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Wang M, He M, Wu B, Ke L, Han T, Wang J, Shan H, Ness P, Guo N, Liu Y, Nelson KE. The association of elevated alanine aminotransferase levels with hepatitis E virus infections among blood donors in China. Transfusion 2017; 57:273-279. [PMID: 28194856 DOI: 10.1111/trf.13991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transfusion transmission of hepatitis E virus (HEV) is an emerging health risk, yet blood donors are rarely screened for this pathogen. Many blood centers instituted screening of blood donors for elevated levels of alanine aminotransferase (ALT) levels to prevent hepatitis C virus, which has continued in China. We evaluated whether elevated ALT levels were associated with HEV among blood donors in China. STUDY DESIGN AND METHODS Blood samples were collected from 9069 qualified volunteer blood donors from four blood centers in China. A total of 5023 had elevated ALT levels, that is, more than 40 IU/L, and 4046 samples had normal ALT. We tested all the 9069 samples for anti-HEV immunoglobulin (Ig)M, anti-HEV IgG, and HEV antigen. Those who were positive for anti-HEV IgM or HEV antigen were tested individually for HEV RNA by polymerase chain reaction. RESULTS The prevalence of anti-HEV IgG in donors with elevated ALT levels (33.3%) was higher than those with normal ALT (24.9%; p < 0.01). The prevalence of anti-HEV IgM was similar in donations with increased ALT (1.41%) and normal ALT (1.46%). More ALT-elevated donations were HEV antigen positive, 62 of 5023 (1.23%), than were ALT-normal donations, seven of 4046 (0.17%; p < 0.01). Six donors with elevated ALT levels and acute HEV infection markers (anti-HEV IgM or HEV antigen) were HEV RNA positive. CONCLUSION Markers of active infection including HEV antigen and HEV RNA are significantly more common among donors with elevated ALT levels in China. These data support the fact that ALT testing of donors to HEV antigen or HEV RNA would have greater specificity and exclude fewer acceptable donors.
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Affiliation(s)
- Meiyu Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Miao He
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Binting Wu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ling Ke
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Tingting Han
- School of Public Health, Anhui Medical University, Anhui, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Hua Shan
- Stanford University Health Center, Stanford, California
| | - Paul Ness
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Nan Guo
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Yu Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
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Pandolfi R, Ramos de Almeida D, Alves Pinto M, Kreutz LC, Frandoloso R. In house ELISA based on recombinant ORF2 protein underline high prevalence of IgG anti-hepatitis E virus amongst blood donors in south Brazil. PLoS One 2017; 12:e0176409. [PMID: 28486512 PMCID: PMC5423711 DOI: 10.1371/journal.pone.0176409] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/09/2017] [Indexed: 01/19/2023] Open
Abstract
Hepatitis E Virus (HEV) is a zoonotic pathogen responsible for causing acute hepatitis in human, especially in developing countries. Diagnosis of HEV usually relies on the detection of antibodies mostly by enzyme-linked immunosorbent assay (ELISA). In the present study, we designed a new indirect ELISA (iELISA) based on a short recombinant peptide derived from the capsid protein (ORF2p) and demonstrated its potential for detecting human IgG against HEV genotype 3. The best polystyrene plate (Maxisorp®), optimal ORF2p coating antigen concentration (0,67μg/well) and primary antibody dilution (1:100) were determined. This iELISA showed a sensitivity of 91.4% and specificity of 95.9%. The comparison of our in house iELISA with a commercial assay (RecomWell, Mikrogen®) showed 94.25% of agreement and a kappa index of 0.88. The ORF2 recombinant ELISA was used to screen 780 blood donors for anti-HEV IgG and we found that 314 (40,25%) of these donors were IgG positive. This high prevalence of antibodies suggests, for the first time, that the Southern Brazil region might be endemic to Hepatitis E Virus genotype 3.
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Affiliation(s)
- Rafael Pandolfi
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Denise Ramos de Almeida
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Marcelo Alves Pinto
- Laboratório de Desenvolvimento Tecnológico em Virologia/IOC - Fundação Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiz Carlos Kreutz
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Rafael Frandoloso
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
- * E-mail:
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53
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Nasrallah GK, Al Absi ES, Ghandour R, Ali NH, Taleb S, Hedaya L, Ali F, Huwaidy M, Husseini A. Seroprevalence of hepatitis E virus among blood donors in Qatar (2013-2016). Transfusion 2017; 57:1801-1807. [DOI: 10.1111/trf.14116] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/02/2017] [Accepted: 02/19/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Gheyath K. Nasrallah
- Department of Biomedical Sciences
- Biomedical Research Center; Qatar University; Doha Qatar
| | | | - Rula Ghandour
- Institute of Community and Public Health, Birzeit University; Birzeit Palestine
| | | | | | | | | | | | - Abdullatif Husseini
- Institute of Community and Public Health, Birzeit University; Birzeit Palestine
- Department of Public Health, College of Health Sciences
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Fearon MA, O'Brien SF, Delage G, Scalia V, Bernier F, Bigham M, Weger S, Prabhu S, Andonov A. Hepatitis E in Canadian blood donors. Transfusion 2017; 57:1420-1425. [PMID: 28394029 DOI: 10.1111/trf.14089] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) is a virus of emerging importance to transfusion medicine as studies on blood donors and other populations demonstrate that the prevalence of endemic cases is higher than previously recognized and the risk to vulnerable transfusion recipients is not insignificant. STUDY DESIGN AND METHODS We carried out an HEV prevalence study on 13,993 Canadian blood donors with polymerase chain reaction (PCR) testing on all donors and antibody testing on a subset of 4102 donors. HEV antibody-positive and age- and sex-matched antibody-negative donors were invited to participate in a scripted telephone interview about risk factors. RESULTS There were no PCR-positive samples found (95% confidence interval [CI], 0%-0.026%). The seroprevalence of HEV in our tested population was 5.9% (95% CI, 5.16%-6.59%). HEV antibody positivity was associated with male sex and increasing age. In case-control analysis history of living outside Canada (odds ratio [OR], 2.9; 95% CI, 1.56-5.32) and contact with farm animals (OR, 1.5; 95% CI, 1.01-2.28) were associated with HEV seropositivity. CONCLUSION This is the largest data set to date on HEV infection in Canada. Results suggest low lifetime exposure to HEV and that infectious donations are rare.
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Affiliation(s)
- Margaret A Fearon
- Canadian Blood Services, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario, Canada.,University of Ottawa, School of Epidemiology, Public Health and Preventative Medicine, Ottawa, Ontario, Canada
| | - Gilles Delage
- Microbiology, Héma-Québec, Saint-Laurent, Québec, Canada
| | - Vito Scalia
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - France Bernier
- Microbiology, Héma-Québec, Saint-Laurent, Québec, Canada
| | - Mark Bigham
- Medical Department, Canadian Blood Services, BC and Yukon, Vancouver, British Columbia, Canada
| | - Steven Weger
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sneha Prabhu
- Institute for Health Promotion Research, University of Texas Medical School at San Antonio, San Antonio, Texas
| | - Anton Andonov
- Molecular and Immunodiagnostics, Bloodborne Pathogens and Hepatitis, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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van der Eijk AA, Pas SD, de Man RA. Hepatitis E virus: A potential threat for patients with liver disease and liver transplantation. Best Pract Res Clin Gastroenterol 2017. [PMID: 28624102 DOI: 10.1016/j.bpg.2017.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Immunocompromised patients are at risk of acquiring acute hepatitis E virus infection (HEV), leading to chronicity. Chronic HEV infection is associated with persistent viraemia, raised transaminase activity, histological features associated with chronic hepatitis and evidence of rapid development of cirrhosis. Extrahepatic manifestations have been associated with HEV. Most frequently reported are neurological disorders with predominantly involvement of the peripheral nervous system. In patients using immunosuppressive drugs antibody production is often delayed and HEV RNA detection is superior to serology to detect infection. Therapeutic options for chronic HEV includes tapering immunosuppressive and secondly ribavirin, pegylated interferon alpha (PEG-IFN). Present recommendation is to treat chronic HEV patients for 3 months, asses serum HEV RNA and stool HEV RNA and stop therapy if both are undetectable. Studies are required to determine which other antiviral agents than ribavirin and (PEG-)IFN are of clinical utility in treating HEV in the minority of patients who do not respond to ribavirin.
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Affiliation(s)
- Annemiek A van der Eijk
- Department of Viroscience, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Suzan D Pas
- Department of Viroscience, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Rivero-Juarez A, Cuenca-Lopez F, Martinez-Peinado A, Camacho A, Real LM, Frias M, Gordon A, Cantisán S, Torre-Cisneros J, Pineda JA, Rivero A. Rural habitat as risk factor for hepatitis E virus seroconversion in HIV-infected patients: A prospective longitudinal study. Zoonoses Public Health 2017; 64:e60-e64. [PMID: 28236361 DOI: 10.1111/zph.12347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Indexed: 12/15/2022]
Abstract
Our objective was to determine the incidence and clinical manifestations of acute hepatitis E virus (HEV) in HIV-infected patients. A prospective longitudinal study including HIV-infected HEV-seronegative patients was conducted; HEV seroconversion (to IgG and/or IgM) was the main outcome variable. All patients were tested for HEV antibodies every 3-6 months. For patients who developed HEV seroconversion, a data collection protocol was followed to identify associated clinical manifestations and analytical alterations. A total of 627 patients (89.9%) were followed during a median of 11.96 months (IQR: 8.52-14.52 months) and formed the study population. Forty-one patients developed detectable anti-HEV antibodies (7.2 cases per 100 patients/year). Our study found a high incidence of HEV in HIV-infected patients in southern Spain strongly associated with a rural habitat.
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Affiliation(s)
- A Rivero-Juarez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - F Cuenca-Lopez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - A Martinez-Peinado
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - A Camacho
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - L M Real
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - M Frias
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - A Gordon
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - S Cantisán
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - J Torre-Cisneros
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - J A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - A Rivero
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
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57
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Prevalence of Hepatitis E Virus Antibodies Among Blood Donors: A Systematic Review and Meta-Analysis. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.42875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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58
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van Gageldonk-Lafeber AB, van der Hoek W, Borlée F, Heederik DJJ, Mooi SH, Maassen CBM, Yzermans CJ, Rockx B, Smit LAM, Reimerink JHJ. Hepatitis E virus seroprevalence among the general population in a livestock-dense area in the Netherlands: a cross-sectional population-based serological survey. BMC Infect Dis 2017; 17:21. [PMID: 28056844 PMCID: PMC5217153 DOI: 10.1186/s12879-016-2160-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023] Open
Abstract
Background Recent serological studies indicate that hepatitis E virus (HEV) is endemic in industrialised countries. The increasing trend in the number of autochthonous cases of HEV genotype 3 in Western European countries, stresses the importance to get insight in the exact routes of exposure. Pigs are the main animal reservoir, and zoonotic food-borne transmission of HEV is proven. However, infected pigs can excrete large amounts of virus via their faeces enabling environmental transmission of HEV to humans. This might pose a risk for of neighbouring residents of livestock farming. Methods Within a large study on the health of people living in the vicinity of livestock farming we performed a cross-sectional population-based serological survey among 2,494 non-farming adults from the general population in a livestock-dense area in the south of the Netherlands. Participants completed risk factor questionnaires and blood samples of 2,422 subjects (median age 58 years, range 20–72) were tested for anti-HEV IgG using an enzyme immune assay (Wantai). The aim of this study was to determine the HEV seroprevalence and to assess whether seropositivity in adults was associated with living in the vicinity of pig farms. Results The average seroprevalence of HEV was 28.7% (95% CI: 26.9–30.5). Determinants associated with an increased risk for HEV seropositivity were male gender and low level of education. There was a clear trend of increasing prevalence with increasing age (Chi-square test for linear trend, X2 = 83.1; p < 0.001). A high number of pigs within 1,000 m of the residential address was not a risk factor for seropositivity. Conclusions This study confirmed the high HEV seroprevalence (29%) in the general population of the Netherlands, but presence of antibodies was not associated with residential proximity to pig farms. The prevalence increased with age from 10% in adolescents to 33% among those aged 50 and above, supporting the assumption of a cumulative lifetime exposure to HEV in the Netherlands as well as a higher infection pressure in the past. Our findings cannot refute the assumption that transmission is primarily food-borne.
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Affiliation(s)
| | - Wim van der Hoek
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Floor Borlée
- Institute for Risk Assessment Sciences, IRAS, Utrecht University, Utrecht, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Dick J J Heederik
- Institute for Risk Assessment Sciences, IRAS, Utrecht University, Utrecht, The Netherlands
| | - Sofie H Mooi
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Catharina B M Maassen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - C Joris Yzermans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Barry Rockx
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Lidwien A M Smit
- Institute for Risk Assessment Sciences, IRAS, Utrecht University, Utrecht, The Netherlands
| | - Johan H J Reimerink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Hepatitis E Virus in Industrialized Countries: The Silent Threat. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9838041. [PMID: 28070522 PMCID: PMC5192302 DOI: 10.1155/2016/9838041] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/07/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022]
Abstract
Hepatitis E virus (HEV) is the main cause of acute viral hepatitis worldwide. Its presence in developing countries has been documented for decades. Developed countries were supposed to be virus-free and initially only imported cases were detected in those areas. However, sporadic and autochthonous cases of HEV infection have been identified and studies reveal that the virus is worldwide spread. Chronic hepatitis and multiple extrahepatic manifestations have also been associated with HEV. We review the data from European countries, where human, animal, and environmental data have been collected since the 90s. In Europe, autochthonous HEV strains were first detected in the late 90s and early 2000s. Since then, serological data have shown that the virus infects quite frequently the European population and that some species, such as pigs, wild boars, and deer, are reservoirs. HEV strains can be isolated from environmental samples and reach the food chain, as shown by the detection of the virus in mussels and in contaminated pork products as sausages or meat. All these data highlight the need of studies directed to control the sources of HEV to protect immunocompromised individuals that seem the weakest link of the HEV epidemiology in industrialized regions.
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Dalton HR, Seghatchian J. Hepatitis E virus: Emerging from the shadows in developed countries. Transfus Apher Sci 2016; 55:271-274. [PMID: 27843081 DOI: 10.1016/j.transci.2016.10.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Following the discovery of HEV in the 1980s, it became apparent that HEV is endemic in a number of developing countries in Asia, Africa and Mexico. In these geographical settings HEV is spread oral faecally by HEV genotypes (gt) 1 and 2, which are obligate human pathogens. Infection occurs oro-faecally, often as a result in the breakdown of fragile sanitary infrastructure allowing drinking water supplies to become contaminated with human sewage. Hepatitis E usually causes a self-limiting hepatitis in young adults with sporadic cases and occasional dramatic outbreaks involving hundreds or thousands of cases. Clinically the illness is indistinguishable from hepatitis A, except in pregnant women where the mortality is 20-25%. Death occurs in the third trimester from fulminant hepatic failure and obstetric complications such as eclampsia, with very high associated foetal loss. For the best part of 20 years hepatitis E was considered as an imported disease in developed countries, and was only seen in travellers returning from endemic developing countries. We got this very badly wrong: HEV gt3 was 'hiding in the shadows' in humans, pigs, and other animals.
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Affiliation(s)
- Harry R Dalton
- Royal Cornwall Hospital and University of Exeter, Truro, UK.
| | - Jerard Seghatchian
- International Consultancy in Blood Component Quality/Safety Improvement & DDR Strategies, London, UK.
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61
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Geng Y, Wang Y. Transmission of Hepatitis E Virus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 948:89-112. [DOI: 10.1007/978-94-024-0942-0_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
In Norway, no published data on seroprevalence of hepatitis E virus (HEV) in humans and swine exists. Serum samples from blood donors, veterinarians, swine farm workers and swine were analysed by ELISA to estimate the seroprevalence of HEV in Norway and to investigate the association between direct contact with swine and HEV seroprevalence in humans. The seroprevalence of HEV IgG antibodies was 30% (24/79) in farm workers, 13% (21/163) in veterinarians, 14% (162/1200) in blood donors and 90% (137/153) in swine. Our results show a high seroprevalence of HEV in humans and swine in Norway. HEV seroprevalence in farm workers and blood donors increased with age, and veterinarians working with swine were twice as likely to be HEV seropositive compared to other veterinarians. High HEV seroprevalence in farm workers and veterinarians working with swine support previous reports suggesting swine as a reservoir for HEV infections in humans in Europe.
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63
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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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64
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Transmission of Hepatitis E Virus in Developing Countries. Viruses 2016; 8:v8090253. [PMID: 27657112 PMCID: PMC5035967 DOI: 10.3390/v8090253] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 12/11/2022] Open
Abstract
Hepatitis E virus (HEV), an RNA virus of the Hepeviridae family, has marked heterogeneity. While all five HEV genotypes can cause human infections, genotypes HEV-1 and -2 infect humans alone, genotypes HEV-3 and -4 primarily infect pigs, boars and deer, and genotype HEV-7 primarily infects dromedaries. The global distribution of HEV has distinct epidemiological patterns based on ecology and socioeconomic factors. In resource-poor countries, disease presents as large-scale waterborne epidemics, and few epidemics have spread through person-to-person contact; however, endemic diseases within these countries can potentially spread through person-to-person contact or fecally contaminated water and foods. Vertical transmission of HEV from infected mother to fetus causes high fetal and perinatal mortality. Other means of transmission, such as zoonotic transmission, can fluctuate depending upon the region and strain of the virus. For instance, zoonotic transmission can sometimes play an insignificant role in human infections, such as in India, where human and pig HEV infections are unrelated. However, recently China and Southeast Asia have experienced a zoonotic spread of HEV-4 from pigs to humans and this has become the dominant mode of transmission of hepatitis E in eastern China. Zoonotic HEV infections in humans occur by eating undercooked pig flesh, raw liver, and sausages; through vocational contact; or via pig slurry, which leads to environmental contamination of agricultural products and seafood. Lastly, blood transfusion-associated HEV infections occur in many countries and screening of donors for HEV RNA is currently under serious consideration. To summarize, HEV genotypes 1 and 2 cause epidemic and endemic diseases in resource poor countries, primarily spreading through contaminated drinking water. HEV genotypes 3 and 4 on the other hand, cause autochthonous infections in developed, and many developing countries, by means of a unique zoonotic food-borne transmission.
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65
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Hartl J, Otto B, Madden RG, Webb G, Woolson KL, Kriston L, Vettorazzi E, Lohse AW, Dalton HR, Pischke S. Hepatitis E Seroprevalence in Europe: A Meta-Analysis. Viruses 2016; 8:v8080211. [PMID: 27509518 PMCID: PMC4997573 DOI: 10.3390/v8080211] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/12/2016] [Accepted: 07/25/2016] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED There have been large numbers of studies on anti-HEV IgG seroprevalence in Europe, however, the results of these studies have produced high variability of seroprevalence rates, making interpretation increasingly problematic. Therefore, the aim of this study was to develop a clearer understanding of anti-HEV IgG seroprevalence in Europe and identify risk groups for HEV exposure by a meta-analysis of published studies. METHODS All European HEV-seroprevalence studies from 2003 to 2015 were reviewed. Data were stratified by assay, geographical location, and patient cohort (general population, patients with HIV, solid-organ transplant recipients, chronic liver disease patients, and individuals in contact with swine/wild animals). Data were pooled using a mixed-effects model. RESULTS Four hundred thirty-two studies were initially identified, of which 73 studies were included in the analysis. Seroprevalence estimates ranged from 0.6% to 52.5%, increased with age, but were unrelated to gender. General population seroprevalence varied depending on assays: Wantai (WT): 17%, Mikrogen (MG): 10%, MP-diagnostics (MP): 7%, DiaPro: 4%, Abbott 2%. The WT assay reported significantly higher seroprevalence rates across all cohorts (p < 0.001). Individuals in contact with swine/wild animals had significantly higher seroprevalence rates than the general population, irrespective of assay (p < 0.0001). There was no difference between any other cohorts. The highest seroprevalence was observed in France (WT: 32%, MP: 16%) the lowest in Italy (WT: 7.5%, MP 0.9%). Seroprevalence varied between and within countries. The observed heterogeneity was attributed to geographical region (23%), assay employed (23%) and study cohort (7%). CONCLUSION Seroprevalcence rates primarily depend on the seroassy that is used, followed by the geographical region and study cohort. Seroprevalence is higher in individuals exposed to swine and/or wild animals, and increases with age.
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Affiliation(s)
- Johannes Hartl
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany.
| | - Benjamin Otto
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany.
| | - Richie Guy Madden
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
| | - Glynn Webb
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
| | - Kathy Louise Woolson
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Ansgar W Lohse
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany.
| | - Harry Richard Dalton
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
| | - Sven Pischke
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany.
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
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66
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Nouhin J, Prak S, Madec Y, Barennes H, Weissel R, Hok K, Pavio N, Rouet F. Hepatitis E virus antibody prevalence, RNA frequency, and genotype among blood donors in Cambodia (Southeast Asia). Transfusion 2016; 56:2597-2601. [PMID: 27480100 DOI: 10.1111/trf.13731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/02/2016] [Accepted: 06/06/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recent studies conducted in developed countries described hepatitis E virus (HEV) as an emerging infectious threat to blood safety. However, data on HEV among blood donors from southeast Asia are lacking. STUDY DESIGN AND METHODS Between July and August 2014, we assessed the presence of HEV immunoglobulin (Ig)G and IgM in 301 Cambodian blood donors. All samples were further tested for the presence of HEV RNA using an in-house reverse transcription-polymerase chain reaction. ORF2/ORF3 phylogenetic analysis was performed on positive HEV RNA specimens. RESULTS We found HEV IgG in 28.2% of blood donors from Cambodia. Three blood donors tested positive for HEV IgM with three distinct patterns: IgM(+)/IgG(-)/RNA(-) (n = 1), IgM(+)/IgG(+)/RNA(-) (n = 1), and IgM(+)/IgG(+)/RNA(+) (n = 1). Thus, the prevalence rates of HEV IgM and HEV RNA were 1.0 and 0.3%. Interestingly, the viremic blood donor harbored a HEV strain that belonged to Genotype 3 (HEV-3) and clustered with a Cambodian riverine HEV-3 isolate. CONCLUSION Due to the high frequency of Cambodian blood donors with positive HEV IgG, we conclude that HEV is endemic in this country. Large-scale studies must be considered to determine whether Cambodian blood donation screening is warranted to enhance blood safety in regard to HEV. In addition, our findings suggest that river water may be a significant source of exposure to HEV-3.
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Affiliation(s)
- Janin Nouhin
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia.,Université Paris Diderot-Paris 7
| | - Sophearot Prak
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Yoann Madec
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Hubert Barennes
- Epidemiology and Public Health Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia.,Epidemiologie-Biostatistique, ISPED, Centre INSERM U897, Bordeaux, France
| | | | - Kimcheng Hok
- National Blood Transfusion Center, Phnom Penh, Cambodia
| | - Nicole Pavio
- UMR 1161 Virologie, Anses Laboratoire de Santé Animale, Maisons-Alfort, France
| | - François Rouet
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia.
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Abstract
BACKGROUND Hepatitis E virus (HEV) is endemic in large parts of the developing world. Waterborne transmission of genotypes 1 or 2 commonly causes acute hepatitis, which is usually self-limited in healthy individuals. In addition, acute HEV infections also occur outside endemic areas, mostly related to foodborne transmission of HEV genotype 3. A growing number of publications in the last decade have reported chronic infection progressing to cirrhosis in immunosuppressed patients. It has also been suggested that HEV transmission may occur via contaminated blood products. This publication aims to provide recommendations for diagnosis, prevention, and treatment of HEV infection, particularly in children after solid organ transplantation. METHODS A systematic PubMed literature search on HEV infection from 1990 to January 2016 was performed focusing on pediatric studies. The existing body of evidence was reviewed and recommendations were agreed upon following discussion and unanimous agreement by all members of the ESPGHAN Hepatology Committee during a consensus meeting in January 2016. In the absence of randomized controlled studies these recommendations were considered to be expert opinions. KEY RECOMMENDATIONS Immunocompetent children with increased transaminases and/or extrahepatic manifestations should be considered for testing for evidence of HEV infection. Immunocompromised children with increased aminotransferases should be repeatedly tested for HEV and may require therapeutic intervention.
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68
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Lucarelli C, Spada E, Taliani G, Chionne P, Madonna E, Marcantonio C, Pezzotti P, Bruni R, La Rosa G, Pisani G, Dell'Orso L, Ragone K, Tomei C, Ciccaglione AR. High prevalence of anti-hepatitis E virus antibodies among blood donors in central Italy, February to March 2014. Euro Surveill 2016; 21:30299. [DOI: 10.2807/1560-7917.es.2016.21.30.30299] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 02/25/2016] [Indexed: 12/23/2022] Open
Abstract
Prevalence of anti-hepatitis E virus (HEV) antibodies is highly variable in developed countries, which seems partly due to differences in assay sensitivity. Using validated sensitive assays, we tested 313 blood donors attending a hospital transfusion unit in central Italy in January and February 2014 for anti-HEV IgG and IgM and HEV RNA. Data on HEV exposure were collected from all donors. Overall anti-HEV IgG prevalence was 49% (153/313). Eating raw dried pig-liver sausage was the only independent predictor of HEV infection (adjusted prevalence rate ratio = 2.14; 95% confidence interval: 1.23–3.74). Three donors were positive for either anti-HEV IgM (n = 2; 0.6%) or HEV RNA (n = 2; 0.6%); they were completely asymptomatic, without alanine aminotransferase (ALT) abnormalities. Of the two HEV RNA-positive donors (both harbouring genotype 3), one was anti-HEV IgG- and IgM-positive, the other was anti-HEV IgG- and IgM-negative. The third donor was positive for anti-HEV IgG and IgM but HEV RNA-negative. HEV infection is therefore hyperendemic among blood donors (80% men 18–64 years-old) from central Italy and associated with local dietary habits. Nearly 1% of donors have acute or recent infection, implying potential transmission to blood recipients. Neither ALT nor anti-HEV IgM testing seems useful to prevent transfusion-transmitted HEV infection.
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Affiliation(s)
- Claudia Lucarelli
- European Program for Public Health Microbiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
- These authors contributed equally to this work
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Enea Spada
- These authors contributed equally to this work
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gloria Taliani
- Department of Infectious and Tropical Diseases, University of Rome La Sapienza, Rome, Italy
| | - Paola Chionne
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Elisabetta Madonna
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cinzia Marcantonio
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Bruni
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giuseppina La Rosa
- Environment and Primary Prevention Department, Istituto Superiore di Sanità, Rome, Italy
| | - Giulio Pisani
- National Centre for Immunobiologicals Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Dell'Orso
- Immunohematology and Blood Transfusion Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Katia Ragone
- National Centre for Immunobiologicals Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Carla Tomei
- Blood Collection Centre, Regional Committee of the Italian Red Cross of Abruzzo, L’Aquila, Italy
| | - Anna Rita Ciccaglione
- Department of Infectious Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
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69
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Baylis SA, Corman VM, Ong E, Linnen JM, Nübling CM, Blümel J. Hepatitis E viral loads in plasma pools for fractionation. Transfusion 2016; 56:2532-2537. [DOI: 10.1111/trf.13722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Victor M. Corman
- Institute of Virology, University of Bonn Medical Centre, and the German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne; Bonn Germany
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70
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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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71
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Minagi T, Okamoto H, Ikegawa M, Ideno S, Takahashi K, Sakai K, Hagiwara K, Yunoki M, Wakisaka A. Hepatitis E virus in donor plasma collected in Japan. Vox Sang 2016; 111:242-246. [DOI: 10.1111/vox.12425] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 01/18/2023]
Affiliation(s)
- T. Minagi
- Quality Control; Kyoto Plant; Japan Blood Products Organization; Kyoto Japan
| | - H. Okamoto
- Quality Control; Kyoto Plant; Japan Blood Products Organization; Kyoto Japan
| | - M. Ikegawa
- Quality Control; Kyoto Plant; Japan Blood Products Organization; Kyoto Japan
| | - S. Ideno
- R & D Division; Japan Blood Products Organization; Tokyo Japan
| | - K. Takahashi
- R & D Division; Japan Blood Products Organization; Tokyo Japan
| | - K. Sakai
- R & D Division; Japan Blood Products Organization; Tokyo Japan
| | - K. Hagiwara
- Graduate School of Veterinary Medicine; Rakuno Gakuen University; Ebetsu Hokkaido Japan
| | - M. Yunoki
- R & D Division; Japan Blood Products Organization; Tokyo Japan
- Graduate School of Veterinary Medicine; Rakuno Gakuen University; Ebetsu Hokkaido Japan
| | - A. Wakisaka
- R & D Division; Japan Blood Products Organization; Tokyo Japan
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72
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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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73
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Khuroo MS, Khuroo MS. Hepatitis E: an emerging global disease - from discovery towards control and cure. J Viral Hepat 2016; 23:68-79. [PMID: 26344932 DOI: 10.1111/jvh.12445] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/16/2015] [Indexed: 12/12/2022]
Abstract
Hepatitis E is a systemic disease affecting the liver predominantly and caused by infection with the hepatitis E virus (HEV). HEV has marked genetic heterogeneity and is known to infect several animal species including pigs, boar, deer, mongoose, rabbit, camel, chicken, rats, ferret, bats and cutthroat trout. HEV is the sole member of the family Hepeviridae and has been divided into 2 genera: Orthohepevirus (mammalian and avian HEV) and Piscihepevirus (trout HEV). Human HEVs included within the genus Orthohepevirus are designated Orthohepevirus A (isolates from human, pig, wild boar, deer, mongoose, rabbit and camel). Hepatitis E is an important public health concern, and an estimated one-third of the world population has been infected with HEV. In recent years, autochthonous hepatitis E is recognized as a clinical problem in industrialized countries. Several animal species especially domestic swine, wild boar and wild deer are reservoirs of genotype HEV-3 and HEV-4 in these countries. Human infections occur through intake of uncooked or undercooked meat of the infected animals and pig livers or sausages made from these livers and sold in supermarkets. HEV can be transmitted through blood and blood component transfusions, and donor screening for HEV is under serious consideration. Chronic hepatitis E resulting in rapidly progressive liver cirrhosis and end-stage liver disease has been described in organ transplant patients. Ribavirin monotherapy attains sustained virological response in most patients. HEV 239 vaccine has been marketed in China and its long-term efficacy over four and a half years reported.
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Affiliation(s)
- Mehnaaz S Khuroo
- Department of Pathology, Govt: Medical College Srinagar, Kashmir, India
| | - Mohammad S Khuroo
- Gastroenterology and Chairman Dept. Medicine, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India.,Digestive Diseases Centre, Dr. Khuroo's Medical Clinic, Kashmir, India
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74
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Dalton HR, Kamar N, van Eijk JJJ, Mclean BN, Cintas P, Bendall RP, Jacobs BC. Hepatitis E virus and neurological injury. Nat Rev Neurol 2015; 12:77-85. [PMID: 26711839 DOI: 10.1038/nrneurol.2015.234] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatitis E is hyperendemic in many developing countries in Asia and Africa, and is caused by hepatitis E virus (HEV) genotypes 1 and 2, which are spread via the faecal-oral route by contaminated water. Recent data show that HEV infection is also endemic in developed countries. In such geographical settings, hepatitis E is caused by HEV genotypes 3 and 4, and is mainly a porcine zoonosis. In a minority of cases, HEV causes acute and chronic hepatitis, but infection is commonly asymptomatic or unrecognized. HEV infection is associated with a number of extrahepatic manifestations, including a range of neurological injuries. To date, 91 cases of HEV-associated neurological injury--most commonly, Guillain-Barré syndrome, neuralgic amyotrophy, and encephalitis/myelitis--have been reported. Here, we review the reported cases, discuss possible pathogenic mechanisms, and present our perspectives on future directions and research questions.
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Affiliation(s)
- Harry R Dalton
- Royal Cornwall Hospital, University of Exeter, Penventinnie Lane, Truro TR1 3LJ, UK.,European Centre for Environment &Human Health, University of Exeter, Penventinnie Lane, Truro TR1 3LJ, UK
| | - Nassim Kamar
- Departments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, 1 Avenue J. Poulhès, Toulouse Cedex 9, France
| | - Jeroen J J van Eijk
- Department of Neurology, Jeroen Bosch Ziekenhuis (JBZ), Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, Netherlands
| | - Brendan N Mclean
- Royal Cornwall Hospital, University of Exeter, Penventinnie Lane, Truro TR1 3LJ, UK
| | - Pascal Cintas
- Department of Neurology, Pierre Paul Riquet Hospital, CHU Purpan, Place du Dr Baylac, 31059 Toulouse, France
| | - Richard P Bendall
- Royal Cornwall Hospital, University of Exeter, Penventinnie Lane, Truro TR1 3LJ, UK.,European Centre for Environment &Human Health, University of Exeter, Penventinnie Lane, Truro TR1 3LJ, UK
| | - Bart C Jacobs
- Department of Neurology/Neuro-Immunology Erasmus MC, Erasmus MC, Afdeling Neurologie, Kamer EE 2287, Postbus 2040, 3000 CA Rotterdam, Netherlands
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75
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Hogema BM, Molier M, Sjerps M, de Waal M, van Swieten P, van de Laar T, Molenaar-de Backer M, Zaaijer HL. Incidence and duration of hepatitis E virus infection in Dutch blood donors. Transfusion 2015; 56:722-8. [PMID: 26559806 DOI: 10.1111/trf.13402] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/22/2015] [Accepted: 09/26/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND The incidence of hepatitis E virus (HEV) infection in the Netherlands is high. Blood donors are not routinely screened for HEV infection, but since January 2013, donations used for the production of solvent/detergent (S/D)-treated plasma have been screened for HEV RNA. STUDY DESIGN AND METHODS Donations were screened for HEV RNA in pools of 96 and 192 donations. In addition, all donations made between 60 days before and after each HEV RNA-positive donation were tested individually for HEV RNA and anti-HEV immunoglobulin G. RESULTS The screening of 59,474 donations between January 2013 and December 2014 resulted in identification of 45 HEV RNA-positive donations (0.076%) from 41 donors. HEV RNA loads ranged from 80 to 2.3 × 10(6) IU/mL. The number of positive donations increased significantly over time (p = 0.03). Thirty-three of 90 donations made up to 60 days before or after HEV RNA-positive donations were positive when tested individually, while they had not been detected in the pool screening. The mean duration of HEV viremia in the healthy blood donor is estimated to be 68 days. CONCLUSION The incidence of HEV infection in the Netherlands is high and increased during the study period. In 2013 and 2014, HEV RNA was detected in 1 per 762 donations intended for production of S/D plasma.
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Affiliation(s)
- Boris M Hogema
- Department of Blood-Borne Infections, Sanquin Research.,Department of Virology, Sanquin Diagnostic Services
| | - Michel Molier
- Department of Blood-Borne Infections, Sanquin Research
| | | | | | | | - Thijs van de Laar
- Department of Blood-Borne Infections, Sanquin Research.,Department of Virology, Sanquin Diagnostic Services
| | - Marijke Molenaar-de Backer
- Department of Blood-Borne Infections, Sanquin Research.,Department of Virology, Sanquin Diagnostic Services
| | - Hans L Zaaijer
- Department of Blood-Borne Infections, Sanquin Research.,Medical Microbiology (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
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76
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Stramer SL, Moritz ED, Foster GA, Ong E, Linnen JM, Hogema BM, Mak M, Chia CP, Dodd RY. Hepatitis E virus: seroprevalence and frequency of viral RNA detection among US blood donors. Transfusion 2015; 56:481-8. [DOI: 10.1111/trf.13355] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/11/2015] [Accepted: 08/16/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Susan L. Stramer
- Scientific Support Office; American Red Cross; Gaithersburg Maryland
| | - Erin D. Moritz
- Scientific Support Office; American Red Cross; Gaithersburg Maryland
| | - Gregory A. Foster
- Scientific Support Office; American Red Cross; Gaithersburg Maryland
| | | | | | - Boris M. Hogema
- Department of Blood-Borne Infections, Virology Diagnostic Services; Sanquin Blood Supply Foundation; Amsterdam the Netherlands
| | - Matthew Mak
- MP Biomedicals Asia Pacific Pte. Ltd.; Singapore
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