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Teles SA, Caetano KAA, Carneiro MADS, Villar LM, Stacciarini JM, Martins RMB. Hepatitis E Prevalence in Vulnerable Populations in Goiânia, Central Brazil. Viruses 2023; 15:2070. [PMID: 37896847 PMCID: PMC10612069 DOI: 10.3390/v15102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
A transversal study was conducted among 472 vulnerable individuals (recyclable waste pickers, immigrants and refugees, homeless individuals, as well as lesbian, gay, bisexual, and transexual individuals) in Goiânia City, the capital of the State of Goiás, Brazil, to investigate the prevalence of hepatitis E virus (HEV) infection. A total of 459 (97.2%) serum samples were tested for anti-HEV IgG and IgM antibodies using fully automated chemiluminescence immunoassays (Liaison® Murex Anti-HEV IgG and IgM assays, DiaSorin, Saluggia, Italy). Positive samples were tested for the presence of HEV RNA by a real-time polymerase chain reaction. A seroprevalence of 0.87% (95% confidence interval [CI]: 0.34-2.22) was found for anti-HEV IgG. Furthermore, anti-HEV IgM was detected in only one individual (0.22%; 95% CI: 0.04-1.22), who was also negative for HEV RNA. These findings revealed that HEV infection is infrequent in vulnerable individuals in Central Brazil, with low seroprevalence of past and recent HEV infections.
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Affiliation(s)
| | | | | | - Livia Melo Villar
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Rio de Janeiro 21045-900, Brazil;
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Cancela F, Icasuriaga R, Cuevas S, Hergatacorzian V, Olivera M, Panzera Y, Pérez R, López J, Borzacconi L, González E, Montaldo N, Gaitán M, López-Verges S, Bortagaray V, Victoria M, Colina R, Arbiza J, Berois M, Mirazo S. Epidemiology Update of Hepatitis E Virus (HEV) in Uruguay: Subtyping, Environmental Surveillance and Zoonotic Transmission. Viruses 2023; 15:2006. [PMID: 37896784 PMCID: PMC10612089 DOI: 10.3390/v15102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Hepatitis E Virus (HEV) infection is an emergent zoonotic disease of increasing concern in developed regions. HEV genotype 3 (HEV-3) is mainly transmitted through consumption of contaminated food in high-income countries and is classified into at least 13 subtypes (3a-3n), based on p-distance values from complete genomes. In Latin America, HEV epidemiology studies are very scant. Our group has previously detected HEV3 in clinical cases, swine, wild boars, captive white-collared peccaries, and spotted deer from Uruguay. Herein, we aimed to provide novel insights and an updated overview of the molecular epidemiology of zoonotic HEV in Uruguay, including data from wastewater-based surveillance studies. A thorough analysis of HEV whole genomes and partial ORF2 sequences from Uruguayan human and domestic pig strains showed that they formed a separate monophyletic cluster with high nucleotide identity and exhibited p-distance values over the established cut-off (0.093) compared with reference subtypes' sequences. Furthermore, we found an overall prevalence of 10.87% (10/92) in wastewater, where two samples revealed a close relationship with humans, and animal reservoirs/hosts isolates from Uruguay. In conclusion, a single, new HEV-3 subtype currently circulates in different epidemiological settings in Uruguay, and we propose its designation as 3o along with its reference sequence.
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Affiliation(s)
- Florencia Cancela
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo 11600, Uruguay; (F.C.)
- Sección Virología, Instituto de Química Biológica, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (N.M.)
| | - Romina Icasuriaga
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo 11600, Uruguay; (F.C.)
| | - Santiago Cuevas
- Sección Virología, Instituto de Química Biológica, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (N.M.)
| | - Valentina Hergatacorzian
- Sección Virología, Instituto de Química Biológica, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (N.M.)
| | - Mauricio Olivera
- Sección Virología, Instituto de Química Biológica, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (N.M.)
| | - Yanina Panzera
- Sección Genética Evolutiva, Instituto de Biología, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (R.P.)
| | - Ruben Pérez
- Sección Genética Evolutiva, Instituto de Biología, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (R.P.)
| | - Julieta López
- Departamento de Ingeniería Ambiental, Facultad de Ingeniería, Universidad de la República, Montevideo 11600, Uruguay
| | - Liliana Borzacconi
- Instituto de Ingeniería Química, Facultad de Ingeniería, Universidad de la República, Montevideo 11600, Uruguay
| | - Elizabeth González
- Departamento de Ingeniería Ambiental, Facultad de Ingeniería, Universidad de la República, Montevideo 11600, Uruguay
| | - Natalia Montaldo
- Sección Virología, Instituto de Química Biológica, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (N.M.)
| | - Melissa Gaitán
- Departamento de Virología y Biotecnología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá 0801, Panama
| | - Sandra López-Verges
- Departamento de Virología y Biotecnología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá 0801, Panama
- Sistema Nacional de Investigación, Senacyt, Panamá 0801, Panama
| | - Viviana Bortagaray
- Laboratorio de Virología molecular, Departamento de Ciencias Biológicas, CENUR Litoral Norte, Sede Salto, Universidad de la República, Salto 50000, Uruguay (M.V.)
| | - Matías Victoria
- Laboratorio de Virología molecular, Departamento de Ciencias Biológicas, CENUR Litoral Norte, Sede Salto, Universidad de la República, Salto 50000, Uruguay (M.V.)
| | - Rodney Colina
- Laboratorio de Virología molecular, Departamento de Ciencias Biológicas, CENUR Litoral Norte, Sede Salto, Universidad de la República, Salto 50000, Uruguay (M.V.)
| | - Juan Arbiza
- Sección Virología, Instituto de Química Biológica, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (N.M.)
| | - Mabel Berois
- Sección Virología, Instituto de Química Biológica, Facultad de Ciencias, Universidad de la República, Montevideo 11600, Uruguay (N.M.)
| | - Santiago Mirazo
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo 11600, Uruguay; (F.C.)
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Viera-Segura O, Calderón-Flores A, Batún-Alfaro JA, Fierro NA. Tracing the History of Hepatitis E Virus Infection in Mexico: From the Enigmatic Genotype 2 to the Current Disease Situation. Viruses 2023; 15:1911. [PMID: 37766316 PMCID: PMC10536485 DOI: 10.3390/v15091911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Hepatitis E virus (HEV) is the major cause of acute viral hepatitis worldwide. This virus is responsible for waterborne outbreaks in low-income countries and zoonosis transmission in industrialized regions. Initially, considered self-limiting, HEV may also lead to chronic disease, and evidence supports that infection can be considered a systemic disease. In the late 1980s, Mexico became a hot spot in the study of HEV due to one of the first virus outbreaks in Latin America related to enterically transmitted viral non-A, non-B hepatitis. Viral stool particles recovered from Mexican viral hepatitis outbreaks represented the first identification of HEV genotype (Gt) 2 (Gt2) in the world. No new findings of HEV-Gt2 have been reported in the country, whereas this genotype has been found in countries on the African continent. Recent investigations in Mexico have identified other strains (HEV-Gt1 and -Gt3) and a high frequency of anti-HEV antibodies in animal and human populations. Herein, the potential reasons for the disappearance of HEV-Gt2 in Mexico and the advances in the study of HEV in the country are discussed along with challenges in studying this neglected pathogen. These pieces of information are expected to contribute to disease control in the entire Latin American region.
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Affiliation(s)
- Oliver Viera-Segura
- Laboratorio de Diagnóstico de Enfermedades Emergentes y Reemergentes, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Arturo Calderón-Flores
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Julio A. Batún-Alfaro
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Nora A. Fierro
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
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Copado-Villagrana ED, Pizuorno A, García-Suárez A, Abarca JC, DuPont G, Jaramillo-Bueno S, Fierro NA. IL-18 discriminates highly frequent hepatitis E virus positive from negative blood donors in Mexico. Ann Hepatol 2023; 28:101117. [PMID: 37268060 DOI: 10.1016/j.aohep.2023.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis E virus (HEV) is not routinely screened in blood banks in low- and middle-income countries, and no specific biomarkers of exposure to this virus have yet been identified. We aimed to identify HEV seropositivity and detect virus RNA among blood donors from Mexico to further correlate risk factors related to infection and levels of interleukin-18 (IL-18) and interferon-gamma (IFN-γ) as potential biomarkers. MATERIALS AND METHODS This cross-sectional, single-center study included 691 serum samples of blood donors obtained in 2019. Anti-HEV IgG and IgM antibodies were detected in sera and the viral genome was screened in pooled samples. A statistical comparison of risk factors for infection, demographic and clinical features was performed; IL-18 and IFN- γ values were tested in sera. RESULTS Of all the individuals, 9.4% were positive for anti-HEV antibodies and viral RNA detection was confirmed in one of the pools positive for anti-HEV. From the analysis of risk factors, age and having pets were statistically significant for anti-HEV antibody detection. Seropositive samples showed significantly higher IL-18 concentrations relative to samples from seronegative donors. Interestingly, IL-18 values were similar when HEV seropositive samples were compared to samples from clinically acute previously confirmed HEV patients. CONCLUSIONS Our findings highlight the need to follow up on HEV in blood banks in Mexico and underscore that IL-18 could represent a biomarker of HEV exposure.
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Affiliation(s)
| | - Antonio Pizuorno
- Department of Internal Medicine, Health Science Center, The University of Texas, Houston 77030, USA
| | - Adrián García-Suárez
- Department of Immunology, Biomedical Research Institute, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Julio C Abarca
- Department of Immunology, Biomedical Research Institute, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Gisela DuPont
- Department of Immunology, Biomedical Research Institute, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Socorro Jaramillo-Bueno
- Regional General Hospital Number 45, Mexican Social Security Institute, Guadalajara 44100, Mexico
| | - Nora A Fierro
- Department of Immunology, Biomedical Research Institute, National Autonomous University of Mexico, Mexico City 04510, Mexico.
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Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis. Pathogens 2023; 12:pathogens12030425. [PMID: 36986347 PMCID: PMC10059948 DOI: 10.3390/pathogens12030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
Background and aims: The increasing number of diagnosed hepatitis E virus (HEV) infections in Europe has led to the implementation of the testing of blood products in various countries. Many nations have not yet implemented such screening. To assess the need for HEV screening in blood products worldwide, we conducted a systematic review and meta-analysis assessing HEV RNA positivity and anti-HEV seroprevalence in blood donors. Methods: Studies reporting anti-HEV IgG/IgM or HEV RNA positivity rates among blood donors worldwide were identified via predefined search terms in PubMed and Scopus. Estimates were calculated by pooling study data with multivariable linear mixed-effects metaregression analysis. Results: A total of 157 (14%) of 1144 studies were included in the final analysis. The estimated HEV PCR positivity rate ranged from 0.01 to 0.14% worldwide, with strikingly higher rates in Asia (0.14%) and Europe (0.10%) in comparison to North America (0.01%). In line with this, anti-HEV IgG seroprevalence in North America (13%) was lower than that in Europe (19%). Conclusions: Our data demonstrate large regional differences regarding the risk of HEV exposure and blood-borne HEV transmission. Considering the cost–benefit ratio, this supports blood product screening in high endemic areas, such as Europe and Asia, in contrast to low endemic regions, such as the U.S.
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Yang L, Sun Y, Chen T, Miao F, Cong Y, Zhao J. Comment on: Hepatitis E virus in blood donors from Argentina: A possible source of viral infection? Travel Med Infect Dis 2023; 51:102474. [PMID: 36307009 DOI: 10.1016/j.tmaid.2022.102474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Lihua Yang
- College of Life Science, Changchun Sci-Tech University, Changchun, 130600, China
| | - Yixue Sun
- Jilin Research & Development Center of Biomedical Engineering, Changchun University, Changchun, 130022, China
| | - Teng Chen
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, 130122, China
| | - Faming Miao
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, 130122, China
| | - Yanlong Cong
- Laboratory of Infectious Diseases, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, 130062, China.
| | - Jinghui Zhao
- College of Life Science, Changchun Sci-Tech University, Changchun, 130600, China; Jilin DaBeiNong Agriculture and Animal Husbandry Technology Co., Ltd, Changchun, 130102, China; State Key Laboratory of Direct-Fed Microbial Engineering, Beijing DaBeiNong Science and Technology Group Co., Ltd, (DBN), Beijing, 100192, China.
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Geng Y, Shi T, Wang Y. Transmission of Hepatitis E Virus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1417:73-92. [PMID: 37223860 DOI: 10.1007/978-981-99-1304-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Transmission of hepatitis E virus (HEV) occurs predominantly by the fecal-oral route. Large epidemics of hepatitis E in the developing countries of Asia and Africa are waterborne and spread through contaminated drinking water. The reservoir of HEV in developed countries is believed to be in animals with zoonotic transmission to humans, possibly through direct contact or the consumption of undercooked contaminated meat. And HEV transmission through blood transfusion, organ transplantation, and vertical transmission has been reported.
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Affiliation(s)
- Yansheng Geng
- Key Laboratory of Public Health Safety of Hebei Province, School of Public Health, Hebei University, Baoding, China
| | - Tengfei Shi
- Key Laboratory of Public Health Safety of Hebei Province, School of Public Health, Hebei University, Baoding, China
| | - Youchun Wang
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, China.
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Sero-epidemiology and Risk Assessment of Hepatitis E Virus Among Blood Donors in North Lebanon. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-129115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Hepatitis E virus (HEV) is the causative agent of over 50% of acute viral hepatitis cases. The blood transfusion route has emerged as a possible route of transmission of HEV. Objectives: This study aimed to determine the seroprevalence of IgM and IgG anti-HEV among blood donors in North Lebanon and to assess the risk factors associated with its occurrence. Methods: A cross-sectional study was conducted from November to December 2020. Blood samples were collected from 78 healthy blood donors. A standardized questionnaire containing sociodemographic, food consumption, lifestyle, and health-related characteristics, was filled out to assess the risk factors of HEV exposure. Serum samples were tested for IgM and IgG anti-HEV by an enzyme-linked immunosorbent assay (ELISA). Results: The seroprevalence of IgM and IgG anti-HEV antibodies was reported in our study, and it reached 1.09% (1/78) and 12.82% (10/78), respectively. The use of private wells as a drinking source and the travel history to endemic countries have been identified as risk factors for HEV infections (P
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Hepatitis E virus in blood donors from Argentina: A possible source of viral infection? Travel Med Infect Dis 2022; 48:102355. [PMID: 35561878 DOI: 10.1016/j.tmaid.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The hepatitis E virus (HEV) causes acute hepatitis, which can progress to chronicity in immunosuppressed patients. It is transmitted mainly by the fecal-oral or zoonotic routes, but there is current evidence that it can be transmitted by blood transfusions. The objective of the study was to investigate HEV infections in blood donors in Argentina, within the framework of a hemovigilance program. METHODS A total of 547 samples from Argentinean blood donors, collected in 2016, 2019 and 2020 was studied for IgG and IgM anti-HEV by ELISA (Diapro) and RNA HEV by RT-real time PCR and RT-Nested-PCR. RESULTS The prevalence of IgG anti-HEV was 3.47% (19/547). No significant differences were registered according to the year studied, sex or age. The presence of RNA HEV was observed in 0.18% (1/547) of the donors studied without serological evidence of infection. CONCLUSIONS This is the first molecular detection in blood donors from Argentina, showing a molecular prevalence within the range described for RNA-HEV in blood donors from other non-endemic countries, in which immunocompetent RNA-HEV positive donors without serological evidence of infection were identified. The presence of viraemic donors could imply transfusion transmission, which deserves further attention and study.
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Villalba R, Mirabet V. Risk assessment of hepatitis E transmission through tissue allografts. World J Gastrointest Pathophysiol 2022; 13:50-58. [PMID: 35433096 PMCID: PMC8976234 DOI: 10.4291/wjgp.v13.i2.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) is a small non-enveloped single stranded RNA virus whose genotypes 3 and 4 have been associated with zoonotic transmission in industrialized countries. HEV infection is considered the main cause of acute hepatitis worldwide. In some cases, transfusion of blood components or organ transplantation have been reported as the source of infection. We have conducted a literature review on the risk of transmission through cell and tissue allografts. Although no case was found, measures to control this risk should be taken when donor profile (based upon geographical and behavioural data) recommended it. Issues to be considered in donor screening and tissue processing to assess and to reduce the risk of HEV transmission are approached.
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Affiliation(s)
- Rafael Villalba
- Center for Blood Transfusion, Tissues and Cells, Córdoba 14004, Spain
| | - Vicente Mirabet
- Cell and Tissue Bank, Centro de Transfusión de Valencia, Valencia 46014, Spain
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Cheung CKM, Wong SH, Law AWH, Law MF. Transfusion-transmitted hepatitis E: What we know so far? World J Gastroenterol 2022; 28:47-75. [PMID: 35125819 PMCID: PMC8793017 DOI: 10.3748/wjg.v28.i1.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/16/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) is a major cause of viral hepatitis globally. There is growing concern about transfusion-transmitted HEV (TT-HEV) as an emerging global health problem. HEV can potentially result in chronic infection in immunocompromised patients, leading to a higher risk of liver cirrhosis and even death. Between 0.0013% and 0.281% of asymptomatic blood donors around the world have HEV viremia, and 0.27% to 60.5% have anti-HEV immunoglobulin G. HEV is infectious even at very low blood concentrations of the virus. Immunosuppressed patients who develop persistent hepatitis E infection should have their immunosuppressant regimen reduced; ribavirin may be considered as treatment. Pegylated interferon can be considered in those who are refractory or intolerant to ribavirin. Sofosbuvir, a nucleotide analog, showed modest antiviral activity in some clinical studies but sustained viral response was not achieved. Therefore, rescue treatment remains an unmet need. The need for HEV screening of all blood donations remains controversial. Universal screening has been adopted in some countries after consideration of risk and resource availability. Various pathogen reduction methods have also been proposed to reduce the risk of TT-HEV. Future studies are needed to define the incidence of transmission through transfusion, their clinical features, outcomes and prognosis.
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Affiliation(s)
| | - Sunny Hei Wong
- Institute of Digestive Disease and Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong 852, China
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
| | | | - Man Fai Law
- Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong 852, China
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