtypes and showed 87.5 and 87.7% sequence identity to the Canadian swine HEV strain Arkell. The V239A substitution within the helicase domain, which is associated with increased virulence of genotype 3 HEV, was detected in one Canadian swine HEV strain. However, no human hepatitis E infections have been associated with this strain.
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Smith DB, Simmonds P. Hepatitis E virus and fulminant hepatitis--a virus or host-specific pathology? Liver Int 2015; 35:1334-40. [PMID: 24974734 PMCID: PMC4676335 DOI: 10.1111/liv.12629] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 06/18/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Fulminant hepatitis is a rare outcome of infection with hepatitis E virus. Several recent reports suggest that virus variation is an important determinant of disease progression. To critically examine the evidence that virus-specific factors underlie the development of fulminant hepatitis following hepatitis E virus infection. METHODS Published sequence information of hepatitis E virus isolates from patients with and without fulminant hepatitis was collected and analysed using statistical tests to identify associations between virus polymorphisms and disease outcome. RESULTS Fulminant hepatitis has been reported following infection with all four hepatitis E virus genotypes that infect humans comprising multiple phylogenetic lineages within genotypes 1, 3 and 4. Analysis of virus sequences from individuals infected by a common source did not detect any common substitutions associated with progression to fulminant hepatitis. Re-analysis of previously reported associations between virus substitutions and fulminant hepatitis suggests that these were probably the result of sampling biases. CONCLUSIONS Host-specific factors rather than virus genotype, variants or specific substitutions appear to be responsible for the development of fulminant hepatitis.
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Affiliation(s)
- Donald B Smith
- Centre for Immunity, Infection and Evolution, Ashworth Laboratories, University of Edinburgh, King's Buildings, West Mains Road, Edinburgh, EH9 3JT, UK
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Characterization of Two Novel Linear B-Cell Epitopes in the Capsid Protein of Avian Hepatitis E Virus (HEV) That Are Common to Avian, Swine, and Human HEVs. J Virol 2015; 89:5491-501. [PMID: 25741007 DOI: 10.1128/jvi.00107-15] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Antisera raised against the avian hepatitis E virus (HEV) capsid protein are cross-reactive with human and swine HEV capsid proteins. In this study, two monoclonal antibodies (MAbs) against the avian HEV capsid protein, namely, 3E8 and 1B5, were shown to cross-react with the swine HEV capsid protein. The motifs involved in binding both MAbs were identified and characterized using phage display biopanning, peptide synthesis, and truncated or mutated protein expression, along with indirect enzyme-linked immunosorbent assay (ELISA) and Western blotting. The results showed that the I/VPHD motif is a necessary core sequence and that P and H are two key amino acids for recognition by MAb 3E8. The VKLYM/TS motif is the minimal amino acid sequence necessary for recognition by MAb 1B5. Cross-reactivity between the two epitopes and antibodies against avian, swine, and human HEVs in sera showed that both epitopes are common to avian, swine, and human HEVs. In addition, amino acid sequence alignment of the capsid proteins revealed that the key motifs of both novel epitopes are the same in HEVs from different animal species, predicting that they may be common to HEV isolates from boars, rabbits, rats, ferrets, mongooses, deer, and camels as well. Protein modeling analysis showed that both epitopes are at least partially exposed on the surface of the HEV capsid protein. Protective capacity analysis demonstrated that the two epitopes are nonprotective against avian HEV infection in chickens. Collectively, these studies characterize two novel linear B-cell epitopes common to avian, swine, and human HEVs, which furthers the understanding of HEV capsid protein antigenic structure. IMPORTANCE More and more evidence indicates that the host range diversity of hepatitis E virus (HEV) is a global public health concern. A better understanding of the antigenic structure of the HEV capsid protein may improve disease diagnosis and prevention. In this study, binding site mapping and localization as well as the antigenic biology of two novel linear B-cell epitopes common to several different species of HEV were characterized. These findings partially reveal the antigenic structure of the HEV capsid protein and provide potential applications for the development of diagnostics and interventions for HEV infection.
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55
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Hong Y, He ZJ, Tao W, Fu T, Wang YK, Chen Y. Experimental infection of Z:ZCLA Mongolian gerbils with human hepatitis E virus. World J Gastroenterol 2015; 21:862-867. [PMID: 25624719 PMCID: PMC4299338 DOI: 10.3748/wjg.v21.i3.862] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/22/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether Z:ZCLA Mongolian gerbils are readily susceptible to infection by human hepatitis E virus (HEV).
METHODS: Z:ZCLA Mongolian gerbils were infected with a clinical HEV strain isolated from an acute hepatitis E patient, and virus pathogenesis was assessed in this host. Non-infected gerbils served as the control group. Feces samples from gerbils were collected weekly for reverse transcription-nested polymerase chain reaction. Serum anti-HEV IgG and alanine aminotransferase (ALT) were detected by enzyme linked immunosorbent assay. At sacrifice, each animal’s liver, spleen and kidney were collected for histopathologic examination.
RESULTS: HEV-infected gerbils showed fatigue, with histopathological changes observed in the liver, spleen and kidney. HEV RNA was detected in fecal samples taken at day 7 after inoculation and the detectable levels lasted out to day 42 after inoculation. Interestingly, ALT levels were only moderately increased in the HEV-infected animals compared with the non-infected control group.
CONCLUSION: Z:ZCLA Mongolian gerbils are susceptible to human HEV.
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MESH Headings
- Alanine Transaminase/blood
- Animals
- Biomarkers/blood
- Disease Models, Animal
- Disease Susceptibility
- Feces/virology
- Gerbillinae
- Hepatitis Antibodies/blood
- Hepatitis E/blood
- Hepatitis E/diagnosis
- Hepatitis E/transmission
- Hepatitis E/virology
- Hepatitis E virus/genetics
- Hepatitis E virus/immunology
- Hepatitis E virus/pathogenicity
- Hepatitis, Viral, Animal/blood
- Hepatitis, Viral, Animal/diagnosis
- Hepatitis, Viral, Animal/transmission
- Hepatitis, Viral, Animal/virology
- Humans
- Immunoglobulin G/blood
- Male
- RNA, Viral/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Serologic Tests
- Time Factors
- Viral Load
- Zoonoses
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56
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Inagaki Y, Oshiro Y, Hasegawa N, Fukuda K, Abei M, Nishi M, Okamoto H, Ohkohchi N. Clinical Features of Hepatitis E Virus Infection in Ibaraki, Japan: Autochthonous Hepatitis E and Acute-on-Chronic Liver Failure. TOHOKU J EXP MED 2015; 235:275-82. [DOI: 10.1620/tjem.235.275] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yuki Inagaki
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, Faculty of Medicine, University of Tsukuba
| | - Yukio Oshiro
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, Faculty of Medicine, University of Tsukuba
| | | | | | - Masato Abei
- Department of Gastroenterology, University of Tsukuba
| | - Masaaki Nishi
- Department of Gastroenterology, Tsukuba Gakuen Hospital
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine
| | - Nobuhiro Ohkohchi
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, Faculty of Medicine, University of Tsukuba
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Hepatitis E: an old infection with new implications. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:6-17. [PMID: 25369613 DOI: 10.2450/2014.0063-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/18/2014] [Indexed: 12/24/2022]
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58
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Teshale EH, Denniston MM, Drobeniuc J, Kamili S, Teo CG, Holmberg SD. Decline in hepatitis E virus antibody prevalence in the United States from 1988-1994 to 2009-2010. J Infect Dis 2014; 211:366-73. [PMID: 25147277 DOI: 10.1093/infdis/jiu466] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous population-based estimates in the United States have shown a relatively high prevalence of hepatitis E virus (HEV) antibody. We sought to determine whether changes in the prevalence of HEV antibody have occurred over time. METHODS We analyzed data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) and NHANES III (1988-1994). Using the same serologic assay, we compared the estimated anti-HEV immunoglobulin G (IgG) prevalence and risk factors for antibody positivity for the 2 periods. RESULTS The prevalence of HEV antibody among those aged ≥6 years declined from 10.2% (95% confidence interval [CI], 9.1%-11.4%) during 1988-1994 to 6.0% (5.2%-6.8%) during 2009-2010, and the prevalence for those of US birth ranged from 9.6% (8.4%-10.9%) to 5.2% (4.4%-6.2%). Among US-born persons, the estimated HEV antibody prevalence declined significantly for all subgroups of age, sex, region of residence, and number of persons per room in the household; significant declines also were observed for persons at or above poverty level and for persons of non-Hispanic white, non-Hispanic black, and Mexican American race/ethnicity. No clear associations with food consumption were found. CONCLUSIONS The anti-HEV prevalence is declining in the United States. Although the decline suggests a decrease in exposure to HEV over time, the risks associated with exposure remain unknown.
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Affiliation(s)
- Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maxine M Denniston
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chong-Gee Teo
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott D Holmberg
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
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59
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Abstract
Hepatitis E virus (HEV) infection is a worldwide disease. An improved understanding of the natural history of HEV infection has been achieved within the last decade. Several reservoirs and transmission modes have been identified. Hepatitis E is an underdiagnosed disease, in part due to the use of serological assays with low sensitivity. However, diagnostic tools, including nucleic acid-based tests, have been improved. The epidemiology and clinical features of hepatitis E differ between developing and developed countries. HEV infection is usually an acute self-limiting disease, but in developed countries it causes chronic infection with rapidly progressive cirrhosis in organ transplant recipients, patients with hematological malignancy requiring chemotherapy, and individuals with HIV. HEV also causes extrahepatic manifestations, including a number of neurological syndromes and renal injury. Acute infection usually requires no treatment, but chronic infection should be treated by reducing immunosuppression in transplant patients and/or the use of antiviral therapy. In this comprehensive review, we summarize the current knowledge about the virus itself, as well as the epidemiology, diagnostics, natural history, and management of HEV infection in developing and developed countries.
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60
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Lim KHJ, Howard M, Jackson N, Verma S. Older men with unexplained hepatitis. BMJ Case Rep 2014; 2014:bcr-2013-202561. [PMID: 24903723 DOI: 10.1136/bcr-2013-202561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old Caucasian man presented with painless jaundice for 6 weeks. He drank 70 units of alcohol per week. Examination revealed jaundice, spider angiomata and a 3 cm firm hepatomegaly. Initial bloods: bilirubin 152 µmol/L, alanine aminotransferase 1484 IU/L, alkaline phosphatase 130 IU/L, γ-glutamyl-transpeptidase 1224 IU/L and International Normalised Ratio 1.1. A standard liver screen was normal, and an abdominal ultrasound/CT scan suggested cirrhosis, confirmed by liver biopsy on day 5. Hepatitis E virus (HEV) serology on day 6 indicated acute infection. He developed severe hepatic decompensation characterised by worsening jaundice, ascites and variceal bleeding. On day 33 ribavirin 600 mg was initiated though discontinued after 2 weeks on receipt of a negative HEV RNA. At the last follow-up he had recovered, and remains abstinent from alcohol. We describe a case of autochthonously (locally) acquired HEV infection with life-threatening hepatic decompensation in the presence of undiagnosed alcohol-related cirrhosis.
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Affiliation(s)
- Kok Haw Jonathan Lim
- Department of Gastroenterology & Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mark Howard
- Department of Pathology, Brighton and Sussex University Hospitals, Brighton, Sussex, UK
| | - Neil Jackson
- Department of Gastroenterology & Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Sumita Verma
- Department of Gastroenterology & Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Brighton and Sussex Medical School, Brighton, UK
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Lara J, Purdy MA, Khudyakov YE. Genetic host specificity of hepatitis E virus. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2014; 24:127-39. [PMID: 24667049 PMCID: PMC5745802 DOI: 10.1016/j.meegid.2014.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/24/2014] [Accepted: 03/16/2014] [Indexed: 01/06/2023]
Abstract
Hepatitis E virus (HEV) causes epidemic and sporadic cases of hepatitis worldwide. HEV genotypes 3 (HEV3) and 4 (HEV4) infect humans and animals, with swine being the primary reservoir. The relevance of HEV genetic diversity to host adaptation is poorly understood. We employed a Bayesian network (BN) analysis of HEV3 and HEV4 to detect epistatic connectivity among protein sites and its association with the host specificity in each genotype. The data imply coevolution among ∼70% of polymorphic sites from all HEV proteins and association of numerous coevolving sites with adaptation to swine or humans. BN models for individual proteins and domains of the nonstructural polyprotein detected the host origin of HEV strains with accuracy of 74-93% and 63-87%, respectively. These findings, taken together with lack of phylogenetic association to host, suggest that the HEV host specificity is a heritable and convergent phenotypic trait achievable through variety of genetic pathways (abundance), and explain a broad host range for HEV3 and HEV4.
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Affiliation(s)
- James Lara
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Michael A Purdy
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yury E Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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62
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Devi SG, Kumar A, Kar P, Husain SA, Sharma S. Association of pregnancy outcome with cytokine gene polymorphisms in HEV infection during pregnancy. J Med Virol 2014; 86:1366-76. [DOI: 10.1002/jmv.23925] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Salam Gyaneshwori Devi
- Department of Obstetrics & Gynaecology; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
| | - Ashok Kumar
- Department of Obstetrics & Gynaecology; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
| | - Premashis Kar
- Department of Medicine; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
| | | | - Shashi Sharma
- Department of Statistics and Epidemiology; Institute of Cytology and Preventive Oncology; Noida India
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63
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Aherfi S, Borentain P, Raissouni F, Le Goffic A, Guisset M, Renou C, Grimaud JC, Hardwigsen J, Garcia S, Botta-Fridlund D, Nafati C, Motte A, Le Treut YP, Colson P, Gerolami R. Liver transplantation for acute liver failure related to autochthonous genotype 3 hepatitis E virus infection. Clin Res Hepatol Gastroenterol 2014; 38:24-31. [PMID: 24462173 DOI: 10.1016/j.clinre.2013.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/28/2013] [Accepted: 05/14/2013] [Indexed: 02/04/2023]
Abstract
Hepatitis E virus of genotype 3 (HEV-3) is an emerging cause of sporadic autochthonous acute hepatitis in Europe. Although spontaneous outcome of hepatitis E is usually favorable, fulminant liver failure has been described worldwide. In Europe, autochthonous hepatitis E associated with fulminant hepatic failure and leading to liver transplantation has been exceptionally reported. We report here four cases of fulminant and sub-fulminant hepatitis E proposed for liver transplantation in Marseille University hospitals between July 2006 and March 2010. HEV diagnosis relied on detection of anti-HEV IgM antibodies and HEV RNA in serum samples. All cases were men, with no travel history in hyperendemic areas. HEV sequence analyses revealed genotype 3 HEV in the four patients. Liver histology indicated severe acute hepatitis in all of them, pre-existing fibrosis being found in two cases. Two patients underwent liver transplantation, and the two other patients could not be transplanted due to septic complications and died. HEV testing should be performed for the initial evaluation of every acute liver failure regardless of the epidemiological and clinical context. With respect to the potentially fulminant evolution of HEV genotype 3 infections, treatment with ribavirin of severe acute hepatitis E should be considered.
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Affiliation(s)
- Sarah Aherfi
- Institut hospitalo-universitaire (IHU) Méditerranée Infection, pôle des maladies infectieuses et tropicales clinique et biologique, fédération de bactériologie-hygiène-virologie, Assistance publique-Hôpitaux de Marseille, centre hospitalo-universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Patrick Borentain
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Ferdaous Raissouni
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Aude Le Goffic
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Michel Guisset
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - Christophe Renou
- Hôpital de jour, centre hospitalier de Hyères, 8, rue Maréchal-Juin, Hyères, France
| | - Jean-Charles Grimaud
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Nord, chemin des Bourrelys, 13915 Marseille cedex 20, France
| | - Jean Hardwigsen
- Service de transplantation hépatique, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Stéphane Garcia
- Service d'anatomopathologie, centre hospitalo-universitaire Nord, chemin des Bourrely, 13015 Marseille, France
| | - Danielle Botta-Fridlund
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Cyril Nafati
- Service de réanimation, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Anne Motte
- Institut hospitalo-universitaire (IHU) Méditerranée Infection, pôle des maladies infectieuses et tropicales clinique et biologique, fédération de bactériologie-hygiène-virologie, Assistance publique-Hôpitaux de Marseille, centre hospitalo-universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Yves Patrice Le Treut
- Service de transplantation hépatique, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Philippe Colson
- Institut hospitalo-universitaire (IHU) Méditerranée Infection, pôle des maladies infectieuses et tropicales clinique et biologique, fédération de bactériologie-hygiène-virologie, Assistance publique-Hôpitaux de Marseille, centre hospitalo-universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; Aix-Marseille Université, URMITE UM63 CNRS 7278 IRD 198 Inserm U1095, facultés de médecine et de pharmacie, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France.
| | - René Gerolami
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France.
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64
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Takahashi M, Okamoto H. Features of hepatitis E virus infection in humans and animals in Japan. Hepatol Res 2014; 44:43-58. [PMID: 23721425 DOI: 10.1111/hepr.12175] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/23/2013] [Accepted: 05/27/2013] [Indexed: 02/08/2023]
Abstract
In Japan, hepatitis E had long been considered to be a rare liver disease which can be accidentally imported from endemic countries in Asia and Africa, where the sanitation conditions are suboptimal. However, since the identification of the first autochthonous hepatitis E case and hepatitis E viremic domestic pigs in Japan in 2001, our understanding of hepatitis E virus (HEV) infection in this country has been changing markedly. This has largely been due to the development of serological and gene-based diagnostic assays, the accumulation of molecular epidemiological findings on HEV infection in humans and animals (as potential reservoirs for HEV in humans) and the recognition of the importance of zoonotic food-borne and other routes of transmission of HEV, including blood-borne transmission. Although it is now evident that autochthonous hepatitis E in Japan is far more common than was previously thought, clinical and subclinical HEV infections indigenous to Japan remain underdiagnosed and their prevalence is still underestimated due to the presence of unknown transmission routes and a low awareness of the infection status by many physicians in Japan. This review focuses on the features of HEV infection in humans and animals, as definitive or potential reservoirs for HEV, in Japan, and updates the current knowledge on the routes of transmission, including zoonotic routes, which are important for the maintenance and spread of HEV in Japan.
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Affiliation(s)
- Masaharu Takahashi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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65
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Rayis DA, Jumaa AM, Gasim GI, Karsany MS, Adam I. An outbreak of hepatitis E and high maternal mortality at Port Sudan, Eastern Sudan. Pathog Glob Health 2013; 107:66-8. [PMID: 23683332 DOI: 10.1179/2047773213y.0000000076] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
During 4 months (November 2010-March 2011) of an outbreak of hepatitis E virus (HEV), 39 pregnant women presented at Port Sudan Hospital, Sudan, with various symptoms of viral hepatitis. The diagnosis of viral hepatitis was confirmed by serology using ELISA anti-HEV IgG and IgM. The mean (SD) maternal age and gestational age were 24·0 (4·2) years and 33·6 (3·7) weeks, respectively. Eight (20·5%) women were primigravidae. There were 11 (28·2%) maternal deaths, 14 (36·0%) intrauterine fetal deaths, and eight (20·5%) cases of postpartum haemorrhage. There were nine (23·0%) cases of preterm (<37 weeks of gestation) deliveries. Fulminant hepatitis with hepatic encephalopathy was the most common cause of death among these patients. Nine of these women died before delivery and the other two died immediately following the delivery due to severe haemorrhage. There were no significant differences in clinical and biochemical data between the women who died (11) and those who survived.
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66
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Lu YH, Qian HZ, Hu AQ, Ren H, Qin X, Jiang QW, Zheng YJ. Duration of viraemia in Chinese acute sporadic hepatitis E. Eur J Clin Microbiol Infect Dis 2013; 33:755-9. [PMID: 24241947 DOI: 10.1007/s10096-013-2007-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/21/2013] [Indexed: 01/15/2023]
Abstract
Acute sporadic hepatitis E (ASHE) cases induced by hepatitis E virus genotype 4 (HEV-4) are increasing in China. Our study aimed to estimate the duration of HEV-4 viraemia in Chinese ASHE. A total of 619 serum specimens from 499 ASHE patients were examined for the presence of HEV RNA. The association between viraemia detection and serum sampling time was compared between subtypes. The cumulative probability of HEV viraemia detection was determined using Kaplan-Meier survival analysis, and the viraemia duration was estimated. A total of 42.7 % of serum specimens were positive for HEV RNA and all the isolated strains were identified as genotype 4 and subsequently assigned to five subtypes. Among the patients infected with subtypes 4d and 4i, the time interval from the initiation of clinical symptoms to serum specimen sampling was shorter than that among the patients with subtypes 4a, 4b and 4h. Kaplan-Meier analysis was conducted with 101 sequential specimens as well as with both 101 sequential specimens and 236 single negative specimens. The cumulative probability of HEV-4 viraemia detection was estimated to decline quickly to approximately 10 % within 32 days after the initiation of clinical symptoms and then to decline very slowly to 5 % by the 41st day and to zero by the 131st day. The majority of ASHE cases maintain detectable HEV-4 viraemia within one month after onset, whereas a small portion of cases maintain long-term viraemia and may act as a reservoir for further transmission.
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Affiliation(s)
- Y-H Lu
- Key Laboratory of Public Health Safety of Ministry of Education-Department of Epidemiology, Fudan University School of Public Health, 138 Yi Xue Yuan Road, Shanghai, 200032, China
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67
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Bouamra Y, Gérolami R, Arzouni JP, Grimaud JC, Lafforgue P, Nelli M, Tivoli N, Ferretti A, Motte A, Colson P. Emergence of autochthonous infections with hepatitis E virus of genotype 4 in Europe. Intervirology 2013; 57:43-8. [PMID: 24157452 DOI: 10.1159/000354801] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/25/2013] [Indexed: 12/26/2022] Open
Abstract
In Europe, autochthonous hepatitis E is caused by genotype 3 hepatitis E virus (HEV) in almost all cases. A total of 15 infections with genotype 4 HEV were diagnosed in France from May 2009 to April 2012, and all but one of the HEV-4 strains implicated in these infections were genetically related and highly similar to HEV-4 sequences isolated from swine in Belgium. In addition, 5 autochthonous HEV-4 infections have been described in the region of Lazio, Italy, during March and April 2011, and these HEV sequences were 100% identical to one another but showed relatively low similarity (74-85%) to HEV-4 RNA samples collected in France. We report 6 additional HEV-4 infections that were diagnosed from May to July 2012 which represented 50% of the HEV infections diagnosed during this period in our clinical microbiology laboratory. Five of these HEV-4 strains were associated with autochthonous infections and were clustered together and with the majority of HEV-4 previously described in France, whereas the sixth strain was genetically divergent. Taken together with reports from other teams, these observations indicate that autochthonous infections with HEV-4 are emerging in Europe and have been transmitted by at least two distinct sources.
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Affiliation(s)
- Yanis Bouamra
- IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, Assistance Publique - Hôpitaux Marseille (AP-HM), Marseille, France
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68
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Transfusion-transmitted hepatitis E in a patient with myelodysplastic syndromes. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:103-6. [PMID: 24120594 DOI: 10.2450/2013.0081-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/17/2013] [Indexed: 01/26/2023]
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69
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Nakano T, Takahashi K, Arai M, Okano H, Kato H, Ayada M, Okamoto H, Mishiro S. Identification of European-type hepatitis E virus subtype 3e isolates in Japanese wild boars: Molecular tracing of HEV from swine to wild boars. INFECTION GENETICS AND EVOLUTION 2013; 18:287-98. [PMID: 23770142 DOI: 10.1016/j.meegid.2013.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 06/01/2013] [Accepted: 06/03/2013] [Indexed: 12/13/2022]
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70
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Wu T, Huang SJ, Zhu FC, Zhang XF, Ai X, Yan Q, Wang ZZ, Yang CL, Jiang HM, Liu XH, Guo M, Du HL, Ng MH, Zhang J, Xia NS. Immunogenicity and safety of hepatitis E vaccine in healthy hepatitis B surface antigen positive adults. Hum Vaccin Immunother 2013; 9:2474-9. [PMID: 23887167 DOI: 10.4161/hv.25814] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A recombinant hepatitis E vaccine, Hecolin, has been proven safe and effective in healthy adults. As hepatitis B surface antigen (HBsAg) positive individuals have a higher risk of poor prognosis after super-infection with hepatitis E virus (HEV), the safety and immunogenicity of Hecolin in this population should be assessed. The present study is an extending analysis of data from a large randomized controlled clinical trial of Hecolin. Healthy participants (n = 14,065) without current or previous evidence of chronic liver disease were randomized to receive Hecolin or placebo (hepatitis B vaccine) and donated their blood samples before vaccination and subsequently over 31 mo. Most of the adverse events were mild and comparable between participants with and without baseline hepatitis B surface antigen (HBsAg). No vaccine-related serious adverse events were reported. Rates of serious adverse events in HBsAg (+) or HBsAg (-) participants were also comparable between both groups. Almost all participants in the Hecolin group seroconverted to anti-HEV one month after full vaccination. The antibody response rates and levels were similar in HBsAg (+) and HBsAg (-) participants (98.38%, 19.32 Wu/mL vs. 98.69%, 19.00 Wu/mL). The two-year antibody dynamics of HBsAg (+) participants overlapped perfectly with those of HBsAg (-) participants. In conclusion, the safety and immunogenicity of Hecolin for HBsAg (+) adults is very similar to that for the general population.
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Affiliation(s)
- Ting Wu
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases; School of Public Health; Xiamen University; Xiamen, P.R. China
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71
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Zhang X, Li A, Shuai J, Dai Y, Zhu Z, Wu S, He Y. Validation of an internally controlled multiplex real time RT-PCR for detection and typing of HEV genotype 3 and 4. J Virol Methods 2013; 193:432-8. [PMID: 23850697 DOI: 10.1016/j.jviromet.2013.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/25/2013] [Accepted: 07/03/2013] [Indexed: 12/31/2022]
Abstract
Hepatitis E virus (HEV) genotypes 1 and 2 are restricted to humans, whereas genotypes 3 (HEV 3) and genotype 4 (HEV 4) infect humans and a variety of animal species. Cross-species infections by animal strains raise potential public health concerns for zoonotic HEV transmission. Therefore, a real-time reverse transcription polymerase chain reaction (RT-qPCR) combining the HEV 3-tpye specific RT-qPCR assay with the HEV 4-tpye specific assay was developed. Furthermore, a heterologous RNA, an in vitro transcript of the enhanced green fluorescent protein (EGFP) gene, was introduced as an internal control. The data showed that EGFP gene provided a very reliable and simple way of monitoring both the sample manipulation and amplification procedures. The final multiplex RT-qPCR assay showed a high analytical sensitivity of less than 50 copies RNA per reaction for both HEV genotypes. The specificity and amplification efficiency of the multiplex assay for the respective HEV were confirmed by co-amplification of the other target. By comparing with the results of mono-specific assay and nested PCR as well as sequencing, HEV infection in a panel of clinical samples was reliably detected and typed, which indicated that the novel multiplex RT-qPCR assay could be used for sensitive detection and rapid differentiation of zoonotic HEV genotype 3 and 4.
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Affiliation(s)
- Xiaofeng Zhang
- Zhejiang Entry-Exit Inspection and Quarantine Bureau, 126 Fuchun Road, Hangzhou 310016, China; Yiwu Entry-Exit Inspection and Quarantine Bureau, 299 Chengbei Road, Yiwu 322000, China.
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72
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Zhu Y, Yu X, Zhang Y, Ni Y, Si F, Yu R, Dong S, Huang Y, Li Z. Infectivity of a genotype 4 hepatitis E virus cDNA clone by intrahepatic inoculation of laboratory rats. Vet Microbiol 2013; 166:405-11. [PMID: 23891307 DOI: 10.1016/j.vetmic.2013.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/17/2013] [Accepted: 06/24/2013] [Indexed: 12/31/2022]
Abstract
A cDNA clone of a genotype 4 swine hepatitis E virus (HEV) strain (SAAS-FX17), identified in Shanghai, has been constructed. Capped RNA transcripts were prepared in vitro and shown to be replication-competent in Huh7 cells. Sprague-Dawley (SD) rats administered the RNA transcripts by intrahepatic inoculation developed active infections as evidenced by fecal virus shedding and sero-conversion to anti-HEV. The former was first detected between 23 and 30 days post-inoculation (dpi) and persisted until 45 dpi. Sera of rats inoculated with RNA transcripts became anti-HEV positive between 30 and 40 dpi, and reverted to anti-HEV negative at 52 dpi. Our data indicate for the first time that intrahepatic inoculation of rats with RNA transcripts of an HEV cDNA clone may serve as an alternative animal model for HEV research.
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Affiliation(s)
- Yumin Zhu
- Institute of Animal Science and Veterinary Medicine, Shanghai Academy of Agricultural Sciences, Shanghai, China
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73
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Feldt T, Sarfo FS, Zoufaly A, Phillips RO, Burchard G, van Lunzen J, Jochum J, Chadwick D, Awasom C, Claussen L, Drosten C, Drexler JF, Eis-Hübinger AM. Hepatitis E virus infections in HIV-infected patients in Ghana and Cameroon. J Clin Virol 2013; 58:18-23. [PMID: 23743346 DOI: 10.1016/j.jcv.2013.05.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/30/2013] [Accepted: 05/05/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic hepatitis E virus (HEV) infections have recently been described in HIV-infected patients. Only few data are available for sub-Saharan Africa, where HIV and HEV are highly co-endemic, and where liver pathology is common in HIV-infected individuals. OBJECTIVES To assess the prevalence of HEV viremia, anti-HEV antibodies, and serum aminotransferase levels in HIV patients in Ghana and Cameroon. STUDY DESIGN We retrospectively surveyed a cross-section of patients who were enrolled in cohort studies in Ghana (West Africa), and Cameroon (Central Africa). Plasma samples from 1029 HIV patients from Ghana and 515 patients from Cameroon including 214 children were analyzed for HEV-RNA by two reverse transcription PCR methods. In a subset of 791 patients, anti-HEV IgG and IgM antibodies were analyzed. RESULTS No HEV-RNA was detected in any of the plasma samples of 1544 patients. HEV seroprevalence was high in adult HIV patients from Ghana (45.3%, n=402) and Cameroon (14.2%, n=289), but low in pediatric HIV patients from Cameroon (2.0%, n=100). Elevations of alanine aminotransferase and aspartate aminotransferase levels were common in adult patients from Ghana (20.8% and 25.4%) and Cameroon (38.9% and 69.8%). The prevalence of hepatitis B virus surface antigen was 11.8% and of hepatitis C virus antibodies 2.5% in our adult Cameroonian study population. CONCLUSIONS Acute or chronic HEV infections did not play a role in liver pathology in two HIV cohorts in Ghana and Cameroon. A better understanding of the epidemiology and genotype-specific characteristics of HEV infections in HIV patients in sub-Saharan Africa is needed.
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Affiliation(s)
- Torsten Feldt
- Clinical Research Unit, Bernhard Nocht Institute of Tropical Medicine, Bernhard-Nocht Str. 74, 20359 Hamburg, Germany.
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74
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Aggarwal R. Hepatitis e: epidemiology and natural history. J Clin Exp Hepatol 2013; 3:125-33. [PMID: 25755486 PMCID: PMC3940526 DOI: 10.1016/j.jceh.2013.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/20/2013] [Indexed: 12/12/2022] Open
Abstract
Hepatitis E is a disease caused by infection with hepatitis E virus (HEV). The virus has four genotypes, named 1 to 4, with one shared serotype. Genotypes 1 and 2 infect only humans, whereas genotypes 3 and 4 primarily infect several mammalian animals, with occasional transmission to humans. Evidence of infection with HEV has been found in most parts of the world, with two distinct epidemiological patterns. In areas with high disease endemicity, primarily developing countries in Asia and Africa, the disease occurs as outbreaks and as sporadic cases of acute hepatitis, and is caused exclusively by infection with genotypes 1 or 2 HEV, which is acquired through fecal-oral route, usually through contamination of water supplies. The disease in these areas occurs most commonly in young adults, and is particularly severe in pregnant women and persons with pre-existing chronic liver disease; chronic infection has not been reported. In areas with lower endemicity, which are mainly developed areas with robust water supply and sanitation systems, occasional sporadic cases of locally-acquired genotype 3 or 4 HEV infection are observed. The affected persons are often elderly and have other coexisting illnesses. The reservoir of infection in these areas is believed to be in animals, such as pigs, wild boar and deer, with zoonotic transmission to humans, possibly through consumption of undercooked meat. Also, in these areas, persistent HEV infection has been well documented among immunosuppressed persons such as organ transplant recipients, and is believed to lead to chronic liver injury, including liver cirrhosis. Further work is needed to better understand the biological basis underlying these widely-differing epidemiological patterns.
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Affiliation(s)
- Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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75
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Jeblaoui A, Haim-Boukobza S, Marchadier E, Mokhtari C, Roque-Afonso AM. Genotype 4 hepatitis e virus in france: an autochthonous infection with a more severe presentation. Clin Infect Dis 2013; 57:e122-6. [PMID: 23667262 DOI: 10.1093/cid/cit291] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Among hepatitis E virus (HEV) infections diagnosed in 2011 by the French Reference Centre for HEV, 9 were due to genotype 4, which until recently was limited to Asia. Sequences from autochthonous cases formed a single cluster very similar to Belgian swine sequences. Clinical presentation differed from genotype 3 infections.
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76
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Abstract
The lack of an efficient cell culture system for hepatitis E virus (HEV) has greatly hampered detailed analyses of this virus. The first efficient cell culture systems for HEV that were developed were capable of secreting infectious HEV progenies in high titers into culture media, using PLC/PRF/5 cells derived from human hepatocellular carcinoma and A549 cells derived from human lung cancer as host cells. The success achieved with the original genotype 3 JE03-1760F strain has now been extended to various HEV strains in fecal and serum samples obtained from hepatitis E patients and to HEV strains in fecal and serum samples and liver tissues obtained from pigs and wild boar across species barriers. In addition, infectious HEV cDNA clones of the wild-type JE03-1760F strain and its variants have been engineered. Cell culture-generated HEV particles and those in circulating blood were found to be associated with lipids and open reading frame 3 (ORF3) protein, thereby likely contributing to the assembly and release of HEV from infected cells both in vivo and in vitro. The ORF3 protein interacts with the tumor susceptibility gene 101, a critical cellular protein required for the budding of enveloped viruses, through the Pro, Ser, Ala, and Pro (PSAP) motif in infected cells; ORF3 is co-localized with multivesicular bodies (MVBs) in the cytoplasm of infected cells, thus suggesting that HEV requires the MVB pathway for the egress of virus particles. This article reviews the development of efficient cell culture systems for a wide variety of infectious HEV strains obtained from humans, pigs, and wild boar, and also provides details of a new model for virion egress.
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Affiliation(s)
- Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke Tochigi, 329-0498 Japan
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77
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Scobie L, Dalton HR. Hepatitis E: source and route of infection, clinical manifestations and new developments. J Viral Hepat 2013; 20:1-11. [PMID: 23231079 DOI: 10.1111/jvh.12024] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis E was previously thought to be a disease of developing countries causing significant morbidity and mortality in young adults, particularly among pregnant women and patients with pre-existing chronic liver disease. Recent studies have shown that hepatitis E is also an issue in developed countries. In this setting, hepatitis E is a zoonotic infection and causes acute infection mainly in middle-aged and elderly men; and chronic infection in the immunosuppressed. The scope and burden of disease are still emerging. The diagnosis of hepatitis E should be considered in any patient with hepatitis, irrespective of their age or travel history.
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Affiliation(s)
- L Scobie
- Glasgow Caledonian University, Glasgow, UK
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78
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Tan LTC, Tan J, Ang LW, Chan KP, Chiew KT, Cutter J, Chew SK, Goh KT. Epidemiology of acute hepatitis E in Singapore. J Infect 2012; 66:453-9. [PMID: 23286967 DOI: 10.1016/j.jinf.2012.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/15/2012] [Accepted: 11/28/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We undertook an epidemiological review to determine the trend and characteristics of acute hepatitis E in Singapore over the last 12 years. METHODS We analysed the epidemiological records of all laboratory-confirmed cases of acute hepatitis E maintained at the Communicable Diseases Division, Ministry of Health, from 2000 to 2011. RESULTS A total of 540 laboratory-confirmed cases of acute hepatitis E was reported with more than half imported, mainly from India and Bangladesh. Among the indigenous cases, the mean annual incidence per 100,000 population increased from 0.05 in 2000-2002 to 0.92 in 2009-2011. There was a male predominance and the median age was 46 years. Among the 3 major ethnic groups of Singapore residents, Chinese and Indians had higher mean annual incidence rate compared to Malays. All the indigenous cases occurred singly and sporadically and could not be epidemiologically linked to one another by person, place or time. No common food item was implicated. CONCLUSIONS Indigenous acute hepatitis E has emerged as a major cause of acute viral hepatitis in Singapore. While epidemiological investigations are ongoing to elucidate the risk factors and modes of transmission, travellers should be reminded to practise a high standard of personal and food hygiene when visiting endemic countries.
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Affiliation(s)
- Louis Tiong Chin Tan
- Manpower Standards & Development Division, Ministry of Health, Singapore College of Medicine Building, 16 College Road, Singapore 169854, Singapore.
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Xu B, Yu HB, Hui W, He JL, Wei LL, Wang Z, Guo XH. Clinical features and risk factors of acute hepatitis E with severe jaundice. World J Gastroenterol 2012; 18:7279-7284. [PMID: 23326133 PMCID: PMC3544030 DOI: 10.3748/wjg.v18.i48.7279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 09/24/2012] [Accepted: 11/28/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To compares the clinical features of patients infected with hepatitis E virus (HEV) with or without severe jaundice. In addition, the risk factors for HEV infection with severe jaundice were investigated.
METHODS: We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group. Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum. We used χ2 analysis, Fisher’s exact test, and Student’s t test where appropriate in this study. Significant predictors in the univariate analysis were then included in a forward, stepwise multiple logistic regression model.
RESULTS: No significant differences in symptoms, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or hepatitis B virus surface antigen between the two groups were observed. HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase (GGT) (median: 170.31 U/L vs 237.96 U/L, P = 0.007), significantly lower ALB levels (33.84 g/L vs 36.89 g/L, P = 0.000), significantly lower acetylcholine esterase (CHE) levels (4500.93 U/L vs 5815.28 U/L, P = 0.000) and significantly higher total bile acid (TBA) levels (275.56 μmol/L vs 147.03 μmol/L, P = 0.000) than those without severe jaundice. The median of the lowest point time tended to be lower in patients with severe jaundice (81.64% vs 96.12%, P = 0.000). HEV infected patients with severe jaundice had a significantly higher viral load (median: 134 vs 112, P = 0.025) than those without severe jaundice. HEV infected patients with severe jaundice showed a trend toward longer median hospital stay (38.17 d vs 18.36 d, P = 0.073). Multivariate logistic regression indicated that there were significant differences in age, sex, viral load, GGT, albumin, TBA, CHE, prothrombin index, alcohol overconsumption, and duration of admission between patients infected with acute hepatitis E with and without severe jaundice.
CONCLUSION: Acute hepatitis E patients may naturally present with severe jaundice.
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80
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Zhu Y, Yu X, Huang F, Yu R, Dong S, Si F, Zhang Y, Li Z. Determination of the full-genome sequence of hepatitis E virus (HEV) SAAS-FX17 and use as a reference to identify putative HEV genotype 4 virulence determinants. Virol J 2012; 9:264. [PMID: 23134633 PMCID: PMC3546022 DOI: 10.1186/1743-422x-9-264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 10/30/2012] [Indexed: 01/14/2023] Open
Abstract
Background Four major genotypes of hepatitis E virus (HEV), the causative agent of hepatitis E, have so far been recognized. While genotypes 3 and 4 are both zoonotic, the disease symptoms caused by the latter tend to be more severe. To examine if specific nucleotide/amino acid variations between genotypes 3 and 4 play a role in determining the severity of hepatitis E disease, the complete genome of one swine HEV genotype 4 isolate, SAAS-FX17, was determined and compared with other genotype 4 and genotype 3 genomes to identify putative HEV genotype 4 virulence determinants. Results A total of 42 conformable nt/aa variations between genotype 3 and 4 HEVs were detected, of which 19 were proposed to be potential disease severity determinants for genotype 4 strains. Conclusions One potential determinant was located in each of the 5'-UTR and 3'-UTR, 3 and 12 within ORF1 and ORF2 respectively, and 2 in the junction region.
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Affiliation(s)
- Yumin Zhu
- Institute of Animal Science and Veterinary Medicine, Shanghai Academy of Agricultural Sciences, Shanghai, 201106, China
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81
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Abstract
Hepatitis E virus (HEV) was discovered during the Soviet occupation of Afghanistan in the 1980s, after an outbreak of unexplained hepatitis at a military camp. A pooled faecal extract from affected soldiers was ingested by a member of the research team. He became sick, and the new virus (named HEV), was detected in his stool by electron microscopy. Subsequently, endemic HEV has been identified in many resource-poor countries. Globally, HEV is the most common cause of acute viral hepatitis. The virus was not initially thought to occur in developed countries, but recent reports have shown this notion to be mistaken. The aim of this Seminar is to describe recent discoveries regarding HEV, and how they have changed our understanding of its effect on human health worldwide.
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Affiliation(s)
- Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France; Centre de Physiopathologie de Toulouse-Purpan, Toulouse, France; Université Paul Sabatier, Toulouse, France
| | - Richard Bendall
- Clinical Microbiology, Royal Cornwall Hospital Trust, Truro, UK
| | - Florence Legrand-Abravanel
- Centre de Physiopathologie de Toulouse-Purpan, Toulouse, France; Université Paul Sabatier, Toulouse, France; Department of Virology, CHU Purpan, Toulouse, France
| | - Ning-Shao Xia
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, China
| | - Samreen Ijaz
- Virus Reference Department, Microbiology Services-Colindale, Health Protection Agency, London, UK
| | - Jacques Izopet
- Centre de Physiopathologie de Toulouse-Purpan, Toulouse, France; Université Paul Sabatier, Toulouse, France; Department of Virology, CHU Purpan, Toulouse, France
| | - Harry R Dalton
- Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, Truro, UK; European Centre of Environment and Human Health, Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth, Truro, UK.
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82
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Nakano T, Okano H, Kobayashi M, Ito K, Ohmori S, Nomura T, Kato H, Ayada M, Nakano Y, Akachi S, Sugimoto K, Fujita N, Shiraki K, Takei Y, Takahashi M, Okamoto H. Molecular epidemiology and genetic history of European-type genotype 3 hepatitis E virus indigenized in the central region of Japan. INFECTION GENETICS AND EVOLUTION 2012; 12:1524-34. [PMID: 22706162 DOI: 10.1016/j.meegid.2012.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/18/2012] [Accepted: 06/05/2012] [Indexed: 02/09/2023]
Abstract
In Mie prefecture in Japan, 12 cases of sporadic hepatitis E occurred from 2004 to 2011. Mie prefecture is located in the central region of Japan, far from the most prevalent regions of hepatitis E virus (HEV) infection in Japan, the north and northeastern part. These 12 cases did not have any common risk factors of HEV infection. We analyzed the molecular epidemiology of the cases in Mie prefecture. We obtained the nucleotide sequences of the HEV strains and analyzed them with the sequences of other HEV strains by phylogenetic and coalescent analyses. Japan-indigenous genotype 3 HEV strains were divided into two major subtypes, namely, 3a and 3b; one minor subtype, 3e; and a few other unassigned lineages. The Japan-indigenous subtype 3e strains were closely related to European subtype 3e HEV strains and were comparatively rare in Japan; however, eight strains of the 12 cases we examined belonged to subtype 3e, indicating a close phylogenetic relationship, despite the lack of common risk factors. Coalescent analyses indicated that the Mie 3e strains seemed to have intruded into Mie prefecture about 10 years ago. Sporadic acute hepatitis E cases caused by the 3e strains occurred consistently from 2004 to 2011 in Mie prefecture. This is the first report of unexpected persistent occurrence of hepatitis by the European-type genotype 3 HEV, subtype 3e, in a country outside of Europe. Phylogenetic and coalescent analyses traced the history of the indigenization of the Mie 3e strains from Europe. Because hepatitis E cases caused by 3e strains are relatively rare in Japan, molecular evolutionary analyses of HEV infection in Mie prefecture is important for preventing a future hepatitis endemic or epidemic by 3e strains in Japan.
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Affiliation(s)
- Tatsunori Nakano
- Department of Internal Medicine, Fujita Health University Nakakuri Sanatorium, Mie 514-1295, Japan.
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83
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Luciano L, Martel C, De Pina JJ, Tesse S, Merens A, Roque AM, Guisset M, Brardjanian S, Coton T. Genotype 3f predominance in symptomatic acute autochthonous hepatitis E: a short case series in south-eastern France. Clin Res Hepatol Gastroenterol 2012; 36:e54-5. [PMID: 22521756 DOI: 10.1016/j.clinre.2012.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 03/02/2012] [Indexed: 02/04/2023]
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84
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de Souza AJS, Gomes-Gouvêa MS, Soares MDCP, Pinho JRR, Malheiros AP, Carneiro LA, dos Santos DRL, Pereira WLA. HEV infection in swine from Eastern Brazilian Amazon: evidence of co-infection by different subtypes. Comp Immunol Microbiol Infect Dis 2012; 35:477-85. [PMID: 22579295 DOI: 10.1016/j.cimid.2012.04.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/10/2012] [Accepted: 04/12/2012] [Indexed: 01/27/2023]
Abstract
Hepatitis E virus (HEV) is a fecal-orally transmitted member of the genus Hepevirus that causes acute hepatitis in humans and is widely distributed throughout the world. Pigs have been reported as the main source of genotypes 3 and 4 infection to humans in non-endemic areas. To investigate HEV infection in pigs from different regions of Pará state (Eastern Brazilian Amazon), we performed serological and molecular analyses of serum, fecal and liver samples from 151 adult pigs slaughtered between April and October 2010 in slaughterhouses in the metropolitan region of Belém, Pará. Among the animals tested, 8.6% (13/151) were positive for anti-HEV IgG but not for anti-HEV IgM. HEV RNA was detected in 4.8% (22/453) of the samples analyzed and 9.9% (15/151) of the animals had at least one positive sample. Phylogenetic analysis showed that all sequences belonged to genotype 3 that were related to human isolates from other non-endemic regions, suggesting that the isolates had zoonotic potential. Subtypes 3c and 3f were simultaneously detected in some pigs, suggesting co-infection by more than one strain and/or the presence of a recombinant virus. These results constitute the first molecular and serologic evidence of swine HEV circulation in the Eastern Brazilian Amazon.
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Affiliation(s)
- Alex Junior Souza de Souza
- Seção de Hepatologia, Instituto Evandro Chagas, Av. Almirante Barroso, 492, 66093-020 Belém, PA, Brazil.
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85
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Nakano T, Takahashi K, Pybus OG, Hashimoto N, Kato H, Okano H, Kobayashi M, Fujita N, Shiraki K, Takei Y, Ayada M, Arai M, Okamoto H, Mishiro S. New findings regarding the epidemic history and population dynamics of Japan-indigenous genotype 3 hepatitis E virus inferred by molecular evolution. Liver Int 2012; 32:675-88. [PMID: 22181032 DOI: 10.1111/j.1478-3231.2011.02728.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 11/22/2011] [Indexed: 02/13/2023]
Abstract
BACKGROUND Since previous studies have investigated the population dynamics of Japan-indigenous genotype 3 hepatitis E virus (HEV) using virus sequences, more nucleotide sequences have been determined, and new techniques have been developed for such analysis. AIMS To prevent future hepatitis E epidemic in Japan, this study aimed to elucidate the cause of past HEV expansion. METHODS The epidemic history of Japan-indigenous genotype 3 HEV was determined using the coalescent analysis framework. Bayesian skyline plot (BSP) and Bayesian estimate of phylogeny with relaxed molecular clock models were calculated using Markov chain Monte Carlo sampling. RESULTS Japan-indigenous strains consist of New World strains (subtype 3a), Japanese strains (3b) and European strains (3e). The oldest lineage, 3b, appeared around 1929. Lineages 3a and 3e appeared around 1960. BSPs indicated similar radical population growth of the 3a and 3b lineages from 1960 to 1980. CONCLUSIONS Population dynamics of the three lineages shared some common characteristics, but had distinguishing features. The appearance of 3a and 3e lineages coincides with the increase of large-race pig importation from Europe and the USA after 1960. The epidemic phase of 3a and 3b strains from 1960 to 1980 could be related to increased opportunity for HEV infection arising from large-scale pig breeding since 1960. Our observations revealed new findings concerning the close relationship between the epidemic history of Japan-indigenous genotype 3 HEV and the improvement of the Japanese pig industry. Infection control in pig farms should be an effective method of preventing HEV infection in humans.
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Affiliation(s)
- Tatsunori Nakano
- Department of Internal Medicine, Fujita Health University Nanakuri Sanatorium, Mie, Japan.
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86
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Seroprevalence of hepatitis E antibodies and risk profile of HEV seropositivity in The Netherlands, 2006–2007. Epidemiol Infect 2012; 140:1838-47. [DOI: 10.1017/s0950268811002913] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
SUMMARYHepatitis E virus (HEV) is now considered an endemic pathogen in industrialized countries, leading to acute and sometimes chronic hepatitis, mostly in vulnerable people. The endemic sources are unclear. A survey in The Netherlands in 2006–2007 showed a 1·9% seroprevalence of HEV antibodies measured by ELISA and confirmed by immunoblot in a nationwide sample. Overall, in 134/7072 (1·9%) seropositive individuals, older age (P<0·01), being male (P<0·01), working with patients (P=0·03), working with animals (P=0·07), recent diarrhoeal complaints (P=0·07) and adhering to a religion that considers pigs unclean (P<0·01) were independently associated with seropositivity in multivariate analysis. Sub-analysis of 59/4022 (1·5%) anti-HEV antibody-positive subjects with probable endemic exposure showed independent association with youngest household member being aged <5 years or between 19 and <65 years (P=0·05) in multivariate analysis. These findings may contribute to a better understanding of the sources of endemic HEV exposure, and also highlight the need for systematic epidemiological and serological evaluation of new cases.
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87
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Kanai Y, Miyasaka S, Uyama S, Kawami S, Kato-Mori Y, Tsujikawa M, Yunoki M, Nishiyama S, Ikuta K, Hagiwara K. Hepatitis E virus in Norway rats (Rattus norvegicus) captured around a pig farm. BMC Res Notes 2012; 5:4. [PMID: 22217009 PMCID: PMC3284388 DOI: 10.1186/1756-0500-5-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 01/05/2012] [Indexed: 12/13/2022] Open
Abstract
Background Hepatitis E virus (HEV) transmitted via the oral route through the consumption of contaminated water or uncooked or undercooked contaminated meat has been implicated in major outbreaks. Rats may play a critical role in HEV outbreaks, considering their negative effects on environmental hygiene and food sanitation. Although the serological evidence of HEV infection in wild rodents has been reported worldwide, the infectivity and propagation of HEV in wild rats remain unknown. To investigate if rats are a possible carrier of HEV, we studied wild Norway rats (Rattus norvegicus) that were caught near a pig farm, where HEV was prevalent among the pigs. Methods We examined 56 Norway rats for HEV. RNA from internal organs was examined for RT-PCR and positive samples were sequenced. Positive tissue samples were incubated with A549 cell line to isolate HEV. Anti-HEV antibodies were detected by ELISA. Results Sixteen rats were seropositive, and the HEV RNA was detected in 10 of the 56 rats. Sequencing of the partial ORF1 gene from 7 samples resulted in partially sequenced HEV, belonging to genotype 3, which was genetically identical to the HEV prevalent in the swine from the source farm. The infectious HEVs were isolated from the Norway rats by using the human A549 cell line. Conclusions There was a relatively high prevalence (17.9%) of the HEV genome in wild Norway rats. The virus was mainly detected in the liver and spleen. The results indicate that these animals might be possible carrier of swine HEV in endemic regions. The HEV contamination risk due to rats needs to be examined in human habitats.
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Affiliation(s)
- Yuta Kanai
- School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan.
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88
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Ozeki I, Kang JH, Mizuo H, Akaike J, Ohmura T, Karino Y, Matsui T, Saga A, Watanabe M, Miura Y, Kura T, Tsunematsu I, Matsubayashi K, Sakata H, Okamoto H, Takahashi K, Arai M. Small epidemic of hepatitis E in the fall 2009 in Sapporo, Hokkaido. ACTA ACUST UNITED AC 2012. [DOI: 10.2957/kanzo.53.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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89
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Man Shrestha S, Shrestha S. Subacute Hepatic Failure: Its Possible Pathogenesis. Euroasian J Hepatogastroenterol 2012. [DOI: 10.5005/jp-journals-10018-1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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90
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Ogawa K, Yamamoto Y, Umemura M, Kang JH, Sakata H, Matsubayashi K, Takahashi K, Arai M, Mishiro S. Two cases of fulminant hepatitis E occurred in Hakodate area 2010, suggesting infection with single source hepatitis E virus separated from small epidemic in Sapporo 2009. ACTA ACUST UNITED AC 2012. [DOI: 10.2957/kanzo.53.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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91
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Kumar S, Pujhari SK, Chawla YK, Chakraborti A, Ratho RK. Molecular detection and sequence analysis of hepatitis E virus in patients with viral hepatitis from North India. Diagn Microbiol Infect Dis 2011; 71:110-7. [DOI: 10.1016/j.diagmicrobio.2011.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/23/2011] [Accepted: 06/29/2011] [Indexed: 11/25/2022]
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92
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Abstract
BACKGROUND The vast majority of patients who are referred to a specialist hepatological centre suffer from acute deterioration of their chronic liver disease. Yet, this entity of acute on chronic liver failure remains poorly defined. AIM The aim of the present study was to highlight the occurrence of hepatitis E viraemia by nested reverse transcriptase polymerase chain reaction (RT-PCR) in patients with acute on chronic liver failure. MATERIALS AND METHODS The study included 100 patients with acute on chronic liver disorders admitted to Mansoura University Hospital, Egypt. Blood samples were obtained from patients and sera were separated. Sera were subjected to a study of viral hepatitis markers for hepatitis A by IgM, for hepatitis B by S antigen and core IgM and for hepatitis C virus by IgG and RT-PCR for HCV. Liver function tests were evaluated including alanine transaminase, aspartate transaminase and bilirubin total and direct by an autoanalyser. Study for hepatitis E virus (HEV) was performed using a molecular technique. Nested RT-PCR was performed for each serum sample. RESULTS HEV RNA was detected in the sera of 13 patients (13%) of the patients with chronic liver disorders. The majority of the positive cases were among patients with cirrhosis (29.9%) followed by patients with HCC (15.4%). On multirisk analysis for the factors associated with the presence of HEV viraemia, younger age < 45 years and lower albumin level < 3.5 g/dl were significantly (P = 0.04, P = 0.03) associated with HEV viraemia. DISCUSSION From this study it appears that HEV viraemia is a common cause of acute on chronic liver disorders in Egypt. CONCLUSION There is no effective vaccine is available against HEV, mass awareness and preventive measures are important to the related.
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Affiliation(s)
- Maysaa El Sayed Zaki
- Department of Clinical Pathology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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93
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Okamoto H. Efficient cell culture systems for hepatitis E virus strains in feces and circulating blood. Rev Med Virol 2011; 21:18-31. [PMID: 21294213 DOI: 10.1002/rmv.678] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Attempts have been made to propagate hepatitis E virus (HEV) in primary hepatocyte culture and various other cultured cells. However, the replication ability of HEV recovered from culture media remains extremely low. Recently, efficient culture systems have been established in PLC/PRF/5 (hepatocellular carcinoma) and A549 (lung cancer) cell lines for HEV strains of genotypes 3 and 4 in our laboratory. They originated in fecal extracts from patients containing HEV RNA in extremely high-titers (10(7) copies/ml), and named the JE03-1760F (genotype 3) and HE-JF5/15F (genotype 4) strains, respectively. HEV RNA in culture supernatants reached 10(8) copies/ml in titer, and were transmitted successively through many passages. An infectious HEV cDNA clone (pJE03-1760F/wt) was constructed that has replication activity comparable to that of the wild-type JE03-1760F in feces. The ORF3 protein is indispensable for shedding HEV particles from cells in the reverse genetics system. HEV recovered from culture media, as well as circulating HEV, possess ORF3 proteins on the surface and are covered with cellular membranes, and therefore, ORF2 epitopes are buried in these particles. In contrast, HEV excreted into feces are naked nucleocapsids without a lipid layer or surface expression of the ORF3 protein. HEV in sera of patients with acute hepatitis E can infect and replicate in PLC/PRF/5 and A549 cells, with efficiency comparable to the circulating HEV RNA levels. High-efficiency cell culture systems for infectious viruses, thus developed, are expected to open up a new era and resolve many mysteries in the epidemiology, molecular biology, and treatment of HEV.
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Affiliation(s)
- Hiroaki Okamoto
- Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke-Shi, Tochigi, Japan.
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94
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Zhang H, Mohn U, Prickett JR, Schalk S, Motz M, Halbur PG, Feagins AR, Meng XJ, Opriessnig T. Differences in capabilities of different enzyme immunoassays to detect anti-hepatitis E virus immunoglobulin G in pigs infected experimentally with hepatitis E virus genotype 3 or 4 and in pigs with unknown exposure. J Virol Methods 2011; 175:156-62. [PMID: 21596064 DOI: 10.1016/j.jviromet.2011.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/25/2011] [Accepted: 05/03/2011] [Indexed: 01/22/2023]
Abstract
Hepatitis E virus (HEV), a major cause of acute viral hepatitis in humans in many developing countries, is highly prevalent in the pig population worldwide. The objective of this study was to assess the capability of three porcine prototypes of a human enzyme-linked immunosorbent assay (ELISA), an in-house ELISA and a line-immunoassay (LIA) to detect anti-HEV antibodies in pigs infected experimentally with HEV (n = 57), known to be negative for HEV infection (n = 27), or with unknown exposure to HEV infection (field samples, n = 90). All 27 samples from non-infected pigs were negative with all five assays. The earliest detection of anti-HEV antibodies occurred at 14 days post-inoculation (dpi) with four of five assays. From 42 dpi, all samples from infected pigs were detected correctly as anti-HEV positive. Kappa analysis demonstrated substantial agreement among tests (0.62-1.00) at 14 dpi and complete agreement (1.00) at 56 dpi. The overall area under the curve for all quantitative tests as determined by receiver operator characteristic analysis ranged from 0.794 to 0.831 indicating moderate accuracy. The results showed that all five assays can detect anti-HEV IgG antibodies accurately in pigs infected experimentally with HEV. In field samples, a higher prevalence of anti-HEV IgG was found in breeding herds than in growing pigs (100% versus 66.7-93.9%). These serological assays should be very useful in veterinary diagnostic labs for HEV diagnosis in swine.
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Affiliation(s)
- H Zhang
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011-1250, USA
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95
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Conlan JV, Jarman RG, Vongxay K, Chinnawirotpisan P, Melendrez MC, Fenwick S, Thompson RCA, Blacksell SD. Hepatitis E virus is prevalent in the pig population of Lao People's Democratic Republic and evidence exists for homogeneity with Chinese Genotype 4 human isolates. INFECTION GENETICS AND EVOLUTION 2011; 11:1306-11. [PMID: 21550423 DOI: 10.1016/j.meegid.2011.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/06/2011] [Accepted: 04/19/2011] [Indexed: 11/25/2022]
Abstract
The objective of this study was to determine the prevalence and genotypic range of Hepatitis E virus (HEV) in the pig population of northern Lao People's Democratic Republic (PDR). We collected 181 faecal samples from indigenous-breed pigs ≤ 6 months of age and the faeces was stored in RNA stabilisation buffer due to cold-chain and transport limitations. Twenty-one (11.6%) pigs had detectable HEV RNA and 43.5% of village pig herds were infected. Based on a 240 base pair-nucleotide sequence flanking the junction of open reading frames 1, 2 and 3 (ORF1, ORF2 and ORF3) the isolates were phylogenetically classified within genotype 4. Phylogenetic analyses revealed distinct genetic groupings of the Lao HEV isolates and two groups clustered with human and pig HEV isolates from China. This was the first study to demonstrate genotype 4 HEV in Lao PDR and indicates pigs are a potential reservoir for human HEV infection.
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Affiliation(s)
- James V Conlan
- School of Veterinary and Biomedical Sciences, Murdoch University, South Street, Murdoch, WA, Australia.
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96
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Sanford BJ, Dryman BA, Huang YW, Feagins AR, Leroith T, Meng XJ. Prior infection of pigs with a genotype 3 swine hepatitis E virus (HEV) protects against subsequent challenges with homologous and heterologous genotypes 3 and 4 human HEV. Virus Res 2011; 159:17-22. [PMID: 21536085 DOI: 10.1016/j.virusres.2011.04.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/08/2011] [Accepted: 04/14/2011] [Indexed: 12/17/2022]
Abstract
Hepatitis E virus (HEV) is an important human pathogen. At least four recognized and two putative genotypes of mammalian HEV have been reported: genotypes 1 and 2 are restricted to humans whereas genotypes 3 and 4 are zoonotic. The current experimental vaccines are all based on a single strain of HEV, even though multiple genotypes of HEV are co-circulating in some countries and thus an individual may be exposed to more than one genotype. Genotypes 3 and 4 swine HEV is widespread in pigs and known to infect humans. Therefore, it is important to know if prior infection with a genotype 3 swine HEV will confer protective immunity against subsequent exposure to genotypes 3 and 4 human and swine HEV. In this study, specific-pathogen-free pigs were divided into 4 groups of 6 each. Pigs in the three treatment groups were each inoculated with a genotype 3 swine HEV, and 12 weeks later, challenged with the same genotype 3 swine HEV, a genotype 3 human HEV, and a genotype 4 human HEV, respectively. The control group was inoculated and challenged with PBS buffer. Weekly sera from all pigs were tested for HEV RNA and IgG anti-HEV, and weekly fecal samples were also tested for HEV RNA. The pigs inoculated with swine HEV became infected as evidenced by fecal virus shedding and viremia, and the majority of pigs also developed IgG anti-HEV prior to challenge at 12 weeks post-inoculation. After challenge, viremia was not detected and only two pigs challenged with swine HEV had 1-week fecal virus shedding, suggesting that prior infection with a genotype 3 swine HEV prevented pigs from developing viremia and fecal virus shedding after challenges with homologous and heterologous genotypes 3 and 4 HEV. The results from this study have important implications for future development of an effective HEV vaccine.
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Affiliation(s)
- Brenton J Sanford
- Center for Molecular Medicine and Infectious Diseases, Department of Biomedical Sciences and Pathobiology, College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
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97
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A systematic review/meta-analysis of primary research investigating swine, pork or pork products as a source of zoonotic hepatitis E virus. Epidemiol Infect 2011; 139:1127-44. [DOI: 10.1017/s0950268811000677] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
SUMMARYThe objectives of our study were to identify and categorize primary research investigating swine/pork as a source of zoonotic hepatitis E virus (HEV) using the relatively new technique of scoping study, and to investigate the potential association between human exposure to swine/pork and HEV infection quantitatively using systematic review/meta-analysis methodology. From 1890 initially identified abstracts, 327 were considered for the review. Five study design types (cross-sectional, prevalence, genotyping, case-report and experimental transmission studies) were identified. A significant association between occupational exposure to swine and human HEV IgG seropositivity was reported in 10/13 cross-sectional studies. The association reported between pork consumption and HEV IgG seropositivity was inconsistent. The quantification of viral load in swine and retail pork, viral load required for infection in primates, cohort and case-control studies in humans, and formal risk assessment are recommended before specific public-health policy actions are taken.
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98
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Meader E, Thomas D, Salmon R, Sillis M. Seroprevalence of hepatitis E virus in the UK farming population. Zoonoses Public Health 2011; 57:504-9. [PMID: 19912601 DOI: 10.1111/j.1863-2378.2009.01254.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hepatitis E is a zoonosis that can be acquired by the consumption of contaminated food or water, or via person-to-person spread. However, little is known about the transmission of hepatitis E virus (HEV) in the UK. We investigated the epidemiology of indigenous hepatitis E infection using the PHLS Farm Cohort, a sentinel group with a history of close contact with a range of domestic animals. Ten of the 413 subjects tested were positive for hepatitis E IgG antibodies (2.4%). Seroprevalence peaked in those aged 51 to 60 years (relative risk 3.3, 95% CI: 1.0-10.5). Male participants (relative risk 3.6, 95% CI: 0.6-21.2) and those from farms in the Hereford area of the United Kingdom (relative risk 2.7, 95% CI: 0.8-8.4), an area of mixed livestock farming, were more likely to have serological evidence of previous HEVs exposure, although these findings were not statistically significant. Exposure to pigs, or water from a private supply, was not identified as a significant risk factor. The results of this study suggest that UK farming populations are exposed to HEV, but the predominant route of transmission remains elusive.
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Affiliation(s)
- E Meader
- The Norfolk & Norwich University Hospital NHS Trust, Colney, Norfolk, NR4 7UY, UK.
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99
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La Rosa G, Muscillo M, Vennarucci VS, Garbuglia AR, La Scala P, Capobianchi MR. Hepatitis E virus in Italy: molecular analysis of travel-related and autochthonous cases. J Gen Virol 2011; 92:1617-1626. [PMID: 21471314 DOI: 10.1099/vir.0.031278-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Human hepatitis E virus (HEV) is considered an emerging pathogen in industrialized countries. The aim of the present study was to contribute to the body of knowledge available on the molecular epidemiology of acute hepatitis E in Italy. Three sets of HEV-specific primers targeting the ORF1 and ORF2 were used to examine serum samples collected from acute hepatitis patients positive for anti-HEV IgG and/or IgM, between 2007 and 2010. Seventeen patients (39.5%) tested HEV RNA-positive: 12 infections, due to genotype 1, were associated with travel to endemic areas (Bangladesh, India and Pakistan), while five infections, due to genotype 3, were presumably autochthonous. Risk factors identified in this group included exposure to raw seafood, pork liver sausages and wild boar. Results from the present study confirm that human HEV infection in Italy is caused by different genotypes, depending on whether the infection is travel-related or autochthonous.
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Affiliation(s)
- Giuseppina La Rosa
- Istituto Superiore di Sanità, Department of Environment and Primary Prevention, Rome, Italy
| | - Michele Muscillo
- Istituto Superiore di Sanità, Department of Environment and Primary Prevention, Rome, Italy
| | | | | | - Patrizia La Scala
- National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy
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100
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Miyamura T. Hepatitis E virus infection in developed countries. Virus Res 2011; 161:40-6. [PMID: 21443914 DOI: 10.1016/j.virusres.2011.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/01/2011] [Accepted: 03/06/2011] [Indexed: 01/26/2023]
Abstract
Hepatitis E was considered to be endemic infectious disease in developing countries in tropical or subtropical regions with poor sanitary conditions. Large, previously reported outbreaks were mainly due to contaminated water or heavy flooding. Prototype hepatitis E viruses of genotypes I and II were obtained from such endemic cases. In developed countries, in contrast, hepatitis E was rare and diagnosed only in travelers or imported cases. However, the development of accurate diagnostic tests, mainly PCR detection elucidated that autochthonous hepatitis E in developed countries is far more common than previously thought. Although the main route of transmission is food-borne, other routes including blood-borne have been suggested. Recent developments of gene-based diagnostic assays and molecular epidemiology have disclosed the significance of hepatitis E virus infection in developed countries.
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