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Pork products associated with human infection caused by an emerging phylotype of hepatitis E virus in England and Wales. Epidemiol Infect 2017; 145:2417-2423. [PMID: 28756783 DOI: 10.1017/s0950268817001388] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Since 2010, human hepatitis E infections have increased in England and Wales. Most cases are locally acquired and caused by hepatitis E virus genotype 3 (HEV G3). HEV G3 is linked to the consumption of pork products. The increase is associated with the emergence of a new phylotype, HEV G3-group 2 (G3-2, also known as G3abcdhij). Sixty individuals with confirmed hepatitis E infection and no history of travel outside the UK were recruited: 19 were infected with HEV G3-group 1 (G3-1 or G3efg) and 41 with G3-2. Epidemiological data relating to usual shopping habits and consumption of ham and sausages were analysed together with typing data to identify any associations with HEV phylotype. Study participants who purchased ham and/or sausage from a major supermarket were more likely to have HEV G3-2 infection (Relative risks 1·85, P = 0·06, CI 0·97-3·53). The HEV G3-2 phylotype has not been detected in indigenous UK pigs and it is suggested that human infections could be the result of consumption of products made from pork originating outside the UK. This does not infer blame on the supermarket but the epidemiology of HEV is dynamic and reflects complex animal husbandry practices which need to be explored further.
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52
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Ankcorn MJ, Tedder RS. Hepatitis E: the current state of play. Transfus Med 2017; 27:84-95. [PMID: 28382704 DOI: 10.1111/tme.12405] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/08/2016] [Accepted: 02/22/2017] [Indexed: 12/16/2022]
Abstract
The hepatitis E virus (HEV) is a major cause of acute hepatitis globally. Genotypes 1 and 2 (G1 and G2) are obligate human pathogens transmitted faeco-orally, leading to epidemics in developing countries. In contrast, genotypes 3 and 4 (G3 and G4) have a wider host range, including humans, but are primarily porcine viruses and are transmitted from animals to humans as a food-borne zoonosis when meat from an infected animal is consumed. HEV is increasingly recognised as a problem in developed countries, including countries in Europe. G3 HEV is now the most common cause of acute viral hepatitis in the UK and cases continue to rise. The majority of these infections are acquired within the UK and thought to be from insufficiently cooked meat, predominantly processed pork meat. Previously thought to only cause self-limiting disease, HEV infection can persist in immunosuppressed patients, which may lead to chronic hepatitis and the rapid development of cirrhosis. Of particular interest to the transfusion community has been the possibility of transfusion-transmitted HEV, which has been reported from countries classically considered HEV-endemic but also non-endemic countries in Europe and Japan. This has prompted some countries to introduce screening for HEV in blood donations.
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Affiliation(s)
- M J Ankcorn
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK.,Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
| | - R S Tedder
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK.,Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
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Ricci A, Allende A, Bolton D, Chemaly M, Davies R, Fernandez Escamez PS, Herman L, Koutsoumanis K, Lindqvist R, Nørrung B, Robertson L, Ru G, Sanaa M, Simmons M, Skandamis P, Snary E, Speybroeck N, Ter Kuile B, Threlfall J, Wahlström H, Di Bartolo I, Johne R, Pavio N, Rutjes S, van der Poel W, Vasickova P, Hempen M, Messens W, Rizzi V, Latronico F, Girones R. Public health risks associated with hepatitis E virus (HEV) as a food-borne pathogen. EFSA J 2017; 15:e04886. [PMID: 32625551 PMCID: PMC7010180 DOI: 10.2903/j.efsa.2017.4886] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hepatitis E virus (HEV) is an important infection in humans in EU/EEA countries, and over the last 10 years more than 21,000 acute clinical cases with 28 fatalities have been notified with an overall 10-fold increase in reported HEV cases; the majority (80%) of cases were reported from France, Germany and the UK. However, as infection in humans is not notifiable in all Member States, and surveillance differs between countries, the number of reported cases is not comparable and the true number of cases would probably be higher. Food-borne transmission of HEV appears to be a major route in Europe; pigs and wild boars are the main source of HEV. Outbreaks and sporadic cases have been identified in immune-competent persons as well as in recognised risk groups such as those with pre-existing liver damage, immunosuppressive illness or receiving immunosuppressive treatments. The opinion reviews current methods for the detection, identification, characterisation and tracing of HEV in food-producing animals and foods, reviews literature on HEV reservoirs and food-borne pathways, examines information on the epidemiology of HEV and its occurrence and persistence in foods, and investigates possible control measures along the food chain. Presently, the only efficient control option for HEV infection from consumption of meat, liver and products derived from animal reservoirs is sufficient heat treatment. The development of validated quantitative and qualitative detection methods, including infectivity assays and consensus molecular typing protocols, is required for the development of quantitative microbial risk assessments and efficient control measures. More research on the epidemiology and control of HEV in pig herds is required in order to minimise the proportion of pigs that remain viraemic or carry high levels of virus in intestinal contents at the time of slaughter. Consumption of raw pig, wild boar and deer meat products should be avoided.
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54
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Shrestha AC, Flower RL, Seed CR, Keller AJ, Hoad V, Harley R, Leader R, Polkinghorne B, Furlong C, Faddy HM. Hepatitis E virus infections in travellers: assessing the threat to the Australian blood supply. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:191-198. [PMID: 27483488 PMCID: PMC5448823 DOI: 10.2450/2016.0064-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/17/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND In many developed countries hepatitis E virus (HEV) infections have occurred predominantly in travellers to countries endemic for HEV. HEV is a potential threat to blood safety as the virus is transfusion-transmissible. To minimise this risk in Australia, individuals diagnosed with HEV are deferred. Malarialdeferrals, when donors are restricted from donating fresh blood components following travel toanareain which malaria is endemic, probably also decrease the HEV risk, by deferring donors who travel to many countries also endemic for HEV. The aim of this study is to describe overseas-acquired HEV cases in Australia, in order to determine whether infection in travellers poses a risk to Australian blood safety. MATERIALS AND METHODS Details of all notified HEV cases in Australia from 2002 to 2014 were accessed, and importation rates estimated. Countries in which HEV was acquired were compared to those for which donations are restricted following travel because of a malaria risk. RESULTS Three hundred and thirty-two cases of HEV were acquired overseas. Travel to India accounted for most of these infections, although the importation rate was highest for Nepal and Bangladesh. Countries for which donations are restricted following travel due to malaria risk accounted for 94% of overseas-acquired HEV cases. DISCUSSION The vast majority of overseas-acquired HEV infections were in travellers returning from South Asian countries, which are subject to donation-related travel restrictions for malaria. This minimises the risk HEV poses to the Australian blood supply.
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Affiliation(s)
- Ashish C. Shrestha
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia
- School of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Robert L.P. Flower
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia
| | - Clive R. Seed
- Medical Services, Australian Red Cross Blood Service, Perth, WA, Australia
| | - Anthony J. Keller
- Medical Services, Australian Red Cross Blood Service, Perth, WA, Australia
| | - Veronica Hoad
- Medical Services, Australian Red Cross Blood Service, Perth, WA, Australia
| | - Robert Harley
- Medical Services, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia
| | - Robyn Leader
- OzFoodNet, Office of Health Protection, Australian Government Department of Health, Canberra, Australia
| | - Ben Polkinghorne
- OzFoodNet, Office of Health Protection, Australian Government Department of Health, Canberra, Australia
| | - Catriona Furlong
- OzFoodNet, New South Wales Department of Health, Sydney, Australia
| | - Helen M. Faddy
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia
- School of Medicine, The University of Queensland, Herston, QLD, Australia
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Phage-displayed peptides that mimic epitopes of hepatitis E virus capsid. Med Microbiol Immunol 2017; 206:301-309. [PMID: 28434129 DOI: 10.1007/s00430-017-0507-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
Abstract
Hepatitis E is an emerging zoonotic infection of increasing public health threat for the UK, especially for immunosuppressed individuals. A human recombinant vaccine has been licensed only in China and is not clear whether it protects against hepatitis E virus (HEV) genotype 3, the most prevalent in Europe. The aim of this study was to use phage display technology as a tool to identify peptides that mimic epitopes of HEV capsid (mimotopes). We identified putative linear and conformational mimotopes using sera from Scottish blood donors that have the immunological imprint of past HEV infection. Four mimotopes did not have homology with the primary sequence of HEV ORF2 capsid but competed effectively with a commercial HEV antigen for binding to anti-HEV reference serum. When the reactivity profile of each mimotope was compared with Wantai HEV-IgG ELISA, the most sensitive HEV immunoassay, mimotopes showed 95.2-100% sensitivity while the specificity ranged from 81.5 to 95.8%. PepSurf algorithm was used to map affinity-selected peptides onto the ORF2 crystal structure of HEV genotype 3, which predicted that these four mimototopes are clustered in the P domain of ORF2 capsid, near conformational epitopes of anti-HEV neutralising monoclonal antibodies. These HEV mimotopes may have potential applications in the design of structural vaccines and the development of new diagnostic tests.
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Hepatitis E Virus Genotypes and Evolution: Emergence of Camel Hepatitis E Variants. Int J Mol Sci 2017; 18:ijms18040869. [PMID: 28425927 PMCID: PMC5412450 DOI: 10.3390/ijms18040869] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 12/18/2022] Open
Abstract
Hepatitis E virus (HEV) is a major cause of viral hepatitis globally. Zoonotic HEV is an important cause of chronic hepatitis in immunocompromised patients. The rapid identification of novel HEV variants and accumulating sequence information has prompted significant changes in taxonomy of the family Hepeviridae. This family includes two genera: Orthohepevirus, which infects terrestrial vertebrates, and Piscihepevirus, which infects fish. Within Orthohepevirus, there are four species, A–D, with widely differing host range. Orthohepevirus A contains the HEV variants infecting humans and its significance continues to expand with new clinical information. We now recognize eight genotypes within Orthohepevirus A: HEV1 and HEV2, restricted to humans; HEV3, which circulates among humans, swine, rabbits, deer and mongooses; HEV4, which circulates between humans and swine; HEV5 and HEV6, which are found in wild boars; and HEV7 and HEV8, which were recently identified in dromedary and Bactrian camels, respectively. HEV7 is an example of a novel genotype that was found to have significance to human health shortly after discovery. In this review, we summarize recent developments in HEV molecular taxonomy, epidemiology and evolution and describe the discovery of novel camel HEV genotypes as an illustrative example of the changes in this field.
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57
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Genotype-Specific Evolution of Hepatitis E Virus. J Virol 2017; 91:JVI.02241-16. [PMID: 28202767 DOI: 10.1128/jvi.02241-16] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022] Open
Abstract
Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis globally. HEV comprises four genotypes with different geographic distributions and host ranges. We utilize this natural case-control study for investigating the evolution of zoonotic viruses compared to single-host viruses, using 244 near-full-length HEV genomes. Genome-wide estimates of the ratio of nonsynonymous to synonymous evolutionary changes (dN/dS ratio) located a region of overlapping reading frames, which is subject to positive selection in genotypes 3 and 4. The open reading frames (ORFs) involved have functions related to host-pathogen interaction, so genotype-specific evolution of these regions may reflect their fitness. Bayesian inference of evolutionary rates shows that genotypes 3 and 4 have significantly higher rates than genotype 1 across all ORFs. Reconstruction of the phylogenies of zoonotic genotypes demonstrates significant intermingling of isolates between hosts. We speculate that the genotype-specific differences may result from cyclical adaptation to different hosts in genotypes 3 and 4.IMPORTANCE Hepatitis E virus (HEV) is increasingly recognized as a pathogen that affects both the developing and the developed world. While most often clinically mild, HEV can be severe or fatal in certain demographics, such as expectant mothers. Like many other viral pathogens, HEV has been classified into several distinct genotypes. We show that most of the HEV genome is evolutionarily constrained. One locus of positive selection is unusual in that it encodes two distinct protein products. We are the first to detect positive selection in this overlap region. Genotype 1, which infects humans only, appears to be evolving differently from genotypes 3 and 4, which infect multiple species, possibly because genotypes 3 and 4 are unable to achieve the same fitness due to repeated host jumps.
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Molecular Epidemiology and Strain Comparison between Hepatitis E Viruses in Human Sera and Pig Livers during 2014 to 2016 in Hong Kong. J Clin Microbiol 2017; 55:1408-1415. [PMID: 28202801 DOI: 10.1128/jcm.02020-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/08/2017] [Indexed: 12/21/2022] Open
Abstract
Hepatitis E virus (HEV) causes substantial morbidity and mortality in developing countries and is considered an emerging foodborne pathogen in developed countries in which it was previously not endemic. To investigate genetic association between human HEV infection and HEV-contaminated high-risk food in Hong Kong, we compared local virus strains obtained from hepatitis E patient sera with those surveyed from high-risk food items during 2014 to 2016. Twenty-four cases of laboratory-confirmed human HEV infections were identified from January 2014 to March 2016 in our hospitals. Five types of food items at risk of HEV contamination were purchased on a biweekly basis from April 2014 to March 2016 in two local market settings: supermarkets (lamb, oyster, and pig liver) and wet markets (oyster, pig blood curd, pig large intestine, and pig liver). HEV RNA detection was performed by a real-time reverse transcription-PCR assay. HEV RNA was detected in pig liver, pig intestine, and oyster samples with prevalences of 1.5%, 0.4%, and 0.2%, respectively. Neighbor-joining phylogenetic inference showed that all human and swine HEV strains belonged to genotype 4. HEV subtype distributions in humans and swine were highly comparable: subtype 4b predominated, while subtype 4d was the minority. Local human and swine HEV genotype 4 strains shared over 95% nucleotide identity and were genetically very similar, implicating swine as an important foodborne source of autochthonous human HEV infections in Hong Kong. Action should be taken to raise the awareness among public and health care professionals of hepatitis E as an emerging foodborne disease.
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59
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Riveiro-Barciela M, Sauleda S, Quer J, Salvador F, Gregori J, Pirón M, Rodríguez-Frías F, Buti M. Red blood cell transfusion-transmitted acute hepatitis E in an immunocompetent subject in Europe: a case report. Transfusion 2017; 57:244-247. [PMID: 27785789 DOI: 10.1111/trf.13876] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acute hepatitis E in industrialized countries is usually related to intake or manipulation of undercooked or raw meat. Cases of transfusion-transmitted hepatitis E have rarely been documented in immunosuppressed patients, mainly after receiving frozen plasma. STUDY DESIGN AND METHODS A 61-year-old man was admitted to hospital for jaundice. His personal history included disseminated bacillus Calmette-Guerin infection treated with antituberculous drugs. He had received red blood cell (RBC) transfusion 2 months previously, during admission for mycotic aneurysm surgery. Since liver function tests worsened despite stopping antituberculous drugs, other causes of acute hepatitis were explored. RESULTS Acute hepatitis E was diagnosed by the presence of both immunoglobulin M and hepatitis E virus (HEV) RNA. Traceback procedure for the 8 RBC units was carried out, and one of the eight archive plasma samples tested positive for HEV RNA, with an estimated viral load of 75,000 IU/mL. Phylogenetic analysis revealed the same HEV strain Genotype 3 in one of the transfused RBC products and in the patient's serum sample. CONCLUSION Transfusion of RBCs with detectable HEV RNA is a risk factor for acute hepatitis E in immunocompetent patients in Europe.
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Affiliation(s)
- Mar Riveiro-Barciela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia Sauleda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Servei Català de la Salut
| | - Josep Quer
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Internal Medicine, Lab. Malalties Hepàtiques, Vall d'Hebron Institut Recerca-Hospital Universitari Vall d'Hebron (VHIR-HUVH)
| | - Fernando Salvador
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, PROSICS Barcelona
| | - Josep Gregori
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Internal Medicine, Lab. Malalties Hepàtiques, Vall d'Hebron Institut Recerca-Hospital Universitari Vall d'Hebron (VHIR-HUVH)
| | - María Pirón
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Servei Català de la Salut
| | - Francisco Rodríguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Liver Pathology Unit, Departments of Biochemistry and Microbiology (Virology Unit), Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Müller A, Collineau L, Stephan R, Müller A, Stärk KD. Assessment of the risk of foodborne transmission and burden of hepatitis E in Switzerland. Int J Food Microbiol 2017; 242:107-115. [DOI: 10.1016/j.ijfoodmicro.2016.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/11/2016] [Accepted: 11/19/2016] [Indexed: 01/16/2023]
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Wallace SJ, Webb GW, Madden RG, Dalton HC, Palmer J, Dalton RT, Pollard A, Martin R, Panayi V, Bennett G, Bendall RP, Dalton HR. Investigation of liver dysfunction: who should we test for hepatitis E? Eur J Gastroenterol Hepatol 2017; 29:215-220. [PMID: 27832041 DOI: 10.1097/meg.0000000000000781] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM Hepatitis E virus (HEV) is endemic in developed countries, but unrecognized infection is common. Many national guidelines now recommend HEV testing in patients with acute hepatitis irrespective of travel history. The biochemical definition of 'hepatitis' that best predicts HEV infection has not been established. This study aimed to determine parameters of liver biochemistry that should prompt testing for acute HEV. METHODS This was a retrospective study of serial liver function tests (LFTs) in cases of acute HEV (n=74) and three comparator groups: common bile duct stones (CBD, n=87), drug-induced liver injury (DILI, n=69) and patients testing negative for HEV (n=530). To identify the most discriminating parameters, LFTs from HEV cases, CBD and DILI were compared. Optimal LFT cutoffs for HEV testing were determined from HEV true positives and HEV true negatives using receiver operating characteristic curve analysis. RESULTS Compared with CBD and DILI, HEV cases had a significantly higher maximum alanine aminotransferase (ALT) (P<0.001) and ALT/alkaline phosphatase (ALKP) ratio (P<0.001). For HEV cases/patients testing negative for HEV, area under receiver operating characteristic curve was 0.805 for ALT (P<0.001) and 0.749 for the ALT/ALKP ratio (P<0.001). Using an ALT of at least 300 IU/l to prompt HEV testing has a sensitivity of 98.6% and a specificity of 30.3% compared with an ALT/ALKP ratio higher than or equal to 2 (sensitivity 100%, specificity 9.4%). CONCLUSION Patients with ALT higher than or equal to 300 IU/l should be tested for HEV. This is simple, detects nearly all cases and requires fewer samples to be tested than an ALT/ALKP ratio higher than or equal to 2. Where clinically indicated, patients with an ALT less than 300 IU/l should also be tested, particularly if HEV-associated neurological injury is suspected.
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Affiliation(s)
- Sebastian J Wallace
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro, UK
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de Vos AS, Janssen MP, Zaaijer HL, Hogema BM. Cost-effectiveness of the screening of blood donations for hepatitis E virus in the Netherlands. Transfusion 2017; 57:258-266. [DOI: 10.1111/trf.13978] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/10/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Anneke S. de Vos
- Transfusion Technology Assessment Unit; Sanquin Research; Amsterdam the Netherlands
| | - Mart P. Janssen
- Transfusion Technology Assessment Unit; Sanquin Research; Amsterdam the Netherlands
| | - Hans L. Zaaijer
- Department of Blood-Borne Infections; Sanquin Research; Amsterdam the Netherlands
| | - Boris M. Hogema
- Department of Blood-Borne Infections; Sanquin Research; Amsterdam the Netherlands
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Miura M, Inoue J, Tsuruoka M, Nishizawa T, Nagashima S, Takahashi M, Shimosegawa T, Okamoto H. Full-length genomic sequence analysis of new subtype 3k hepatitis E virus isolates with 99.97% nucleotide identity obtained from two consecutive acute hepatitis patients in a city in northeast Japan. J Med Virol 2016; 89:1116-1120. [PMID: 27922191 DOI: 10.1002/jmv.24743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 12/27/2022]
Abstract
Full-length genomic sequences of hepatitis E virus (HEV) obtained from two consecutive cases of acute self-limiting hepatitis E in a city in northeast Japan were determined. Interestingly, two HEV isolates from each patient shared nucleotide identity of 99.97% in 7 225 nucleotides, and a phylogenetic analysis showed that they formed a cluster of Japanese isolates that is considered as a new HEV subtype 3k. The high similarity of HEV sequences of two isolates from these patients in this study suggested that a subtype 3k HEV strain had spread via a commonly distributed food in the city, possibly pig liver.
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Affiliation(s)
- Masahito Miura
- Department of Gastroenterology, Omagari Kousei Medical Center, Omagari, Japan
| | - Jun Inoue
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mio Tsuruoka
- Department of Gastroenterology, Omagari Kousei Medical Center, Omagari, Japan
| | - Tsutomu Nishizawa
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Shigeo Nagashima
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Masaharu Takahashi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
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Doceul V, Bagdassarian E, Demange A, Pavio N. Zoonotic Hepatitis E Virus: Classification, Animal Reservoirs and Transmission Routes. Viruses 2016; 8:v8100270. [PMID: 27706110 PMCID: PMC5086606 DOI: 10.3390/v8100270] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/22/2016] [Indexed: 12/11/2022] Open
Abstract
During the past ten years, several new hepatitis E viruses (HEVs) have been identified in various animal species. In parallel, the number of reports of autochthonous hepatitis E in Western countries has increased as well, raising the question of what role these possible animal reservoirs play in human infections. The aim of this review is to present the recent discoveries of animal HEVs and their classification within the Hepeviridae family, their zoonotic and species barrier crossing potential, and possible use as models to study hepatitis E pathogenesis. Lastly, this review describes the transmission pathways identified from animal sources.
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Affiliation(s)
- Virginie Doceul
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Animal Health Laboratory, UMR (joint research unit) 1161 Virology, 94701 Maisons-Alfort, France.
- French National Institute for Agricultural Research (INRA), UMR (joint research unit) 1161 Virology, 94700 Maisons-Alfort, France.
- Association of Universities and High Education Institutions (ComUE), Paris-Est Créteil Val-de-Marne University, National Veterinary School, UMR (joint research unit) 1161 Virology, 94700 Maisons-Alfort, France.
| | - Eugénie Bagdassarian
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Animal Health Laboratory, UMR (joint research unit) 1161 Virology, 94701 Maisons-Alfort, France.
- French National Institute for Agricultural Research (INRA), UMR (joint research unit) 1161 Virology, 94700 Maisons-Alfort, France.
- Association of Universities and High Education Institutions (ComUE), Paris-Est Créteil Val-de-Marne University, National Veterinary School, UMR (joint research unit) 1161 Virology, 94700 Maisons-Alfort, France.
| | - Antonin Demange
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Animal Health Laboratory, UMR (joint research unit) 1161 Virology, 94701 Maisons-Alfort, France.
- French National Institute for Agricultural Research (INRA), UMR (joint research unit) 1161 Virology, 94700 Maisons-Alfort, France.
- Association of Universities and High Education Institutions (ComUE), Paris-Est Créteil Val-de-Marne University, National Veterinary School, UMR (joint research unit) 1161 Virology, 94700 Maisons-Alfort, France.
| | - Nicole Pavio
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Animal Health Laboratory, UMR (joint research unit) 1161 Virology, 94701 Maisons-Alfort, France.
- French National Institute for Agricultural Research (INRA), UMR (joint research unit) 1161 Virology, 94700 Maisons-Alfort, France.
- Association of Universities and High Education Institutions (ComUE), Paris-Est Créteil Val-de-Marne University, National Veterinary School, UMR (joint research unit) 1161 Virology, 94700 Maisons-Alfort, France.
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65
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Shrestha AC, Flower RL, Seed CR, Keller AJ, Harley R, Chan HT, Hoad V, Warrilow D, Northill J, Holmberg JA, Faddy HM. Hepatitis E virus RNA in Australian blood donations. Transfusion 2016; 56:3086-3093. [DOI: 10.1111/trf.13799] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/16/2016] [Accepted: 07/17/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Ashish C. Shrestha
- Research and Development; The University of Queenslan; Brisbane Queensland Australia
- School of Medicine; The University of Queenslan; Brisbane Queensland Australia
| | - Robert L.P. Flower
- Research and Development; The University of Queenslan; Brisbane Queensland Australia
| | - Clive R. Seed
- Medical Services; Australian Red Cross Blood Servic; Brisbane Queensland Australia
| | - Anthony J. Keller
- Medical Services; Australian Red Cross Blood Servic; Brisbane Queensland Australia
| | - Robert Harley
- Medical Services; Australian Red Cross Blood Servic; Brisbane Queensland Australia
| | - Hiu-Tat Chan
- Medical Services; Australian Red Cross Blood Servic; Brisbane Queensland Australia
| | - Veronica Hoad
- Medical Services; Australian Red Cross Blood Servic; Brisbane Queensland Australia
| | - David Warrilow
- Public Health Virology Laboratory, Forensic and Scientific Services; Queensland Healt; Brisbane Queensland Australia
| | - Judith Northill
- Public Health Virology Laboratory, Forensic and Scientific Services; Queensland Healt; Brisbane Queensland Australia
| | | | - Helen M. Faddy
- Research and Development; The University of Queenslan; Brisbane Queensland Australia
- School of Medicine; The University of Queenslan; Brisbane Queensland Australia
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66
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First Directly Sequenced Genome of Hepatitis E Virus from the Serum of a Patient from the United Kingdom. GENOME ANNOUNCEMENTS 2016; 4:4/5/e00931-16. [PMID: 27634993 PMCID: PMC5026433 DOI: 10.1128/genomea.00931-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hepatitis E virus (HEV) genotype 3 is endemic in the United Kingdom but the complete sequence of HEV, generated directly from a clinical sample, is lacking. We report a near full-length genome sequence of genotype 3 HEV from the serum of a patient with acute hepatitis.
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67
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Adlhoch C, Avellon A, Baylis SA, Ciccaglione AR, Couturier E, de Sousa R, Epštein J, Ethelberg S, Faber M, Fehér Á, Ijaz S, Lange H, Manďáková Z, Mellou K, Mozalevskis A, Rimhanen-Finne R, Rizzi V, Said B, Sundqvist L, Thornton L, Tosti ME, van Pelt W, Aspinall E, Domanovic D, Severi E, Takkinen J, Dalton HR. Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15. J Clin Virol 2016; 82:9-16. [DOI: 10.1016/j.jcv.2016.06.010] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/19/2016] [Indexed: 01/10/2023]
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68
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O'Riordan J, Boland F, Williams P, Donnellan J, Hogema BM, Ijaz S, Murphy WG. Hepatitis E virus infection in the Irish blood donor population. Transfusion 2016; 56:2868-2876. [DOI: 10.1111/trf.13757] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Joan O'Riordan
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
| | - Fiona Boland
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
| | - Padraig Williams
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
| | - Joe Donnellan
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
| | - Boris M. Hogema
- Departments of Blood-borne Infections and Virology; Sanquin Research and Diagnostic Services; Amsterdam the Netherlands
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department; National Infection Service, Public Health England; London UK
| | - William G. Murphy
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
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69
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Harritshøj LH, Holm DK, Saekmose SG, Jensen BA, Hogema BM, Fischer TK, Midgley SE, Krog JS, Erikstrup C, Ullum H. Low transfusion transmission of hepatitis E among 25,637 single-donation, nucleic acid-tested blood donors. Transfusion 2016; 56:2225-32. [PMID: 27385646 DOI: 10.1111/trf.13700] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hepatitis E virus genotype-3 (HEV-gt-3) causes autochthonous infections in western countries, with a primary reservoir in animals, especially pigs. HEV transfusion transmission has been reported, and HEV-gt-3 prevalence is high in some European countries. The prevalence of HEV RNA was investigated among Danish blood donors, and the prevalence of HEV transfusion-transmitted infection (TTI) was investigated among recipients. STUDY DESIGN AND METHODS Samples from 25,637 consenting donors collected during 1 month in 2015 were screened retrospectively using an individual-donation HEV RNA nucleic acid test with a 95% detection probability of 7.9 IU/mL. HEV-positive samples were quantified by real-time polymerase chain reaction and genotyped. Transmission was evaluated among recipients of HEV RNA-positive blood components. Phylogenetic analyses compared HEV sequences from blood donors, symptomatic patients, and swine. RESULTS Eleven donations (0.04%) were confirmed as positive for HEV RNA (median HEV RNA level, 13 IU/mL). Two donations were successfully genotyped as HEV-gt-3. Only one donor had a travel history outside Europe. Nine of 11 donors were male, but the gender ratio was nonsignificant compared with the total donor population. Seven available recipients tested negative for HEV RNA and anti-HEV immunoglobulin M in follow-up samples. One recipient was HEV RNA-negative but anti-HEV immunoglobulin G-positive. HEV TTI was considered unlikely, but a transfusion-induced secondary immune response could not be excluded. Phylogenetic analysis showed relatively large sequence differences between HEV from donors, symptomatic patients, and swine. CONCLUSIONS Despite an HEV RNA prevalence of 0.04% in Danish blood donations, all HEV-positive donations carried low viral loads, and no evidence of TTI was found.
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Affiliation(s)
- Lene H Harritshøj
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Bitten A Jensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Boris M Hogema
- Departments of Blood-borne Infections and Virology, Sanquin Research and Diagnostic Services, Amsterdam, the Netherlands
| | - Thea K Fischer
- Virus Surveillance and Research Section, Statens Serum Institute, Copenhagen, Denmark
| | - Sofie E Midgley
- Virus Surveillance and Research Section, Statens Serum Institute, Copenhagen, Denmark
| | - Jesper S Krog
- Section for Diagnostics and Scientific Advice, National Veterinary Institute, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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70
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Servant-Delmas A, Abravanel F, Lefrère JJ, Lionnet F, Hamon C, Izopet J, Laperche S. New insights into the natural history of hepatitis E virus infection through a longitudinal study of multitransfused immunocompetent patients in France. J Viral Hepat 2016; 23:569-75. [PMID: 26990022 DOI: 10.1111/jvh.12531] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/19/2016] [Indexed: 12/13/2022]
Abstract
Little is known about the natural history of Hepatitis E virus (HEV) infection in immunocompetent individuals. The prevalence, the course of infection and the occurrence of transmission by transfusion were investigated in multitransfused immunocompetent patients/blood donor pairs included in a longitudinal sample repository collection and followed up between 1988 and 2010. Ninety-eight subjects aged 6-89 years and suffering from acquired haemoglobinopathies were tested for HEV markers (IgM, IgG and RNA) in serial samples collected every 2 or 3 years. Eighteen patients (18.4%) were positive for HEV-IgG at baseline with a prevalence increasing from 12.5% below 26 years to 32% above 56 years. Nine patients remained IgG positive along the study and nine lost their antibodies after a mean follow-up of 7.4 years (1-22 years). One seropositive patient showed an increase of IgG level and RNA-HEV reappearance 1 year after inclusion, suggesting a reinfection and one seroconversion, probably acquired through blood transfusion was observed. This first longitudinal study including immunocompetent individuals confirms that HEV infection is common in Western Europe and that transfusion transmission occurs probably less frequently than expected. In addition, seroreversion and reinfection seem to be common. This suggests that the anti-HEV may not persist overtime naturally. However, repeat exposure to the virus related to the high prevalence of HEV infection may result in a sustainable specific IgG response.
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Affiliation(s)
- A Servant-Delmas
- Institut National de la Transfusion Sanguine (INTS), Département d'études des Agents Transmissibles par le Sang, Centre national de référence des hépatites virales B et C et du VIH en Transfusion, Paris, France
| | - F Abravanel
- Centre National de Référence Hépatite E, Institut Fédératif de Biologie, CHU Toulouse, Université Toulouse III, Toulouse, France.,INSERM U1043, Toulouse, France
| | - J-J Lefrère
- Institut National de la Transfusion Sanguine (INTS), Département d'études des Agents Transmissibles par le Sang, Centre national de référence des hépatites virales B et C et du VIH en Transfusion, Paris, France.,Université Paris-Descartes, Paris, France
| | - F Lionnet
- Hematology Unit, Tenon Hospital, AP-HP, Paris, France
| | - C Hamon
- Institut National de la Transfusion Sanguine (INTS), Département d'études des Agents Transmissibles par le Sang, Centre national de référence des hépatites virales B et C et du VIH en Transfusion, Paris, France
| | - J Izopet
- Centre National de Référence Hépatite E, Institut Fédératif de Biologie, CHU Toulouse, Université Toulouse III, Toulouse, France.,INSERM U1043, Toulouse, France
| | - S Laperche
- Institut National de la Transfusion Sanguine (INTS), Département d'études des Agents Transmissibles par le Sang, Centre national de référence des hépatites virales B et C et du VIH en Transfusion, Paris, France
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71
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Thermal Stability of Hepatitis E Virus as Estimated by a Cell Culture Method. Appl Environ Microbiol 2016; 82:4225-4231. [PMID: 27208095 DOI: 10.1128/aem.00951-16] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/29/2016] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Hepatitis E virus (HEV) is an increasingly recognized zoonotic pathogen. Transmission is suspected to occur from infected pigs or wild boars to humans through direct contact, environmental pathways, or contaminated food. However, the physical and chemical stability of HEV is largely unknown, because suitable cell culture methods for infectivity measurement are missing. Here, we developed a titration method using infection of the cell line A549/D3 with HEV genotype 3 strain 47832c and subsequent counting of focus-forming units by immunofluorescence, which allowed HEV infectivity measurements within a 4-log-dilution range. Long-term storage of HEV in cell culture medium at different temperatures indicated a phase of rapid virus inactivation, followed by a slower progression of virus inactivation. Infective HEV was detected up to 21 days at 37°C, up to 28 days at room temperature, and until the end of the experiment (56 days) with a 2.7-log decrease of infectious virus at 4°C. Heat treatment for 1 min resulted in moderate decreases of infectivity up to 60°C, 2- to 3.5-log decreases between 65°C and 75°C, and no remaining virus was detected at temperatures of ≥80°C. Heating for 70°C resulted in a 3.6-log decrease after 1.5 min and the absence of detectable virus (>3.9-log decrease) after 2 min. The data were used to calculate predictive heat inactivation models for HEV. The results may help estimate HEV stability in the environment or food. The established method may be used to study other aspects of HEV stability in the future. IMPORTANCE In this study, a cell culture method was developed which allows the measurement of hepatitis E virus (HEV) infectivity. Using this system, the stability of HEV at different time-temperature combinations was assessed, and a predictive model was established. The obtained data may help estimate HEV stability in the environment or food, thus enabling an assessment of the relative risks of HEV infection through distinct routes and by distinct types of food in the future.
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72
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Kuniholm MH, Ong E, Hogema BM, Koppelman M, Anastos K, Peters MG, Seaberg EC, Chen Y, Nelson KE, Linnen JM. Acute and Chronic Hepatitis E Virus Infection in Human Immunodeficiency Virus-Infected U.S. Women. Hepatology 2016; 63:712-20. [PMID: 26646162 PMCID: PMC4764464 DOI: 10.1002/hep.28384] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/03/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Exposure to hepatitis E virus (HEV) is common in the United States, but there are few data on prevalence of HEV/human immunodeficiency virus (HIV) coinfection in U.S. POPULATIONS We tested 2,919 plasma samples collected from HIV-infected (HIV(+)) women and men enrolled in U.S. cohort studies for HEV viremia using a high-throughput nucleic acid testing (NAT) platform. NAT(+) samples were confirmed by real-time polymerase chain reaction. Samples were selected for testing primarily on the basis of biomarkers of liver disease and immune suppression. Prevalence of HEV viremia was 3 of 2,606 and 0 of 313 in tested plasma samples collected from HIV(+) women and men, respectively. All HEV isolates were genotype 3a. Based on follow-up testing of stored samples, 1 woman had chronic HEV infection for >4 years whereas 2 women had acute HEV detectable at only a single study visit. CONCLUSIONS To our knowledge, this is the first reported case of chronic HEV infection in an HIV(+) U.S. individual. We also confirm that chronic HEV infection can persist despite a CD4(+) count >200 cells/mm(3). Overall, though, these data suggest that HEV infection is rare in the HIV(+) U.S. population.
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Affiliation(s)
- Mark H. Kuniholm
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Boris M. Hogema
- Sanquin Research and Diagnostics, Departments of Virology, Blood-borne Infections and the National Screening Laboratory, Amsterdam, the Netherlands
| | - Marco Koppelman
- Sanquin Research and Diagnostics, Departments of Virology, Blood-borne Infections and the National Screening Laboratory, Amsterdam, the Netherlands
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA,Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Marion G. Peters
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Eric C. Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yue Chen
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kenrad E. Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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73
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Grierson S, Heaney J, Cheney T, Morgan D, Wyllie S, Powell L, Smith D, Ijaz S, Steinbach F, Choudhury B, Tedder RS. Prevalence of Hepatitis E Virus Infection in Pigs at the Time of Slaughter, United Kingdom, 2013. Emerg Infect Dis 2016. [PMID: 26196216 PMCID: PMC4517718 DOI: 10.3201/eid2108.141995] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pigs raised in the United Kingdom are unlikely to be the source of UK human infections. Since 2010, reports of infection with hepatitis E virus (HEV) have increased in England and Wales. Despite mounting evidence regarding the zoonotic potential of porcine HEV, there are limited data on its prevalence in pigs in the United Kingdom. We investigated antibody prevalence, active infection, and virus variation in serum and cecal content samples from 629 pigs at slaughter. Prevalence of antibodies to HEV was 92.8% (584/629), and HEV RNA was detected in 15% of cecal contents (93/629), 3% of plasma samples (22/629), and 2% of both (14/629). However, although HEV is prevalent in pigs in the United Kingdom and viremic pigs are entering the food chain, most (22/23) viral sequences clustered separately from the dominant type seen in humans. Thus, pigs raised in the United Kingdom are unlikely to be the main source of human HEV infections in the United Kingdom. Further research is needed to identify the source of these infections.
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74
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Wang X, Li M, Li S, Wu T, Zhang J, Xia N, Zhao Q. Prophylaxis against hepatitis E: at risk populations and human vaccines. Expert Rev Vaccines 2016; 15:815-27. [PMID: 26775537 DOI: 10.1586/14760584.2016.1143365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatitis E is an emerging global disease caused by hepatitis E virus (HEV) infection. While in developing countries the infection was primarily due to poor sanitary conditions through intake of contaminated water or undercooked meats of infected animals, increasing cases of chronic hepatitis E resulting in rapidly progressive liver cirrhosis and end-stage liver disease have been reported in organ transplant patients or in immune compromised patients in developed countries. Fortunately, hepatitis E is now a vaccine preventable disease with a HEV239 based vaccine licensed for human use. Much work is needed to enable its use outside China. This review recounted the development process of the vaccine, outlined the critical quality attributes of the vaccine antigen and, most importantly, listed the populations at risk for HEV infection and the subsequent disease. These at risk populations could benefit the most from the vaccination if the vaccine is widely adopted.
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Affiliation(s)
- Xin Wang
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases , Xiamen University , Xiamen , PR China.,b School of Public Health , Xiamen University , Xiamen , PR China
| | - Min Li
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases , Xiamen University , Xiamen , PR China.,b School of Public Health , Xiamen University , Xiamen , PR China
| | - Shaowei Li
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases , Xiamen University , Xiamen , PR China.,b School of Public Health , Xiamen University , Xiamen , PR China.,c School of Life Science , Xiamen University , Xiamen , PR China
| | - Ting Wu
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases , Xiamen University , Xiamen , PR China.,b School of Public Health , Xiamen University , Xiamen , PR China.,c School of Life Science , Xiamen University , Xiamen , PR China
| | - Jun Zhang
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases , Xiamen University , Xiamen , PR China.,b School of Public Health , Xiamen University , Xiamen , PR China.,c School of Life Science , Xiamen University , Xiamen , PR China
| | - Ningshao Xia
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases , Xiamen University , Xiamen , PR China.,b School of Public Health , Xiamen University , Xiamen , PR China.,c School of Life Science , Xiamen University , Xiamen , PR China
| | - Qinjian Zhao
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases , Xiamen University , Xiamen , PR China.,b School of Public Health , Xiamen University , Xiamen , PR China
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75
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Tedder RS, Tettmar KI, Brailsford SR, Said B, Ushiro-Lumb I, Kitchen A, Morgan D, Lattimore S, Tossell J, Ijaz S, Hewitt PE. Virology, serology, and demography of hepatitis E viremic blood donors in South East England. Transfusion 2016; 56:1529-36. [PMID: 26841005 DOI: 10.1111/trf.13498] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/06/2015] [Accepted: 12/06/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hepatitis E virus (HEV) Genotype 3 (G3) in England comprises two principal phylogenetic groups (Group 1 and Group 2) and can be transmitted by transfusion. Unselected screening identified 79 viremic donors; 76 participated in a follow-up study. STUDY DESIGN AND METHODS Viral RNA dynamics, phylogenetics, and seroconversion were characterized in the donors. Detailed demographic, travel, clinical, and lifestyle questionnaires were undertaken. RESULTS The majority of viremic individuals (57/79) were seronegative at time of donation but all seroconverted. Viremia was short-lived, with a median of 6.5 weeks to confirmed viral clearance. All infections were acquired in the United Kingdom and were G3, with Group 2 viruses predominating (43/54; 80%). Infection was associated with some clinical symptoms both at and after donation (8/77; 10%). Viral loads and symptoms were more pronounced in Group 1 infections. There was no serologic evidence of reinfection. Donors were more commonly male (p = 0.002); both male and female donors were older than comparator donors. Animal contact was unlikely to be the source of infection. Consumption of chicken and pig meat was common to all infected donors; processed pig meat was most commonly purchased from one particular retail chain. CONCLUSION Viremic donors represent primary infection in older members of the community and reflect a widespread zoonotic in the United Kingdom. The two phylogenetic groups of HEV G3 display different pathogenicity and the more common Group 2 appears less adapted to humans. There are no objective demographic criteria that can identify donors at enhanced HEV risk.
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Affiliation(s)
- Richard S Tedder
- Microbiology Services, National Health Service Blood and Transplant, London.,Blood Borne Virus Unit, Virus Reference Department, National Infection Service.,University College London, London, UK
| | - Kate I Tettmar
- Microbiology Services, National Health Service Blood and Transplant, London.,Blood Borne Virus Unit, Virus Reference Department, National Infection Service
| | - Su R Brailsford
- Microbiology Services, National Health Service Blood and Transplant, London.,NHSBT/PHE Epidemiology Unit, Department of Immunisation, Hepatitis and Blood Safety
| | - Bengu Said
- Emerging Infections and Zoonoses, National Infection Service, Public Health England, London
| | - Ines Ushiro-Lumb
- Microbiology Services, National Health Service Blood and Transplant, London.,Blood Borne Virus Unit, Virus Reference Department, National Infection Service
| | - Alan Kitchen
- Microbiology Services, National Health Service Blood and Transplant, London
| | - Dilys Morgan
- Emerging Infections and Zoonoses, National Infection Service, Public Health England, London
| | - Sam Lattimore
- NHSBT/PHE Epidemiology Unit, Department of Immunisation, Hepatitis and Blood Safety
| | - Joanne Tossell
- Microbiology Services, National Health Service Blood and Transplant, London
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service
| | - Patricia E Hewitt
- Microbiology Services, National Health Service Blood and Transplant, London
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76
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Smith DB, Simmonds P, Izopet J, Oliveira-Filho EF, Ulrich RG, Johne R, Koenig M, Jameel S, Harrison TJ, Meng XJ, Okamoto H, Van der Poel WHM, Purdy MA. Proposed reference sequences for hepatitis E virus subtypes. J Gen Virol 2016; 97:537-542. [PMID: 26743685 DOI: 10.1099/jgv.0.000393] [Citation(s) in RCA: 306] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The nomenclature of hepatitis E virus (HEV) subtypes is inconsistent and makes comparison of different studies problematic. We have provided a table of proposed complete genome reference sequences for each subtype. The criteria for subtype assignment vary between different genotypes and methodologies, and so a conservative pragmatic approach has been favoured. Updates to this table will be posted on the International Committee on Taxonomy of Viruses website (http://talk.ictvonline.org/r.ashx?C). The use of common reference sequences will facilitate communication between researchers and help clarify the epidemiology of this important human pathogen. This subtyping procedure might be adopted for other taxa of the genus Orthohepevirus.
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Affiliation(s)
- Donald B Smith
- University of Edinburgh, Centre for Immunity, Infection and Evolution, Edinburgh, Scotland, UK
| | - Peter Simmonds
- University of Edinburgh, Centre for Immunity, Infection and Evolution, Edinburgh, Scotland, UK
| | | | - Edmilson F Oliveira-Filho
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, Fundamental and Applied Research for Animal Health Centre, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Rainer G Ulrich
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute for Novel and Emerging Infectious Diseases, Greifswald - Insel Riems, Germany.,German Center for Infection Research DZIF, partner site Hamburg-Luebeck-Borstel-Insel Riems, Germany
| | - Reimar Johne
- Federal Institute for Risk Assessment, Berlin, Germany
| | | | - Shahid Jameel
- The Wellcome Trust/DBT India Alliance, Hyderabad, India
| | | | - Xiang-Jin Meng
- College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi-ken, Japan
| | - Wim H M Van der Poel
- Central Veterinary Institute, Wageningen University and Research Centre, Lelystad, The Netherlands
| | - Michael A Purdy
- Centers for Disease Control and Prevention, National Center for HIV/Hepatitis/STD/TB Prevention, Division of Viral Hepatitis, Atlanta, GA, USA
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77
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Kokki I, Smith D, Simmonds P, Ramalingam S, Wellington L, Willocks L, Johannessen I, Harvala H. Hepatitis E virus is the leading cause of acute viral hepatitis in Lothian, Scotland. New Microbes New Infect 2015; 10:6-12. [PMID: 26904201 PMCID: PMC4726789 DOI: 10.1016/j.nmni.2015.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 12/12/2022] Open
Abstract
Acute viral hepatitis affects all ages worldwide. Hepatitis E virus (HEV) is increasingly recognized as a major cause of acute hepatitis in Europe. Because knowledge of its characteristics is limited, we conducted a retrospective study to outline demographic and clinical features of acute HEV in comparison to hepatitis A, B and C in Lothian over 28 months (January 2012 to April 2014). A total of 3204 blood samples from patients with suspected acute hepatitis were screened for hepatitis A, B and C virus; 913 of these samples were also screened for HEV. Demographic and clinical information on patients with positive samples was gathered from electronic patient records. Confirmed HEV samples were genotyped. Of 82 patients with confirmed viral hepatitis, 48 (59%) had acute HEV. These patients were older than those infected by hepatitis A, B or C viruses, were more often male and typically presented with jaundice, nausea, vomiting and/or malaise. Most HEV cases (70%) had eaten pork or game meat in the few months before infection, and 14 HEV patients (29%) had a recent history of foreign travel. The majority of samples were HEV genotype 3 (27/30, 90%); three were genotype 1. Acute HEV infection is currently the predominant cause of acute viral hepatitis in Lothian and presents clinically in older men. Most of these infections are autochthonous, and further studies confirming the sources of infection (i.e. food or blood transfusion) are required.
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Affiliation(s)
- I Kokki
- Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D Smith
- CIIE, University of Edinburgh, King's Buildings, Edinburgh, UK
| | - P Simmonds
- Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, UK
| | - S Ramalingam
- Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - L Wellington
- Public Health and Health Policy and NHS Lothian, Edinburgh, UK
| | - L Willocks
- Public Health and Health Policy and NHS Lothian, Edinburgh, UK
| | - I Johannessen
- Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - H Harvala
- Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK; Public Health Agency of Sweden, Solna, Sweden; European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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78
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Smith DB, Paddy JO, Simmonds P. The use of human sewage screening for community surveillance of hepatitis E virus in the UK. J Med Virol 2015; 88:915-8. [PMID: 26461450 PMCID: PMC4832372 DOI: 10.1002/jmv.24403] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 12/16/2022]
Abstract
Hepatitis E virus sequences were detected by RT‐PCR in 14/15 (93%) of untreated sewage samples from Edinburgh, Scotland, UK. Phylogenetic analysis of amplicons at limiting dilution revealed the co‐circulation of multiple variants of HEV‐3, with a pattern of diversity matching that observed in a local cohort of HEV‐infected hepatitis patients. J. Med. Virol. 88:915–918, 2016. © 2015 The Authors. Journal of Medical Virology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Donald B Smith
- CIIE, Ashworth Laboratories, King's Buildings, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Julius O Paddy
- Roslin Institute, Easter Bush, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Peter Simmonds
- Roslin Institute, Easter Bush, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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79
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De Schryver A, De Schrijver K, François G, Hambach R, van Sprundel M, Tabibi R, Colosio C. Hepatitis E virus infection: an emerging occupational risk? Occup Med (Lond) 2015; 65:667-72. [PMID: 26452392 DOI: 10.1093/occmed/kqv154] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) infection is endemic in many developing countries, causing substantial morbidity. Transmission is primarily faeco-oral and is associated with both sporadic infections and epidemics in areas where poor sanitation and weak public health infrastructures exist. Recently, it has become clear that HEV is also an endemic disease in industrialized countries. Moreover, a porcine reservoir and growing evidence of zoonotic transmission have been reported in these countries, suggesting the possibility of occupational transmission to man. AIMS To summarize the current knowledge on the epidemiology and prevention of transmission of HEV infection in occupational settings. METHODS The following key words were used to explore PubMed: hepatitis E, disease, epidemiology, profession(al), occupation(al). RESULTS After screening of the results, 107 publications were retained. In non-endemic regions, seroprevalence varied from a few per cent (2-7.8%) in Europe, Japan and South America to 18.2-20.6% in the USA, Russia, UK, southern France and Asia. A meta-analysis of 12 cross-sectional studies evaluating HEV immunoglobulin G (IgG) seroprevalence in individuals occupationally exposed to swine showed greater odds of seropositivity in the exposed group but also a high degree of heterogeneity. A funnel plot suggested publication bias. CONCLUSIONS There was a significant association between occupational exposure to swine and HEV IgG seroprevalence, but the level of prevalence detected depended also on the type of HEV IgG kits used. Further research, including on mechanisms and risk factors for infection, as well as the development of better serological tests for identification of infection, is required.
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Affiliation(s)
- A De Schryver
- IDEWE Occupational Health Services, 3001 Leuven, Belgium, Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium,
| | - K De Schrijver
- Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - G François
- Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - R Hambach
- Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - M van Sprundel
- Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - R Tabibi
- Department of Health Sciences, University of Milan and International Centre for Rural Health, University Hospital San Paolo of Milan, 20142 Milan, Italy
| | - C Colosio
- Department of Health Sciences, University of Milan and International Centre for Rural Health, University Hospital San Paolo of Milan, 20142 Milan, Italy
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80
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Smith DB, Ijaz S, Tedder RS, Hogema B, Zaaijer HL, Izopet J, Bradley-Stewart A, Gunson R, Harvala H, Kokki I, Simmonds P. Variability and pathogenicity of hepatitis E virus genotype 3 variants. J Gen Virol 2015; 96:3255-3264. [PMID: 26282123 PMCID: PMC4806580 DOI: 10.1099/jgv.0.000264] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Infection with hepatitis E virus (HEV) can be clinically inapparent or produce symptoms and signs of hepatitis of varying severity and occasional fatality. This variability in clinical outcomes may reflect differences in host susceptibility or the presence of virally encoded determinants of pathogenicity. Analysis of complete genome sequences supports the division of HEV genotype 3 (HEV-3) variants into three major clades: 3ra comprising HEV isolates from rabbits, and 3efg and 3abchij comprising the corresponding named subtypes derived from humans and pigs. Using this framework, we investigated associations between viral genetic variability of HEV-3 in symptomatic and asymptomatic infections by comparing HEV-3 subgenomic sequences previously obtained from blood donors with those from patients presenting with hepatitis in the UK (54 blood donors, 148 hepatitis patients), the Netherlands (38 blood donors, 119 hepatitis patients), France (24 blood donors, 55 hepatitis patients) and Germany (14 blood donors, 36 hepatitis patients). In none of these countries was evidence found for a significant association between virus variants and patient group (P>0.05 Fisher's exact test). Furthermore, within a group of 123 patients in Scotland with clinically apparent HEV infections, we found no evidence for an association between variants of HEV-3 and disease severity or alanine aminotransferase level. The lack of detectable virally encoded determinants of disease outcomes in HEV-3 infection implies a more important role for host factors in its clinical phenotype.
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Affiliation(s)
- Donald B Smith
- University of Edinburgh, CIIE, Ashworth Laboratories, King's Buildings, Edinburgh EH9 3FL, UK
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department, MS-Colindale, Public Health England, London NW9 5EQ, UK
| | - Richard S Tedder
- Blood Borne Virus Unit, Virus Reference Department, MS-Colindale, Public Health England, London NW9 5EQ, UK.,University College London, Gower Street, London WC1E 6BT, UK
| | - Boris Hogema
- Department of Blood-borne Infections, Sanquin Research, PO Box 9190, 1006 AD Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Sanquin Research, PO Box 9190, 1006 AD Amsterdam, The Netherlands
| | - Jacques Izopet
- Institut National de la Sante et de la Recherche Medicale Unite 1043, Toulouse, France
| | | | - Rory Gunson
- West of Scotland Specialist Virology Centre, New Lister Building, Glasgow, UK
| | - Heli Harvala
- Specialist Virology Centre, Royal Infirmary of Edinburgh, UK.,Public Health Agency of Sweden (previously Swedish Institute for Communicable Disease Control), Solna, Sweden.,European Programme for Public Health Microbiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Inka Kokki
- Specialist Virology Centre, Royal Infirmary of Edinburgh, UK
| | - Peter Simmonds
- University of Edinburgh, Roslin Institute, Easter Bush, Edinburgh EH25 9RG, UK
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81
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Nouhin J, Barennes H, Madec Y, Prak S, Hou SV, Kerleguer A, Kim S, Pean P, Rouet F. Low frequency of acute hepatitis E virus (HEV) infections but high past HEV exposure in subjects from Cambodia with mild liver enzyme elevations, unexplained fever or immunodeficiency due to HIV-1 infection. J Clin Virol 2015; 71:22-7. [PMID: 26370310 DOI: 10.1016/j.jcv.2015.07.304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/08/2015] [Accepted: 07/26/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND In Cambodia, previous studies conducted on hepatitis E virus (HEV) infection are scant, sometimes old, and showed inconsistent results. Moreover, there is no data about HEV infection in Cambodian HIV-1-infected patients. OBJECTIVES To assess the occurrence of acute HEV infections and the level of past HEV exposure in one Mekong country. STUDY DESIGN Using anti-HEV IgM and HEV RNA detection, we retrospectively investigated the presence of acute HEV infection in 825 individuals, including 350 subjects with or without fever, 300 subjects with or without liver enzyme elevations (LEE) and 175 antiretroviral treatment (ART)-naïve, severely immunocompromised HIV-1-infected patients. The detection of anti-HEV IgG was also performed to assess ancient HEV exposure. RESULTS Nine individuals tested positive for anti-HEV IgM yielding an overall rate of 1.1% (95% confidence interval (CI), 0.5-2.0). We did not find significant differences for anti-HEV IgM rates between subjects with unexplained fevers (1.5%) and those with malaria or dengue-associated fever (1.7%) or non-febrile individuals (0%) (P=0.49), and between subjects with (1.5%) and without (2.0%) LEE (P=0.87). No HIV-infected patient tested positive for anti-HEV IgM. HEV RNA was not detected in all tested plasma specimens (n=578). Overall, the anti-HEV IgG prevalence rate was 30.1% (95% CI, 27.0-33.2). CONCLUSIONS The scarcity of recent HEV infection contrasted with the high level of past HEV exposure. The role of HEV in liver disease is likely minor in Cambodia since no HEV RNA was detected in our studied populations, including HIV-positive patients with severe immunodepression.
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Affiliation(s)
- Janin Nouhin
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Hubert Barennes
- Epidemiology and Public Health Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Yoann Madec
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Sophearot Prak
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Serey Vannak Hou
- Medical Laboratory, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | | | - Saorin Kim
- Malaria Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Polidy Pean
- Immunology Platform, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - François Rouet
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia.
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82
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Lhomme S, Abravanel F, Dubois M, Chapuy-Regaud S, Sandres-Saune K, Mansuy JM, Rostaing L, Kamar N, Izopet J. Temporal evolution of the distribution of hepatitis E virus genotypes in Southwestern France. INFECTION GENETICS AND EVOLUTION 2015. [PMID: 26218544 DOI: 10.1016/j.meegid.2015.07.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Southwest France is a highly endemic region for hepatitis E virus (HEV). This study examined the circulation of HEV strains between 2003 and 2014 in the Midi-Pyrénées, and compared these data with those from the rest of France. The polyproline region (PPR) of the ORF1 region of the HEV genome was also analyzed. HEV genotype was determined by sequencing a 348-nt fragment within the ORF2 gene for 333 strains in the Midi-Pyrénées and for 571 strains from the rest of France. PPR region was characterized for 56 strains. The frequency of subgenotype 3f decreased over time, whereas subgenotype 3c increased in the Midi-Pyrénées. Repartition of strains did not differ in the Midi-Pyrénées compared to the rest of France. HEV3i and HEV4 have been recently detected throughout France. PPR lengths showed that two major groups of HEV3f exist. Our study shows that HEV3 distribution in the Midi-Pyrénées was similar to the whole of France. Local dietary habits could explain the higher seroprevalence in the Midi-Pyrénées rather the circulation of a particular variant in this region.
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Affiliation(s)
- Sebastien Lhomme
- INSERM, UMR1043, Toulouse F-31300, France; Department of Virology, National Reference Center for Hepatitis E Virus, CHU Purpan, Toulouse F-31300, France; Université Paul Sabatier, Toulouse, France
| | - Florence Abravanel
- INSERM, UMR1043, Toulouse F-31300, France; Department of Virology, National Reference Center for Hepatitis E Virus, CHU Purpan, Toulouse F-31300, France; Université Paul Sabatier, Toulouse, France
| | - Martine Dubois
- INSERM, UMR1043, Toulouse F-31300, France; Department of Virology, National Reference Center for Hepatitis E Virus, CHU Purpan, Toulouse F-31300, France; Université Paul Sabatier, Toulouse, France
| | - Sabine Chapuy-Regaud
- INSERM, UMR1043, Toulouse F-31300, France; Department of Virology, National Reference Center for Hepatitis E Virus, CHU Purpan, Toulouse F-31300, France; Université Paul Sabatier, Toulouse, France
| | - Karine Sandres-Saune
- INSERM, UMR1043, Toulouse F-31300, France; Department of Virology, National Reference Center for Hepatitis E Virus, CHU Purpan, Toulouse F-31300, France; Université Paul Sabatier, Toulouse, France
| | - Jean-Michel Mansuy
- Department of Virology, National Reference Center for Hepatitis E Virus, CHU Purpan, Toulouse F-31300, France
| | - Lionel Rostaing
- INSERM, UMR1043, Toulouse F-31300, France; Université Paul Sabatier, Toulouse, France; Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse F-31300, France
| | - Nassim Kamar
- INSERM, UMR1043, Toulouse F-31300, France; Université Paul Sabatier, Toulouse, France; Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse F-31300, France
| | - Jacques Izopet
- INSERM, UMR1043, Toulouse F-31300, France; Department of Virology, National Reference Center for Hepatitis E Virus, CHU Purpan, Toulouse F-31300, France; Université Paul Sabatier, Toulouse, France.
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83
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O'Connor M, Roche SJ, Sammin D. Seroprevalence of Hepatitis E virus infection in the Irish pig population. Ir Vet J 2015; 68:8. [PMID: 25977752 PMCID: PMC4431038 DOI: 10.1186/s13620-015-0036-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/28/2015] [Indexed: 11/24/2022] Open
Abstract
Background Hepatitis E is an acute viral disease of humans, occurring in explosive outbreaks in the developing world and as sporadic cases in returning travellers. Increasing recognition of indigenous transmission in Western countries suggests a zoonotic source of infection, most likely pigs. To determine if hepatitis E virus is present in Irish pigs, sera from 330 animals were examined for antibodies using a commercially available ELISA. Findings Antibodies were detected in 89 pigs (27%) in 13 herds (81%). Conclusions Hepatitis E virus is present in most Irish pig herds and in many animals within these herds.
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Affiliation(s)
- Michael O'Connor
- Department of Agriculture, Food and the Marine Laboratories, Backweston, Celbridge, Co., Kildare, Ireland
| | - Sarah-Jayne Roche
- Department of Agriculture, Food and the Marine Laboratories, Backweston, Celbridge, Co., Kildare, Ireland
| | - Dónal Sammin
- Department of Agriculture, Food and the Marine Laboratories, Backweston, Celbridge, Co., Kildare, Ireland
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84
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Thiry D, Mauroy A, Pavio N, Purdy MA, Rose N, Thiry E, de Oliveira-Filho EF. Hepatitis E Virus and Related Viruses in Animals. Transbound Emerg Dis 2015; 64:37-52. [PMID: 25919649 PMCID: PMC7169709 DOI: 10.1111/tbed.12351] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Indexed: 12/28/2022]
Abstract
Hepatitis E is an acute human liver disease in healthy individuals which may eventually become chronic. It is caused by the hepatitis E virus (HEV) and can have a zoonotic origin. Nearly 57,000 people die yearly from hepatitis E-related conditions. The disease is endemic in both developing and developed countries with distinct epidemiologic profiles. In developing countries, the disease is associated with inadequate water treatment, while in developed countries, transmission is associated with animal contact and the ingestion of raw or uncooked meat, especially liver. All human HEV are grouped into at least four genotypes, while HEV or HEV-related viruses have been identified in an increasing number of domestic and wild animal species. Despite a high genetic diversity, only one single HEV serotype has been described to date for HEV genotypes 1-4. The discovery of new HEV or HEV-related viruses leads to a continuing increase in the number of genotypes. In addition, the genome organization of all these viruses is variable with overlapping open reading frames (ORF) and differences in the location of ORF3. In spite of the role of some domestic and wild animals as reservoir, the origin of HEV and HEV-related viruses in humans and animals is still unclear. This review discusses aspects of the detection, molecular virology, zoonotic transmission and origin of HEV and HEV-related viruses in the context of 'One Health' and establishes a link between the previous and the new taxonomy of this growing virus family.
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Affiliation(s)
- D Thiry
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - A Mauroy
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - N Pavio
- UMR 1161 Virology, ANSES, Animal Health Laboratory, Maisons-Alfort, France.,UMR 1161 Virology, INRA, Maisons-Alfort, France.,UMR 1161 Virology, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - M A Purdy
- National Center for HIV/Hepatitis/STD/TB Prevention, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N Rose
- ANSES Laboratory of Ploufragan/Plouzané, Unit of Pig Epidemiology and Welfare, Ploufragan, France
| | - E Thiry
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - E F de Oliveira-Filho
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
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85
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Chijioke O, Bawohl M, Springer E, Weber A. Hepatitis e virus detection in liver tissue from patients with suspected drug-induced liver injury. Front Med (Lausanne) 2015; 2:20. [PMID: 25870858 PMCID: PMC4378310 DOI: 10.3389/fmed.2015.00020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/15/2015] [Indexed: 02/03/2023] Open
Abstract
Hepatitis E virus (HEV) infection is increasingly recognized as a cause of acute hepatitis in the industrialized world. We aimed to determine the frequency of acute HEV infection in cases of suspected drug-induced liver injury (DILI), mainly a diagnosis of exclusion. To this aim, formalin-fixed paraffin-embedded (FFPE) liver tissues of all cases routinely processed in our institute during a 2 1/2 years period in which DILI was among the differential diagnoses (157 liver biopsies, 1 liver explant) were subjected to semi-nested RT-PCR for the detection of HEV RNA. Histopathology was re-evaluated on all cases tested positive. HEV RNA was detectable in 3 of 158 cases (2%) tested, comprising autochthonic as well as travel-related infections with genotypes 1, 3, and 4 each found once, respectively. Histopathologic findings comprised one case with subtotal hepatic necrosis and two cases of acute (cholestatic) hepatitis not distinguishable from acute hepatitis of other etiology. Thus, the overall frequency of acute HEV infection as determined by detection of HEV RNA in liver tissue is substantially increased in patients with suspected DILI compared to the healthy population, emphasizing the need to actively look for HEV infection in cases of suspected DILI. Molecular testing for HEV RNA in routinely processed FFPE liver tissues can be applied to cases with undetermined HEV status.
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Affiliation(s)
- Obinna Chijioke
- Institute of Surgical Pathology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
| | - Marion Bawohl
- Institute of Surgical Pathology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
| | - Erik Springer
- Institute of Pathology, Johannes Gutenberg University Mainz , Mainz , Germany
| | - Achim Weber
- Institute of Surgical Pathology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
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86
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Pariente A, Renou C. [Epidemiology of hepatitis E: a (re) emerging disease?]. Presse Med 2015; 44:333-8. [PMID: 25639625 DOI: 10.1016/j.lpm.2014.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/08/2014] [Indexed: 12/15/2022] Open
Abstract
Hepatitis E virus (VHE) is a RNA, non-enveloped, enterically transmitted virus. VHE is present all around the world, with different distribution of its genotypes. VHE of genotypes 1 and 2 predominate in Asia, Africa and in Mexico, responsible for outbreaks transmitted through contaminated water, with an increased mortality in pregnant women. Genotype 3 VHE are globally distributed, with an animal reservoir (swine mainly) endemic in high-income countries. They are transmitted by the ingestion of raw or poorly cooked meat, and possibly by other routes (water, molluscs?) not yet firmly established. Rare post-transfusion hepatitis E cases have been reported. The prevalence of viremic blood donations is around 5 to 10,000 in Europe and in France. Screening tests and/or alternative strategies for viral elimination could be implemented soon.
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Affiliation(s)
- Alexandre Pariente
- Centre hospitalier de Pau, unité d'hépatogastro-entérologie, 64046 Pau cedex, France.
| | - Christophe Renou
- Centre hospitalier d'Hyères, hôpital de jour, 83400 Hyères, France
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87
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Detection of hepatitis E virus in pork liver sausages. Int J Food Microbiol 2015; 193:29-33. [DOI: 10.1016/j.ijfoodmicro.2014.10.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 09/30/2014] [Accepted: 10/04/2014] [Indexed: 01/31/2023]
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88
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Deranged liver function tests in a patient with Hodgkin's lymphoma. J Clin Virol 2015; 62:118-21. [DOI: 10.1016/j.jcv.2014.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 11/21/2022]
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89
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Behrendt P, Steinmann E, Manns MP, Wedemeyer H. The impact of hepatitis E in the liver transplant setting. J Hepatol 2014; 61:1418-29. [PMID: 25195557 DOI: 10.1016/j.jhep.2014.08.047] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 12/27/2022]
Abstract
Hepatitis E virus (HEV) infection has been identified as a cause of graft hepatitis in liver transplant recipients. The true frequency and clinical importance of HEV infections after liver transplantations is a matter of debate. It is proposed that consumption of HEV-contaminated undercooked meat is a main source for HEV infections in developed countries--which might also account for some hepatitis E cases after organ transplantation. However, HEV is also transmitted by transfusion of blood products, likely representing a previously underestimated risk particularly for patients in the transplant setting. HEV infection can take chronic courses in immunocompromised individuals, associated in some cases with rapid progression to cirrhosis within 1-2 years of infection. Diagnosis in transplanted patients is based on HEV RNA testing as antibody assays are not sensitive enough. Selection of immunosuppressive drugs is important as different compounds may influence viral replication and the course of liver disease. Ribavirin has antiviral activity against HEV and should be administered for at least three months in chronically infected individuals; however, treatment failure may occur. HEV infections have also been linked to a variety of extrahepatic manifestations both during and after resolution of infection. In this review we summarize the emerging data on hepatitis E with a particular focus on the importance of HEV infections for liver transplant recipients.
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Affiliation(s)
- Patrick Behrendt
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infection Research, Hannover, Germany; Twincore, Centre for Experimental and Clinical Infection Research, A Joint Venture Between Medical School Hannover and Helmholtz Centre for Infection Research, Hannover, Germany
| | - Eike Steinmann
- Twincore, Centre for Experimental and Clinical Infection Research, A Joint Venture Between Medical School Hannover and Helmholtz Centre for Infection Research, Hannover, Germany
| | - Michael P Manns
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infection Research, Hannover, Germany
| | - Heiner Wedemeyer
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infection Research, Hannover, Germany.
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90
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Abstract
The prevalence of anti-HEV isotype-specific antibodies and viraemia were investigated in serum samples collected from slaughter-age pigs (aged 22-24 weeks) from 23 farms in Scotland. Of 176 serum samples tested, 29·0% (n = 51) were anti-HEV IgG positive, 36·9% (n = 65) anti-HEV IgA positive and 29·0% (n = 51) anti-HEV IgM positive. Overall seroprevalence (anti-HEV IgG+ and/or IgA+ and/or IgM+) was 61·4% (n = 108). HEV RNA was detected in 72/162 serum samples (44·4%). Partial sequence of ORF2 (98 nt) was obtained from eight HEV RNA-positive samples and phylogenetic analysis confirmed that they were all of genotype 3. This is the first report on the prevalence of HEV in pigs in Scotland. Given the increasing incidence of locally acquired HEV infection in the UK, evidence that HEV is a foodborne zoonosis emphasizes the need for surveillance in pigs.
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91
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Hewitt PE, Ijaz S, Brailsford SR, Brett R, Dicks S, Haywood B, Kennedy ITR, Kitchen A, Patel P, Poh J, Russell K, Tettmar KI, Tossell J, Ushiro-Lumb I, Tedder RS. Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. Lancet 2014; 384:1766-73. [PMID: 25078306 DOI: 10.1016/s0140-6736(14)61034-5] [Citation(s) in RCA: 379] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of hepatitis E virus (HEV) genotype 3 infections in the English population (including blood donors) is unknown, but is probably widespread, and the virus has been detected in pooled plasma products. HEV-infected donors have been retrospectively identified through investigation of reported cases of possible transfusion-transmitted hepatitis E. The frequency of HEV transmission by transfusion and its outcome remains unknown. We report the prevalence of HEV RNA in blood donations, the transmission of the virus through a range of blood components, and describe the resulting morbidity in the recipients. METHODS From Oct 8, 2012, to Sept 30, 2013, 225,000 blood donations that were collected in southeast England were screened retrospectively for HEV RNA. Donations containing HEV were characterised by use of serology and genomic phylogeny. Recipients, who received any blood components from these donations, were identified and the outcome of exposure was ascertained. FINDINGS 79 donors were viraemic with genotype 3 HEV, giving an RNA prevalence of one in 2848. Most viraemic donors were seronegative at the time of donation. The 79 donations had been used to prepare 129 blood components, 62 of which had been transfused before identification of the infected donation. Follow-up of 43 recipients showed 18 (42%) had evidence of infection. Absence of detectable antibody and high viral load in the donation rendered infection more likely. Recipient immunosuppression delayed or prevented seroconversion and extended the duration of viraemia. Three recipients cleared longstanding infection after intervention with ribavirin or alteration in immunosuppressive therapy. Ten recipients developed prolonged or persistent infection. Transaminitis was common, but short-term morbidity was rare; only one recipient developed apparent but clinically mild post-transfusion hepatitis. INTERPRETATION Our findings suggest that HEV genotype 3 infections are widespread in the English population and in blood donors. Transfusion-transmitted infections rarely caused acute morbidity, but in some immunosuppressed patients became persistent. Although at present blood donations are not screened, an agreed policy is needed for the identification of patients with persistent HEV infection, irrespective of origin, so that they can be offered antiviral therapy. FUNDING Public Health England and National Health Service Blood and Transplant.
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Affiliation(s)
- Patricia E Hewitt
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK
| | - Su R Brailsford
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Rachel Brett
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
| | - Steven Dicks
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK; Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK
| | - Becky Haywood
- Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK
| | - Iain T R Kennedy
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Alan Kitchen
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
| | - Poorvi Patel
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK; Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK
| | - John Poh
- Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK
| | - Katherine Russell
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Kate I Tettmar
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK; Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK
| | - Joanne Tossell
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
| | - Ines Ushiro-Lumb
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK; Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK
| | - Richard S Tedder
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK; Blood Borne Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, UK; University College London, Gower Street, London, UK.
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92
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Kmush BL, Nelson KE, Labrique AB. Risk factors for hepatitis E virus infection and disease. Expert Rev Anti Infect Ther 2014; 13:41-53. [DOI: 10.1586/14787210.2015.981158] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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93
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Smith DB, Simmonds P, Jameel S, Emerson SU, Harrison TJ, Meng XJ, Okamoto H, Van der Poel WHM, Purdy MA. Consensus proposals for classification of the family Hepeviridae. J Gen Virol 2014; 95:2223-2232. [PMID: 24989172 PMCID: PMC4165930 DOI: 10.1099/vir.0.068429-0] [Citation(s) in RCA: 482] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The family Hepeviridae consists of positive-stranded RNA viruses that infect a wide range of mammalian species, as well as chickens and trout. A subset of these viruses infects humans and can cause a self-limiting acute hepatitis that may become chronic in immunosuppressed individuals. Current published descriptions of the taxonomical divisions within the family Hepeviridae are contradictory in relation to the assignment of species and genotypes. Through analysis of existing sequence information, we propose a taxonomic scheme in which the family is divided into the genera Orthohepevirus (all mammalian and avian hepatitis E virus (HEV) isolates) and Piscihepevirus (cutthroat trout virus). Species within the genus Orthohepevirus are designated Orthohepevirus A (isolates from human, pig, wild boar, deer, mongoose, rabbit and camel), Orthohepevirus B (isolates from chicken), Orthohepevirus C (isolates from rat, greater bandicoot, Asian musk shrew, ferret and mink) and Orthohepevirus D (isolates from bat). Proposals are also made for the designation of genotypes within the human and rat HEVs. This hierarchical system is congruent with hepevirus phylogeny, and the three classification levels (genus, species and genotype) are consistent with, and reflect discontinuities in the ranges of pairwise distances between amino acid sequences. Adoption of this system would include the avoidance of host names in taxonomic identifiers and provide a logical framework for the assignment of novel variants.
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Affiliation(s)
- Donald B. Smith
- University of Edinburgh, Centre for Immunity, Infection and Evolution, Edinburgh, Scotland, UK
| | - Peter Simmonds
- University of Edinburgh, Centre for Immunity, Infection and Evolution, Edinburgh, Scotland, UK
| | | | | | - Suzanne U. Emerson
- Special Volunteer, Retired Head Molecular Hepatitis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Xiang-Jin Meng
- College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi-ken, Japan
| | - Wim H. M. Van der Poel
- Central Veterinary Institute, Wageningen University and Research Centre, Lelystad, The Netherlands
| | - Michael A. Purdy
- Centers for Disease Control and Prevention, National Center for HIV/Hepatitis/STD/TB Prevention, Division of Viral Hepatitis, Atlanta, GA, USA
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94
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Andonov A, Rock G, Lin L, Borlang J, Hooper J, Grudeski E, Wu J. Serological and molecular evidence of a plausible transmission of hepatitis E virus through pooled plasma. Vox Sang 2014; 107:213-9. [PMID: 24830322 DOI: 10.1111/vox.12156] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/26/2014] [Accepted: 03/28/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Recently, hepatitis E virus has been recognized as a new transfusion-associated risk; however, its efficiency of transmission through blood products requires further investigation. Asymptomatic viremia of short duration has been observed in blood donors from several European countries to the rate of <1:10,000 and HEV transmission in recipients of blood products has been documented in Japan and Europe. Although HEV RNA was detected in large plasma fractionation pools used for manufacturing of plasma derived products, HEV transmission has not been demonstrated so far. In this study, we investigated the possibility of HEV transmission in patients with thrombotic thrombocytopenic purpura whose treatment included up to 40 l of plasma exchange. MATERIALS AND METHODS Thirty-six TTP patients received either solvent-detergent-treated plasma prepared by pooling of 2500 single-donor or cryosupernatant plasma. Three samples were collected from TTP patients at time 0, 1 and 6 months post-treatment and tested for anti-HEV antibodies. Patients with HEV seroconversion were also tested for viremia by PCR. RESULTS Two of seventeen TTP patients treated with SDP showed serological evidence of HEV infection. The 1-month samples from these patients were also positive for HEV RNA. A distinct rise of anti-HEV IgG level was detected in two other TTP patients with weak pre-existing immunity to HEV; this observation is indicative of a possible immune response boost due to a breakthrough infection. CONCLUSION This work provides, for the first time, indirect evidence of HEV transmission by pooled plasma and warrants further studies.
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Affiliation(s)
- A Andonov
- Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada
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95
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Dalton HR. Hepatitis e: the 'new kid on the block' or an old friend? Transfus Med Hemother 2014; 41:6-9. [PMID: 24659942 PMCID: PMC3949609 DOI: 10.1159/000358103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Harry R. Dalton
- Royal Cornwall Hospital Trust, and European Centre of Environment and Human Health, University of Exeter Medical School, Truro, UK
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