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Ouyang G, Pan G, Li Q, Li S, Liu T, Yi X, Liu Z. Global burden of acute hepatitis E between 1990 and 2019 and projections until 2030. Liver Int 2024; 44:1329-1342. [PMID: 38426633 DOI: 10.1111/liv.15883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/17/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND AIMS Acute hepatitis E (AHE) is still a public health issue worldwide. Here, we report the global burden of AHE in 204 countries and territories from 1990 to 2019 by age, sex and socio-demographic index (SDI), and predict the future trends to 2030. METHODS Data on AHE were collected from the Global Burden of Diseases, Injuries and Risk Factors Study 2019. The average annual percentage change (AAPC) and joinpoint analysis were used to determine the burden trend. RESULTS In 2019, there were 19.47 million (95% UI, 16.04 to 23.37 million) incident cases of AHE globally, with a 19% increase since 1990. Age-standardized rate (ASR) of disability-adjusted life years (DALYs), prevalent and incident cases declined from 1990 to 2019. In 2019, the ASR of incidence, prevalence and DALYs due to HEV infection were highest in the same regions of South Asia for both sexes. Southern Sub-Saharan Africa presented the highest increases in the ASR for incidence of HEV infection in both males (AAPC = .25) and females (AAPC = .24) from 1990 to 2019. Incident cases are higher in males than females before 55-59 years old. The SDI values were negatively correlated with the age-standardized DALYs. Between 2019 and 2030, the ASR for incidence and prevalence of HEV for both sexes showed an increasing trend. CONCLUSIONS Although the overall ASR of AHE decreased, the burden of AHE remains an underappreciated problem for society. The findings may provide useful information for policymakers to develop appropriate strategies aimed at reducing the burden of AHE.
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Affiliation(s)
- Guoqing Ouyang
- Department of General Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi, China
- Liuzhou Hepatobiliary and Pancreatic Diseases Precision Diagnosis Research Center of Engineering Technology, Liuzhou, Guangxi, China
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Guangdong Pan
- Department of General Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi, China
- Liuzhou Hepatobiliary and Pancreatic Diseases Precision Diagnosis Research Center of Engineering Technology, Liuzhou, Guangxi, China
| | - Qiuyun Li
- Department of General Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi, China
- Liuzhou Hepatobiliary and Pancreatic Diseases Precision Diagnosis Research Center of Engineering Technology, Liuzhou, Guangxi, China
| | - Shuang Li
- Department of General Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi, China
- Liuzhou Hepatobiliary and Pancreatic Diseases Precision Diagnosis Research Center of Engineering Technology, Liuzhou, Guangxi, China
| | - Tao Liu
- Department General Surgery, Luzhai People's Hospital, Liuzhou, Guangxi, China
| | - Xiaolei Yi
- Department of Hepatobiliary Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Zhipeng Liu
- Department of General Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi, China
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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2
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You S, Zhu B, Xin S. Clinical Manifestations of Hepatitis E. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1417:185-197. [PMID: 37223867 DOI: 10.1007/978-981-99-1304-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The clinical manifestations of hepatitis E are similar to those of other types of viral hepatitis. While acute hepatitis E is usually self-limited, pregnant women and chronic liver disease patients suffering from acute hepatitis E usually present with severe clinical manifestations that may develop into fulminant hepatic failure. Chronic HEV infection is typically seen in organ transplant patients; most HEV cases are asymptomatic and rarely display jaundice, fatigue, abdominal pain, fever, fatigue, or ascites. The clinical manifestations of HEV infection in neonates are diverse and have varied clinical signs, biochemistry, and virus-biomarkers. Lastly, the extrahepatic manifestations and complications of hepatitis E are in need of further study.
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Affiliation(s)
- Shaoli You
- Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bing Zhu
- Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shaojie Xin
- Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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3
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Animal Models for Hepatitis E virus. Viruses 2019; 11:v11060564. [PMID: 31216711 PMCID: PMC6630473 DOI: 10.3390/v11060564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) is an underdiagnosed pathogen with approximately 20 million infections each year and currently the most common cause of acute viral hepatitis. HEV was long considered to be confined to developing countries but there is increasing evidence that it is also a medical problem in the Western world. HEV that infects humans belongs to the Orthohepevirus A species of the Hepeviridae family. Novel HEV-like viruses have been observed in a variety of animals and some have been shown to be able to cross the species barrier, causing infection in humans. Several cell culture models for HEV have been established in the past years, but their efficiency is usually relatively low. With the circulation of this virus and related viruses in a variety of species, several different animal models have been developed. In this review, we give an overview of these animal models, indicate their main characteristics, and highlight how they may contribute to our understanding of the basic aspects of the viral life cycle and cross-species infection, the study of pathogenesis, and the evaluation of novel preventative and therapeutic strategies.
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4
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Risk analysis and seroprevalence of HEV in people living with HIV/AIDS in Brazil. Acta Trop 2019; 189:65-68. [PMID: 30292751 DOI: 10.1016/j.actatropica.2018.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 02/08/2023]
Abstract
Acute Hepatitis E virus (HEV) infection in people living with HIV/AIDS (PLHA) can lead to fulminant hepatic failure, cirrhosis and death. The prevalence of anti-HEV antibodies within this group varies according to the geographical area. However, in South America, studies concerning the detection of HEV in PLHA are rare. Here, we investigated the presence of HEV by serological and molecular detection and evaluated the risk factors associated with infection in PLHA in Pernambuco state, Brazilian Northeast. Serological and molecular detection of HEV was performed in 366 samples of PLHA by ELISA for anti-HEV IgG and RT-PCR, respectively. Anti-HEV IgG prevalence was 4.1% (15/366) and no HEV RNA was detected. Concerning the risk factors, we evaluated, in multivariable analysis, age, years of school, sexual orientation, oral-anal sex, use of injectable drugs and piped water. Among them, only piped water availability could be associated with the HEV infection in PLHA (OR: 0.08; CI 95%: 0.01-0.66; p = 0.0182). This study showed for the first time the association of piped water as protection factor for HEV infection in PLHA. Finally, this is also the first report of HEV seroprevalence in PLHA in the Northeast Brazil.
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5
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Marinho ANR, Rocha DCC, Kanai YK, Alves CM, Costa DC, Sousa AH, Barros BCV, Bonfim MCMS, Mascarenhas JDP. Rotavirus analyses by SYBR Green real-time PCR and microbiological contamination in bivalves cultivated in coastal water of Amazonian Brazil. JOURNAL OF WATER AND HEALTH 2018; 16:970-979. [PMID: 30540271 DOI: 10.2166/wh.2018.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The contamination of mussels and oysters by viruses and bacteria is often associated with water contamination and gastroenteritis in humans. The present study evaluated viral and bacterial contamination in 380 samples, from nine mollusk-producing regions in coastal water north of the Brazilian Amazon. Rotavirus contamination was studied for groups A to H, using a two-step SYBR Green RT-qPCR (quantitative reverse transcription polymerase chain reaction), and bacterial families Enterobacteriaceae, Vibrionaceae, and Aeromonadaceae by classical and molecular methods. From the 19 pools analyzed, 26.3% (5/19) were positive for group A Rotavirus, I2 genotype for VP6 region, without amplifications for groups B-H. Bacteriological analysis identified Escherichia coli isolates in 89.5% (17/19) with identification of atypical enteropathogenic E. coli aEPEC in 10.5% (2/19), Salmonella (Groups C1 and G) (10.5%, 2/19), Vibrio alginolyticus (57.9%, 11/19) V. parahaemolyticus (63.2%, 12/19), V. fluvialis (42.1%, 8/19), V. vulnificus (10.5%, 2/19), V. cholerae non-O1, non O139(10.5%, 2/19) and Aeromonas salmonicida (52.6%, 10/19). All the samples investigated presented some level of contamination by enterobacteria, rotavirus, or both, and these results may reflect the level of contamination in the Northern Amazon Region, due to the natural maintenance of some of these agents or by the proximity with human populations and their sewer.
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Affiliation(s)
- A N R Marinho
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail: ; Health Surveillance Secretariat, Brazilian Ministry of Health, Evandro Chagas Institute, Rodovia BR 316-KM 07, S/N, Levilandia, 67.030-000, Ananindeua, Para, Brazil
| | - D C C Rocha
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail:
| | - Y K Kanai
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail:
| | - C M Alves
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail:
| | - D C Costa
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail:
| | - A H Sousa
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail:
| | - B C V Barros
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail:
| | - M C M S Bonfim
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail:
| | - J D P Mascarenhas
- Instituto Evandro Chagas, IEC, BR-316 km 7, Ananindeua, Para, Brazil E-mail:
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King NJ, Hewitt J, Perchec-Merien AM. Hiding in Plain Sight? It's Time to Investigate Other Possible Transmission Routes for Hepatitis E Virus (HEV) in Developed Countries. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:225-252. [PMID: 29623595 DOI: 10.1007/s12560-018-9342-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
Historically in developed countries, reported hepatitis E cases were typically travellers returning from countries where hepatitis E virus (HEV) is endemic, but now there are increasing numbers of non-travel-related ("autochthonous") cases being reported. Data for HEV in New Zealand remain limited and the transmission routes unproven. We critically reviewed the scientific evidence supporting HEV transmission routes in other developed countries to inform how people in New Zealand may be exposed to this virus. A substantial body of indirect evidence shows domesticated pigs are a source of zoonotic human HEV infection, but there is an information bias towards this established reservoir. The increasing range of animals in which HEV has been detected makes it important to consider other possible animal reservoirs of HEV genotypes that can or could infect humans. Foodborne transmission of HEV from swine and deer products has been proven, and a large body of indirect evidence (e.g. food surveys, epidemiological studies and phylogenetic analyses) support pig products as vehicles of HEV infection. Scarce data from other foods suggest we are neglecting other potential sources of foodborne HEV infection. Moreover, other transmission routes are scarcely investigated in developed countries; the role of infected food handlers, person-to-person transmission via the faecal-oral route, and waterborne transmission from recreational contact or drinking untreated or inadequately treated water. People have become symptomatic after receiving transfusions of HEV-contaminated blood, but it is unclear how important this is in the overall hepatitis E disease burden. There is need for broader research efforts to support establishing risk-based controls.
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Affiliation(s)
- Nicola J King
- Institute of Environmental Science and Research, 34 Kenepuru Drive, Kenepuru, Porirua, 5022, New Zealand
| | - Joanne Hewitt
- Institute of Environmental Science and Research, 34 Kenepuru Drive, Kenepuru, Porirua, 5022, New Zealand.
| | - Anne-Marie Perchec-Merien
- New Zealand Ministry for Primary Industries, Pastoral House, 25 The Terrace, Wellington, New Zealand
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La Rosa G, Proroga YTR, De Medici D, Capuano F, Iaconelli M, Della Libera S, Suffredini E. First Detection of Hepatitis E Virus in Shellfish and in Seawater from Production Areas in Southern Italy. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:127-131. [PMID: 28956272 DOI: 10.1007/s12560-017-9319-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/23/2017] [Indexed: 05/21/2023]
Abstract
Shellfish samples (n = 384) from production areas, water samples from the same areas (n = 39) and from nearby sewage discharge points (n = 29) were analyzed for hepatitis E virus (HEV) by real-time and nested RT-PCR. Ten shellfish samples (2.6%) and five seawater samples (12.8%) tested positive for HEV; all characterized strains were G3 and showed high degree of sequence identity. An integrated surveillance in seafood and waters is relevant to reduce the risk of shellfish-associated illnesses.
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Affiliation(s)
- G La Rosa
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Y T R Proroga
- Department of Food Inspection, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Via della Salute 2, 80055, Portici, Italy
| | - D De Medici
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - F Capuano
- Department of Food Inspection, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Via della Salute 2, 80055, Portici, Italy
| | - M Iaconelli
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - S Della Libera
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - E Suffredini
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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8
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Xin S, Xiao L. Clinical Manifestations of Hepatitis E. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 948:175-189. [PMID: 27738985 DOI: 10.1007/978-94-024-0942-0_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The clinical manifestations of hepatitis E are similar to those of other types of viral hepatitis. While acute hepatitis E is usually self-limited, pregnant women and chronic liver disease patients suffering from acute hepatitis E usually present with severe clinical manifestations that may develop into fulminant hepatic failure. Chronic HEV infection is typically only seen in organ transplant patients; most HEV cases are asymptomatic and rarely display jaundice, fatigue, abdominal pain, fever, fatigue, or ascites. The clinical manifestations of HEV infection in neonates are diverse and have varied clinical signs, biochemistry, and virus biomarkers. Lastly, the extrahepatic manifestations and complications of hepatitis E are in need of further study.
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Affiliation(s)
- Shaojie Xin
- Liver Failure Treatment and Research Center, 302 Hospital, No.100 West 4th middle Road, Fengtai District, Beijing, 100039, China.
| | - Long Xiao
- Liver Failure Treatment and Research Center, 302 Hospital, No.100 West 4th middle Road, Fengtai District, Beijing, 100039, China
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Baumann-Popczyk A, Popczyk B, Gołąb E, Rożej-Bielicka W, Sadkowska-Todys M. A cross-sectional study among Polish hunters: seroprevalence of hepatitis E and the analysis of factors contributing to HEV infections. Med Microbiol Immunol 2017; 206:367-378. [PMID: 28776194 PMCID: PMC5599476 DOI: 10.1007/s00430-017-0515-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/24/2017] [Indexed: 12/15/2022]
Abstract
Hepatitis E virus (HEV) is known as zoonotic agent. The main reservoirs of HEV in Europe are pigs, wild boars, and deer. Hunting activity is considered to be a risk factor for HEV infection. We conducted a cross-sectional study among 1021 Polish hunters. To understand socio-demographic characteristics of this population and to gather information on potential exposures, all participants completed a questionnaire. Commercial immunoassays were employed to estimate seroprevalence anti-HEV. Samples with confirmed positive result of anti-HEV IgM were examined for HEV RNA. Anti-HEV IgG were identified in 227 people, 22.2% of the studied group. Seroprevalence among the studied hunters was associated with age ≥65 [adjusted prevalence ratio (aPR) 1.6, p = 0.037), living in a house (aPR 1.54, p = 0.013), professional contact with farm animals (aPR 1.09, p = 0.01), and consumption of stewed offal (aPR 1.61, p = 0.00). Washing hands after disembowelment was linked to lower seroprevalence (aPR 0.53; p = 0.00). Lower prevalence of anti-HEV IgG among hunters living in cities was associated with age: 35–49 (aPR 0.52, p = 0.011) and 50–64 (aPR 0.93, p = 0.58), living in a house (aPR 1.58, p = 0.002) and owning a cat (aPR 0.58, p = 0.042). Among hunters living in rural areas, seropositivity was associated with contact with farm animals (aPR 1.66, p = 0.013) and consumption of stewed offal (aPR 1.81; p = 0.001). Contrary to initial assumptions, it was concluded that hunting was of significantly lesser importance than other factors. Due to the high level of HEV seroprevalence identified, we recommend conducting a large-scale study in the general population of Poland.
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Affiliation(s)
- Anna Baumann-Popczyk
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Chocimska str 24, 00-791, Warsaw, Poland.
| | - Bartłomiej Popczyk
- Department of Genetic and Animal Breeding, Faculty of Animal Science, University of Life Sciences, Warsaw, Poland.,Polish Hunting Association, Warsaw, Poland
| | - Elżbieta Gołąb
- Department of Parasitology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Wioletta Rożej-Bielicka
- Department of Parasitology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Małgorzata Sadkowska-Todys
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Chocimska str 24, 00-791, Warsaw, Poland
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Donnelly MC, Scobie L, Crossan CL, Dalton H, Hayes PC, Simpson KJ. Review article: hepatitis E-a concise review of virology, epidemiology, clinical presentation and therapy. Aliment Pharmacol Ther 2017; 46:126-141. [PMID: 28449246 DOI: 10.1111/apt.14109] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/21/2016] [Accepted: 03/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lead to cirrhosis and organ failure. AIM To detail current understanding of the molecular biology of HEV, diagnostic and therapeutic strategies and propose future directions for basic science and clinical research. METHODS PubMed was searched for English language articles using the key words "hepatitis E", "viral hepatitis", "autochthonous infection", "antiviral therapy", "liver transplantation", "acute", "chronic", "HEV", "genotype", "transmission" "food-borne", "transfusion". Additional relevant publications were identified from article reference lists. RESULTS There has been increasing recognition of autochthonous HEV infection in Western countries, mainly associated with genotype 3. Chronic HEV infection has been recognised since 2008, and in transplant recipients this may lead to cirrhosis and organ failure. Modes of transmission include food-borne transmission, transfusion of blood products and solid organ transplantation. Ribavirin therapy is used to treat patients with chronic HEV infection, but new therapies are required as there have been reports of treatment failure with ribavirin. CONCLUSIONS Autochthonous HEV infection is a clinical issue with increasing burden. Future work should focus on increasing awareness of HEV infection in the developed world, emphasising the need for clinicians to have a low threshold for HEV testing, particularly in immunosuppressed patients. Patients at potential risk of chronic HEV infection must also be educated and given advice regarding prevention of infection.
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Affiliation(s)
- M C Donnelly
- Department of Hepatology and Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - L Scobie
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | - C L Crossan
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | - H Dalton
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro, UK
| | - P C Hayes
- Department of Hepatology and Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - K J Simpson
- Department of Hepatology and Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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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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12
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Tarantino G, Bagnarelli P, Marzioni M, Marinelli K, Surace G, Traini S, Baroni GS, Menzo S, Benedetti A. Hepatitis E in a region of Italy: An emerging autochthonous infection? Dig Liver Dis 2016; 48:1340-1345. [PMID: 27476463 DOI: 10.1016/j.dld.2016.06.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent data showed an increasing number of "autochthonous" cases of hepatitis E in Italy. AIMS Analysing cases of acute hepatitis E to define frequency, clinical features, prognosis and risk factors. METHODS We considered all the patients admitted to our Regional Hospital between August 2011 and September 2014, with a diagnosis of acute hepatitis; serological screening for hepatitis B, C and A viruses was performed; in the event of negative results, sera were tested for cytomegalovirus, Epstein-Barr and hepatitis E viruses. RESULTS Among 200 patients, 66 were affected by viral infection. IgM anti-HEV was detected in 14 patients with a predominance of males (79%) with a mean age of 55. Genotype 3 of HEV was found in 8 patients. Only one patient died of acute on chronic liver failure; all others evolved favourably towards clinical remission within two months from clinical onset. Thirteen patients had had local exposure to infection and 9 reported the consumption of raw or undercooked locally produced pork. CONCLUSION The incidence of HEV in our cohort of patients with acute viral hepatitis is high (about 20% per year). In over 85% an autochthonous exposure to infection could be recognised, with a clear link with food habits.
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Affiliation(s)
- Giuseppe Tarantino
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy.
| | - Patrizia Bagnarelli
- Department of Biomedical Sciences and Public Health, Virology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Marco Marzioni
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Katia Marinelli
- Department of Biomedical Sciences and Public Health, Virology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Giulia Surace
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Sara Traini
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Gianluca Svegliati Baroni
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Stefano Menzo
- Department of Biomedical Sciences and Public Health, Virology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Antonio Benedetti
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
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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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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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15
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Tsai MH, Chou CM, Lan KC. Avoiding Biased-Feeding in the Scheduling of Collaborative Multipath TCP. PLoS One 2016; 11:e0161213. [PMID: 27529783 PMCID: PMC4986957 DOI: 10.1371/journal.pone.0161213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/30/2016] [Indexed: 11/29/2022] Open
Abstract
Smartphones have become the major communication and portable computing devices that access the Internet through Wi-Fi or mobile networks. Unfortunately, users without a mobile data subscription can only access the Internet at limited locations, such as hotspots. In this paper, we propose a collaborative bandwidth sharing protocol (CBSP) built on top of MultiPath TCP (MPTCP). CBSP enables users to buy bandwidth on demand from neighbors (called Helpers) and uses virtual interfaces to bind the subflows of MPTCP to avoid modifying the implementation of MPTCP. However, although MPTCP provides the required multi-homing functionality for bandwidth sharing, the current packet scheduling in collaborative MPTCP (e.g., Co-MPTCP) leads to the so-called biased-feeding problem. In this problem, the fastest link might always be selected to send packets whenever it has available cwnd, which results in other links not being fully utilized. In this work, we set out to design an algorithm, called Scheduled Window-based Transmission Control (SWTC), to improve the performance of packet scheduling in MPTCP, and we perform extensive simulations to evaluate its performance.
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Affiliation(s)
- Meng-Hsun Tsai
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Ming Chou
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Kun-chan Lan
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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Park WJ, Park BJ, Ahn HS, Lee JB, Park SY, Song CS, Lee SW, Yoo HS, Choi IS. Hepatitis E virus as an emerging zoonotic pathogen. J Vet Sci 2016; 17:1-11. [PMID: 27051334 PMCID: PMC4808633 DOI: 10.4142/jvs.2016.17.1.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/27/2015] [Accepted: 08/22/2015] [Indexed: 12/15/2022] Open
Abstract
Hepatitis E outbreaks are a serious public health concern in developing countries. The disease causes acute infections, primarily in young adults. The mortality rate is approximately 2%; however, it can exceed 20% in pregnant women in some regions in India. The causative agent, hepatitis E virus (HEV), has been isolated from several animal species, including pigs. HEV genotypes 3 and 4 have been isolated from both humans and animals, and are recognized as zoonotic pathogens. Seroprevalence studies in animals and humans indirectly suggest that HEV infections occur worldwide. The virus is primarily transmitted to humans via undercooked animal meats in developed countries. Moreover, transfusion- and transplantation-mediated HEV infections have recently been reported. This review summarizes the general characteristics of hepatitis E, HEV infection status in animals and humans, the zoonotic transmission modes of HEV, and HEV vaccine development status.
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Affiliation(s)
- Woo-Jung Park
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Byung-Joo Park
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Hee-Seop Ahn
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Joong-Bok Lee
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Seung-Yong Park
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Chang-Seon Song
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Sang-Won Lee
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Han-Sang Yoo
- Department of Infectious Diseases, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - In-Soo Choi
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
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17
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Evaluation of rapid tests for diagnosis of acute hepatitis E. J Clin Virol 2016; 78:4-8. [PMID: 26930580 DOI: 10.1016/j.jcv.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/28/2016] [Accepted: 02/10/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hepatitis E virus diagnosis still presents difficulties due to discordant results among diagnostic tests. OBJECTIVES The aim of this study was to evaluate the performance of two rapid tests for detection of anti-HEV IgM antibodies. STUDY DESIGN The rapid tests were compared with three commercial anti-HEV ELISA assays and one Real-Time PCR assay on 59 sera from patients with acute viral non-AC hepatitis. RESULTS The presence of anti-HEV IgM antibodies was evaluated by two rapid tests (Wantai and Assure) on 25 HEV RNA positive samples. Anti-HEV IgM antibodies were detected in 24/25 and 23/25 samples respectively. The sensitivity and specificity of Wantai and Assure Rapid tests were evaluated using the 25 HEV RNA positive samples and 50 HEV RNA negative samples (including sera from acute-phase HAV and HBV infections and blood donors). Overall, the sensitivity of Wantai Rapid and Assure Rapid tests was 96.1% and 92.6% respectively; the specificity of the 2 tests was 100%. CONCLUSION Our data suggest the potential use of anti-HEV IgM rapid assays as a first line test in primary health care settings, particularly useful for patients with chronic liver disease or pregnant women who urgently need an antiviral treatment.
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Gao S, Li D, Liu Y, Zha E, Wang S, Li Y, Zhou T, Yue X. Development and evaluation of a RT-LAMP assay for rapid detection of hepatitis E virus from shellfish. Int J Food Microbiol 2015; 220:1-5. [PMID: 26741532 DOI: 10.1016/j.ijfoodmicro.2015.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 12/03/2015] [Accepted: 12/20/2015] [Indexed: 01/10/2023]
Abstract
Hepatitis E virus (HEV) has becoming a well known zoonotic enteric pathogen and circulated widely inter human-animal-water-food. Generally, detection of the virus has relied on conventional reverse transcription-PCR (RT-PCR) and TaqMan/SYBR quantitative real-time RT-PCR (RT-qPCR), but these tools are usually disadvantages in time-consuming and expensive instruments required. In the present study, we report here on the development of a one-step single-tube reverse transcription-loop-mediated isothermal amplification (RT-LAMP) assay for rapid detection of HEV contamination in shellfish. The amplification is completed under the isothermal condition (63 °C) for 60 min, and can be visually evaluated by staining at a time in about 1h. In addition, a total of 315 shellfish (80 Anadara granosa, 115 Scapharca subcrenata and 120 Ruditapes philippinarum) collected monthly from the Jinzhou coastal estuary of China Bohai gulf were investigated for HEV contamination by the RT-LAMP compared with a standard RT-qPCR. It was found that genotype 4 HEV was detected in all three species of shellfish sampled using the RT-LAMP assay and was in accordance with RT-qPCR detection of HEV in shellfish. Summarily, our results indicate that the RT-LAMP is a rapid, specific, sensitive and reliable method. This method offers a new tool for the routine monitoring of HEV contamination in shellfish or its harvesting waters in field.
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Affiliation(s)
- Shenyang Gao
- College of Animal Husbandry & Veterinary Medicine, Liaoning Medical University, No. 5-48 Renmin Street, Jinzhou 121001, China; College of Food Science, Shenyang Agricultural University, No. 120 Dongling Road, Shenyang 110866, China.
| | - Dandan Li
- Animal Quarantine Lab, Inspection & Quarantine Technology Center of Hainan Entry-Exit Inspection & Quarantine Bureau, Haikou 570000, China
| | - Ying Liu
- College of Animal Husbandry & Veterinary Medicine, Liaoning Medical University, No. 5-48 Renmin Street, Jinzhou 121001, China
| | - Enhui Zha
- College of Animal Husbandry & Veterinary Medicine, Liaoning Medical University, No. 5-48 Renmin Street, Jinzhou 121001, China
| | - Shen Wang
- College of Animal Husbandry & Veterinary Medicine, Liaoning Medical University, No. 5-48 Renmin Street, Jinzhou 121001, China
| | - Yonggang Li
- College of Animal Husbandry & Veterinary Medicine, Liaoning Medical University, No. 5-48 Renmin Street, Jinzhou 121001, China
| | - Tiezhong Zhou
- College of Animal Husbandry & Veterinary Medicine, Liaoning Medical University, No. 5-48 Renmin Street, Jinzhou 121001, China
| | - Xiqing Yue
- College of Food Science, Shenyang Agricultural University, No. 120 Dongling Road, Shenyang 110866, China
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Licata A, Ingrassia D, Serruto A, Soresi M, Giannitrapani L, Montalto G, Craxì A, Almasio PL. Clinical course and management of acute and chronic viral hepatitis during pregnancy. J Viral Hepat 2015; 22:515-23. [PMID: 25288051 DOI: 10.1111/jvh.12335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pregnancy is a para-physiologic condition, which usually evolves without any complications in the majority of women, even if in some circumstances moderate or severe clinical problems can also occur. Among complications occurring during the second and the third trimester very important are those considered as concurrent to pregnancy such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, HELLP syndrome and acute fatty liver of pregnancy. The liver diseases concurrent to pregnancy typically occur at specific times during the gestation and they may lead to significant maternal and foetal morbidity and mortality. Commonly, delivery of the foetus, even preterm, usually terminates the progression of these disorders. All chronic liver diseases, such as chronic viral hepatitis, autoimmune hepatitis, Wilson's disease, and cirrhosis of different aetiologies may cause liver damage, independently from pregnancy. In this review we will also comment the clinical implications of pregnancies occurring in women who received a orthotopic liver transplantation (OLT) Therefore, the management of immunosuppressive therapy before and after the delivery in women who received liver transplant is becoming a relevant clinical issue. Finally, we will focus on acute and chronic viral hepatitis occurring during pregnancy, on management of advanced liver disease and we will review the literature on the challenging issue regarding pregnancy and OLT.
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MESH Headings
- Acute Disease
- Chronic Disease
- Disease Management
- Female
- Hepatitis, Viral, Human/complications
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/pathology
- Hepatitis, Viral, Human/therapy
- Hepatitis, Viral, Human/virology
- Humans
- Liver Transplantation
- Pregnancy
- Pregnancy Complications, Infectious
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Affiliation(s)
- A Licata
- Sezione di Gastroenterologia & Epatologia, Sezione di Medicina Interna, Di.Bi.M.I.S., Università di Palermo, Palermo, Italy
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Mansuy JM, Sauné K, Rech H, Abravanel F, Mengelle C, L’Homme S, Destruel F, Kamar N, Izopet J. Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011. Euro Surveill 2015. [DOI: 10.2807/1560-7917.es2015.20.19.21127] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The apparent seroprevalence of hepatitis E Virus (HEV) varies greatly among developed countries depending on the geographical area and the sensitivity of immunoassays. We used a validated assay to determine the prevalence of HEV IgG and IgM antibodies among 3,353 blood donors living in southern France, who gave blood during the two first weeks of October 2011 and participated in the study. Demographic and epidemiological information was collected using a specific questionnaire. We also screened 591 samples for HEV RNA. Overall IgG seroprevalence was 39.1% and varied from 20% to 71.3% depending on the geographical area (p?<?0.001) while IgM seroprevalence was 3.31%. Anti-HEV IgG was significantly correlated with increasing age (p?<?0.001), eating uncooked pork liver sausages (p?<?0.001), offal (p?=?0.003), or mussels (p?=?0.02). Anti-HEV IgM was associated with being male (p?=?0.01) and eating uncooked pork liver sausages (p?=?0.02). HEV RNA was detected in one of the 99 anti-HEV IgM-positive samples, but in none of the 492 anti-HEV IgM-negative samples. HEV is hyperendemic in southern France. Dietary and culinary habits alone cannot explain the epidemiology of HEV in this region, indicating that other modes of contamination should be investigated.
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Affiliation(s)
- J M Mansuy
- Department of Virology, CHU Purpan, Toulouse, France
| | - K Sauné
- Department of Virology, CHU Purpan, Toulouse, France
- Medicine University Purpan, Toulouse, France
| | - H Rech
- Pyrénées Méditerranée French Blood Service, Toulouse, France
| | - F Abravanel
- Department of Physiopathology, INSERM U1043, Toulouse, France
- Medicine University Purpan, Toulouse, France
- Department of Virology, CHU Purpan, Toulouse, France
| | - C Mengelle
- Department of Virology, CHU Purpan, Toulouse, France
| | - S L’Homme
- Medicine University Purpan, Toulouse, France
- Department of Physiopathology, INSERM U1043, Toulouse, France
- Department of Virology, CHU Purpan, Toulouse, France
| | - F Destruel
- Pyrénées Méditerranée French Blood Service, Toulouse, France
| | - N Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France
- Department of Physiopathology, INSERM U1043, Toulouse, France
| | - J Izopet
- Department of Virology, CHU Purpan, Toulouse, France
- Department of Physiopathology, INSERM U1043, Toulouse, France
- Medicine University Purpan, Toulouse, France
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Abstract
Background: Viral hepatitis is an infection that has been reported to be present throughout the year, but some particular months are associated with higher incidences. The primary objective was to review and report on the current knowledge and evidence that existed on seasonality of different type of acute viral hepatitis worldwide in order to develop recommendations for future research, prevention and control. Materials and Methods: A systematic literature review was performed to identify all the primary reports and studies published during 1970-2013 on acute hepatitis A, B, C and E (AHA, AHB, AHC and AHE) in human subjects by searching PubMed, reference lists of major articles and correspondence with scientific experts. For each report or study included, the following information was extracted (as applicable to study): Location (country and setting), study population (number of cases, patients), seasonal or monthly rate and study duration. Results: There is no definite and consistent seasonal pattern has been observed on AHA; AHB; AHE and AHC, although evidence points towards spring and summer peak for hepatitis A, B, C and E. Multiple source of transmission such as; summer travel to an endemic area, swimming habits of the population in hot months, increase sexual contact, tattoo, poor hygiene and environmental sanitation and food habits (feco-oral transmission of viral hepatitis) probably exists and should be further investigated through analytical and epidemiological.
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Affiliation(s)
- Auda Fares
- Albert-Schlangen, Str.36 Bedburg-Germany
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22
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Systematic serological testing for hepatitis E virus in kidney transplant recipients. J Clin Microbiol 2015; 53:1523-30. [PMID: 25694530 DOI: 10.1128/jcm.03624-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/11/2015] [Indexed: 12/24/2022] Open
Abstract
Hepatitis E virus (HEV) genotype 3 is endemic in Europe and hyperendemic in southern France. Recent reports of a high prevalence of HEV RNA in blood donations and in culinary specialties from this geographical area confirmed the endemicity of HEV and sources of viral transmission in this geographical area. HEV causes acute and chronic hepatitis in solid organ transplant recipients. Since March 2012, we have implemented systematic HEV serological testing in our cohort of kidney transplant recipients (KTRs) in Marseille in southeastern France. The aim of our study was to assess HEV exposure in this cohort between March 2012 and May 2014. During these 27 months, we found that 39% of the patients who underwent kidney transplantation had an anti-HEV IgG response using a sensitive microplate enzyme immunoassay. This seroprevalence was approximately 43% at both 1 and 8 years after, using the same assay. In addition, systematic HEV serological testing detected 6 cases of HEV infection among 578 KTRs (1%) during the 27 months of the study, with 5 at an acute stage and 1 at a chronic stage. In conclusion, continuous HEV monitoring in this population is useful for better understanding the epidemiology of HEV in France, because these patients are a well-monitored population. Moreover, HEV monitoring in KTRs is clinically relevant because HEV represents a clinical threat in these patients. Nevertheless, HEV serological testing may be more fruitful for identifying HEV infections when performed in cases of biological liver abnormalities than when performed systematically.
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23
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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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Ben-Ayed Y, Hannachi H, Ben-Alaya-Bouafif N, Gouider E, Triki H, Bahri O. Hepatitis E virus seroprevalence among hemodialysis and hemophiliac patients in Tunisia (North Africa). J Med Virol 2014; 87:441-5. [DOI: 10.1002/jmv.24082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Yousr Ben-Ayed
- Laboratory of Clinical Virology; Institute Pasteur of Tunis; University of Tunis El Manar; Tunis Tunisia
| | - Hela Hannachi
- Laboratory of Clinical Virology; Institute Pasteur of Tunis; University of Tunis El Manar; Tunis Tunisia
| | | | - Emna Gouider
- Hematological Unit; Aziza Othmana Hospital; Tunis Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology; Institute Pasteur of Tunis; University of Tunis El Manar; Tunis Tunisia
| | - Olfa Bahri
- Laboratory of Clinical Virology; Institute Pasteur of Tunis; University of Tunis El Manar; Tunis Tunisia
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Yoon Y, Jeong HS, Yun H, Lee H, Hwang YS, Park B, Lee CJ, Lee S, Hyeon JY. Hepatitis E Virus (HEV) seroprevalence in the general population of the Republic of Korea in 2007-2009: a nationwide cross-sectional study. BMC Infect Dis 2014; 14:517. [PMID: 25248488 PMCID: PMC4262127 DOI: 10.1186/1471-2334-14-517] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/18/2014] [Indexed: 01/28/2023] Open
Abstract
Background Hepatitis E virus (HEV) is an emerging pathogen associated with endemic and acute viral hepatitis. In this study, we investigate the HEV seroprevalence and putative risk factors by a nationwide cross-sectional study in the Republic of Korea. Methods The prevalence of anti-HEV antibody was investigated in 2,450 serum samples collected in fourth Korea National Health and Nutrition Examination Survey. In addition, epidemiological information on possible risk factors including gender, age, education, occupation, and residence location for exposure to HEV was obtained. Results The frequency of anti-EIA reactive sample was 5.9% (144/2450). The individuals in groups with male, older age, low education level and living in rural or coastal regions had high seroprevalence estimates (P ≤ 0.001). In addition, seroprevalence was significantly higher among individuals with self-identified skilled agricultural, forestry, and fishery workers (31.3%, P < 0.001). Conclusions This study provides valuable data that could be used to investigate associations of HEV seroprevalence and putative risk factors by a nationwide cross-sectional study. The high HEV seroprevalence of skilled agricultural, forestry, and fishery workers and individuals lived in coastal and rural area indicated that zoonotic transmission is an important risk factor for HEV infection in the republic of Korea. Further studies that include detailed and continuous nationwide surveys are required to identify unrecognized risk factors and to monitor the HEV infection prevalence. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-517) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ji-Yeon Hyeon
- Division of Vaccine Research, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Osong-eup, CheongJu, Chungcheongbuk-do 363-951, Republic of Korea.
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Krog J, Larsen L, Schultz A. Enteric porcine viruses in farmed shellfish in Denmark. Int J Food Microbiol 2014; 186:105-9. [DOI: 10.1016/j.ijfoodmicro.2014.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 12/19/2022]
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Masclaux FG, Hotz P, Gashi D, Savova-Bianchi D, Oppliger A. Assessment of airborne virus contamination in wastewater treatment plants. ENVIRONMENTAL RESEARCH 2014; 133:260-5. [PMID: 24981824 DOI: 10.1016/j.envres.2014.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/20/2014] [Accepted: 06/04/2014] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Occupational exposure to bioaerosols in wastewater treatment plants (WWTP) and its consequence on workers' health are well documented. Most studies were devoted to enumerating and identifying cultivable bacteria and fungi, as well as measuring concentrations of airborne endotoxins, as these are the main health-related factors found in WWTP. Surprisingly, very few studies have investigated the presence and concentrations of airborne virus in WWTP. However, many enteric viruses are present in wastewater and, due to their small size, they should become aerosolized. Two in particular, the norovirus and the adenovirus, are extremely widespread and are the major causes of infectious gastrointestinal diseases reported around the world. The third one, hepatitis E virus, has an emerging status. GOAL AND METHODS This study׳s objectives were to detect and quantify the presence and concentrations of 3 different viruses (adenovirus, norovirus and the hepatitis E virus) in air samples from 31 WWTPs by using quantitative polymerase chain reaction (qPCR) during two different seasons and two consecutive years. RESULTS Adenovirus was present in 100% of summer WWTP samples and 97% of winter samples. The highest airborne concentration measured was 2.27 × 10(6) genome equivalent/m(3) and, on average, these were higher in summer than in winter. Norovirus was detected in only 3 of the 123 air samples, and the hepatitis E virus was not detected. CONCLUSIONS Concentrations of potentially pathogenic viral particles in WWTP air are non-negligible and could partly explain the work-related gastrointestinal symptoms often reported in employees in this sector.
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Affiliation(s)
- Frédéric G Masclaux
- Institute for Work and Health (IST), University of Lausanne and University of Geneva, Route de la Corniche 2, 1066 Epalinges-Lausanne, Switzerland.
| | - Philipp Hotz
- Occupational and Environmental Medicine Unit, Med. Poliklinik USZ, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Drita Gashi
- Occupational and Environmental Medicine Unit, Med. Poliklinik USZ, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Dessislava Savova-Bianchi
- Institute for Work and Health (IST), University of Lausanne and University of Geneva, Route de la Corniche 2, 1066 Epalinges-Lausanne, Switzerland
| | - Anne Oppliger
- Institute for Work and Health (IST), University of Lausanne and University of Geneva, Route de la Corniche 2, 1066 Epalinges-Lausanne, Switzerland.
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Seroprevalence of hepatitis E virus (HEV) in humans living in high pig density areas of Germany. Med Microbiol Immunol 2014; 203:273-82. [PMID: 24744181 DOI: 10.1007/s00430-014-0336-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 03/25/2014] [Indexed: 12/14/2022]
Abstract
An increase in acute autochthonous hepatitis E virus (HEV) infections has been recorded in Germany. These are suspected to be zoonotically transmitted from wild boar, deer and domestic pig. The latter may represent a major reservoir for HEV. In this study, 537 sera from humans living in Westphalia and Lower Saxony, representing areas of high pig density in Germany, were tested for the presence of HEV-specific antibodies. Among them were 302 individuals with occupational, direct contact to pigs and 235 individuals without direct contact to pigs. Two commercial tests and one in-house assay were applied for the detection of HEV-specific immunoglobulin G (IgG) antibodies. Sera were also tested in an assay that detects all classes of HEV-specific antibodies. Depending on the test used, the seroprevalence ranged from 4.1 to 27.9 %. Exposition to pigs was found to be associated with a significantly higher seroprevalence in subjects with contact to pigs (13.2-32.8 %) compared with that in non-exposed humans (7.7-21.7 %). In particular, individuals younger than 40 years with occupational exposure exhibited a markedly higher HEV seroprevalence compared with non-exposed individuals of that age group. In general, HEV seroprevalence increased with age resulting in a similar prevalence level in the age group of ≥ 50 years for exposed and non-exposed individuals. Analysis of all sera by a commercial anti-HEV IgM ELISA revealed 35 positive and 25 borderline samples. However, only one positive serum could be confirmed by an IgM line assay. Selected samples from IgM and/or IgG as well as total HEV antibody-positive individuals were also tested for the presence of HEV RNA. In one of the 78 samples, the only IgM ELISA positive and IgM line assay confirmed sample, RNA of HEV genotype 3 was detected. This sequence has high similarity to HEV sequences obtained from wild boars and domestic pigs from Germany and The Netherlands. This study demonstrates that in addition to the consumption of raw or undercooked meat, direct contact to pigs has to be considered as an additional risk factor for HEV infection.
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Renou C, Gobert V, Locher C, Moumen A, Timbely O, Savary J, Roque-Afonso AM. Prospective study of Hepatitis E Virus infection among pregnant women in France. Virol J 2014; 11:68. [PMID: 24716485 PMCID: PMC4011159 DOI: 10.1186/1743-422x-11-68] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis E Virus (HEV) infection has a poor prognosis among pregnant women from high endemic countries. HEV-prevalence and incidence among pregnant women is unknown in high-income countries such as France. This prospective study was conducted to assess HEV infection in this setting. FINDINGS An overall HEV prevalence of 7.74% was observed among 315 pregnant women. Seroprevalence was higher in south than in north of France (29.3% vs. 3.6%, p < 0.0001), and women with detectable IgG were older. No IgG seroconversion or IgM detection were observed during pregnancy. CONCLUSIONS Data suggest that HEV infection is a rare occurrence during pregnancy even in regions of western countries with high seroprevalence rates.
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Aherfi S, Borentain P, Raissouni F, Le Goffic A, Guisset M, Renou C, Grimaud JC, Hardwigsen J, Garcia S, Botta-Fridlund D, Nafati C, Motte A, Le Treut YP, Colson P, Gerolami R. Liver transplantation for acute liver failure related to autochthonous genotype 3 hepatitis E virus infection. Clin Res Hepatol Gastroenterol 2014; 38:24-31. [PMID: 24462173 DOI: 10.1016/j.clinre.2013.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/28/2013] [Accepted: 05/14/2013] [Indexed: 02/04/2023]
Abstract
Hepatitis E virus of genotype 3 (HEV-3) is an emerging cause of sporadic autochthonous acute hepatitis in Europe. Although spontaneous outcome of hepatitis E is usually favorable, fulminant liver failure has been described worldwide. In Europe, autochthonous hepatitis E associated with fulminant hepatic failure and leading to liver transplantation has been exceptionally reported. We report here four cases of fulminant and sub-fulminant hepatitis E proposed for liver transplantation in Marseille University hospitals between July 2006 and March 2010. HEV diagnosis relied on detection of anti-HEV IgM antibodies and HEV RNA in serum samples. All cases were men, with no travel history in hyperendemic areas. HEV sequence analyses revealed genotype 3 HEV in the four patients. Liver histology indicated severe acute hepatitis in all of them, pre-existing fibrosis being found in two cases. Two patients underwent liver transplantation, and the two other patients could not be transplanted due to septic complications and died. HEV testing should be performed for the initial evaluation of every acute liver failure regardless of the epidemiological and clinical context. With respect to the potentially fulminant evolution of HEV genotype 3 infections, treatment with ribavirin of severe acute hepatitis E should be considered.
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Affiliation(s)
- Sarah Aherfi
- Institut hospitalo-universitaire (IHU) Méditerranée Infection, pôle des maladies infectieuses et tropicales clinique et biologique, fédération de bactériologie-hygiène-virologie, Assistance publique-Hôpitaux de Marseille, centre hospitalo-universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Patrick Borentain
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Ferdaous Raissouni
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Aude Le Goffic
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Michel Guisset
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - Christophe Renou
- Hôpital de jour, centre hospitalier de Hyères, 8, rue Maréchal-Juin, Hyères, France
| | - Jean-Charles Grimaud
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Nord, chemin des Bourrelys, 13915 Marseille cedex 20, France
| | - Jean Hardwigsen
- Service de transplantation hépatique, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Stéphane Garcia
- Service d'anatomopathologie, centre hospitalo-universitaire Nord, chemin des Bourrely, 13015 Marseille, France
| | - Danielle Botta-Fridlund
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Cyril Nafati
- Service de réanimation, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Anne Motte
- Institut hospitalo-universitaire (IHU) Méditerranée Infection, pôle des maladies infectieuses et tropicales clinique et biologique, fédération de bactériologie-hygiène-virologie, Assistance publique-Hôpitaux de Marseille, centre hospitalo-universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Yves Patrice Le Treut
- Service de transplantation hépatique, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Philippe Colson
- Institut hospitalo-universitaire (IHU) Méditerranée Infection, pôle des maladies infectieuses et tropicales clinique et biologique, fédération de bactériologie-hygiène-virologie, Assistance publique-Hôpitaux de Marseille, centre hospitalo-universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; Aix-Marseille Université, URMITE UM63 CNRS 7278 IRD 198 Inserm U1095, facultés de médecine et de pharmacie, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France.
| | - René Gerolami
- Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France.
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Fatal fulminant hepatitis E associated with autoimmune hepatitis and excessive paracetamol intake in Southeastern France. J Clin Microbiol 2014; 52:1294-7. [PMID: 24478416 DOI: 10.1128/jcm.03372-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We present, to our knowledge, the first case of fatal fulminant liver failure associated with hepatitis E virus infection, autoimmune hepatitis, and excessive paracetamol intake, which occurred in a 77-year-old woman. Hepatitis E testing should be performed in severe acute liver failure cases, even when another cause has been identified.
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32
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Krain LJ, Nelson KE, Labrique AB. Host immune status and response to hepatitis E virus infection. Clin Microbiol Rev 2014; 27:139-65. [PMID: 24396140 PMCID: PMC3910912 DOI: 10.1128/cmr.00062-13] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatitis E virus (HEV), identified over 30 years ago, remains a serious threat to life, health, and productivity in developing countries where access to clean water is limited. Recognition that HEV also circulates as a zoonotic and food-borne pathogen in developed countries is more recent. Even without treatment, most cases of HEV-related acute viral hepatitis (with or without jaundice) resolve within 1 to 2 months. However, HEV sometimes leads to acute liver failure, chronic infection, or extrahepatic symptoms. The mechanisms of pathogenesis appear to be substantially immune mediated. This review covers the epidemiology of HEV infection worldwide, the humoral and cellular immune responses to HEV, and the persistence and protection of antibodies produced in response to both natural infection and vaccines. We focus on the contributions of altered immune states (associated with pregnancy, human immunodeficiency virus [HIV], and immunosuppressive agents used in cancer and transplant medicine) to the elevated risks of chronic infection (in immunosuppressed/immunocompromised patients) and acute liver failure and mortality (among pregnant women). We conclude by discussing outstanding questions about the immune response to HEV and interactions with hormones and comorbid conditions. These questions take on heightened importance now that a vaccine is available.
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Affiliation(s)
- Lisa J. Krain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenrad E. Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alain B. Labrique
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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33
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Samala N, Ghany MG. Hepatitis E: The nonendemic perspective. Clin Liver Dis (Hoboken) 2013; 2:245-249. [PMID: 30992873 PMCID: PMC6448665 DOI: 10.1002/cld.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/15/2013] [Accepted: 08/17/2013] [Indexed: 02/04/2023] Open
Affiliation(s)
- Niharika Samala
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of HealthBethesdaMD
| | - Marc G. Ghany
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of HealthBethesdaMD
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34
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Hepatitis E virus: foodborne, waterborne and zoonotic transmission. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4507-33. [PMID: 24071919 PMCID: PMC3823334 DOI: 10.3390/ijerph10104507] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/20/2013] [Accepted: 09/03/2013] [Indexed: 02/07/2023]
Abstract
Hepatitis E virus (HEV) is responsible for epidemics and endemics of acute hepatitis in humans, mainly through waterborne, foodborne, and zoonotic transmission routes. HEV is a single-stranded, positive-sense RNA virus classified in the family Hepeviridae and encompasses four known Genotypes (1–4), at least two new putative genotypes of mammalian HEV, and one floating genus of avian HEV. Genotypes 1 and 2 HEVs only affect humans, while Genotypes 3 and 4 are zoonotic and responsible for sporadic and autochthonous infections in both humans and several other animal species worldwide. HEV has an ever-expanding host range and has been identified in numerous animal species. Swine serve as a reservoir species for HEV transmission to humans; however, it is likely that other animal species may also act as reservoirs. HEV poses an important public health concern with cases of the disease definitively linked to handling of infected pigs, consumption of raw and undercooked animal meats, and animal manure contamination of drinking or irrigation water. Infectious HEV has been identified in numerous sources of concern including animal feces, sewage water, inadequately-treated water, contaminated shellfish and produce, as well as animal meats. Many aspects of HEV pathogenesis, replication, and immunological responses remain unknown, as HEV is an extremely understudied but important human pathogen. This article reviews the current understanding of HEV transmission routes with emphasis on food and environmental sources and the prevalence of HEV in animal species with zoonotic potential in humans.
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35
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Sharma B, Nagpal K, Bakki Sannegowda R, Prakash S. Hepatitis E with Gullain-Barré syndrome: still a rare association. J Neurovirol 2013; 19:186-7. [PMID: 23471727 DOI: 10.1007/s13365-013-0156-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/19/2013] [Accepted: 02/20/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Bhawna Sharma
- Department of Neurology, SMS Medical College Hospital, Jaipur, Rajasthan, India.
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36
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Lhomme S, Dubois M, Abravanel F, Top S, Bertagnoli S, Guerin JL, Izopet J. Risk of zoonotic transmission of HEV from rabbits. J Clin Virol 2013; 58:357-62. [PMID: 23474012 PMCID: PMC7172140 DOI: 10.1016/j.jcv.2013.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/14/2013] [Accepted: 02/08/2013] [Indexed: 12/17/2022]
Abstract
Hepatitis E virus strains from rabbits indicate that these mammals may be a reservoir for HEVs that cause infection in humans. Further issues remain to be clarified, including whether the genotype of rabbit HEV differs from human and swine HEV genotype 3 and whether rabbit HEV can infect human and other animals. HEV was found in farmed rabbits in several geographic areas of China, in USA and more recently in France. The prevalence of antibodies against HEV was 36%, 57% and 55% in rabbits from Virginia (USA), Gansu Province and Beijing (China), respectively. HEV RNA was detected in 16.5% of serum samples from farmed rabbits in Virginia, 7.5% in Gansu Province and 7.0% in Beijing. HEV RNA was detected in 7% of bile samples from farmed rabbits and in 23% of liver samples from wild rabbits in France. The full-length genomic sequences analysis indicates that all the rabbit strains belong to the same clade. Nucleotide sequences were 72.2-78.2% identical to HEV genotypes 1-4. Comparison with HEV sequences of human strains circulating in France and reference sequences identified a human strain closely related to rabbit HEV. A 93-nucleotide insertion in the X domain of the ORF1 of the human strain and in all the rabbit HEV strains was found. Moreover, the ability of rabbit HEV to cause cross-species infection in a pig model has recently been demonstrated. Rabbit HEV can replicate efficiently in human cell lines. Collectively, these data support the possibility of zoonotic transmission of HEV from rabbits.
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Affiliation(s)
- Sébastien Lhomme
- INSERM, UMR 1043, F-31300 Toulouse, France; Laboratoire de Virologie, CHU Purpan, 330 Avenue de Grande Bretagne, F-31300 Toulouse, France
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37
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Kaba M, Moal V, Gérolami R, Colson P. Epidemiology of mammalian hepatitis E virus infection. Intervirology 2013; 56:67-83. [PMID: 23343760 DOI: 10.1159/000342301] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/28/2012] [Indexed: 12/26/2022] Open
Abstract
Mammalian hepatitis E virus (HEV), the etiological agent of hepatitis E in humans, is a recently discovered infectious agent. It was identified for the first time in 1983 using electron microscopy on a faecal specimen of a person infected with non-A, non-B enterically-transmitted hepatitis. Based on retrospective and prospective studies, HEV was long described as one of the leading causes of acute viral hepatitis in tropical and subtropical countries, whereas in developed countries hepatitis E was considered an imported disease from HEV hyperendemic countries. Data from studies conducted during the past decade have greatly shifted our knowledge on the epidemiology and clinical spectrum of HEV. Recently, it has been shown that contrary to previous beliefs, hepatitis E is also an endemic disease in several developed countries, particularly in Japan and in Europe, as evidenced by reports of high anti-HEV immunoglobulin G prevalence in healthy individuals and an increasing number of non-travel-related acute hepatitis E cases. Moreover, a porcine reservoir and growing evidence of zoonotic transmission have been reported in these countries. This review summarizes the current knowledge on the epidemiology and prevention of transmission of mammalian HEV.
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Affiliation(s)
- Mamadou Kaba
- Aix-Marseille Université, URMITE UM63 CNRS 7278 IRD 198 INSERM U1095, IHU Méditerranée Infection, Facultés de Médecine et de Pharmacie, Marseille, France
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38
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Izopet J, Dubois M, Bertagnoli S, Lhomme S, Marchandeau S, Boucher S, Kamar N, Abravanel F, Guérin JL. Hepatitis E virus strains in rabbits and evidence of a closely related strain in humans, France. Emerg Infect Dis 2013; 18:1274-81. [PMID: 22840216 PMCID: PMC3414036 DOI: 10.3201/eid1808.120057] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The host range of HEV in Europe is expanding, and zoonotic transmission of HEV from rabbits is possible. Hepatitis E virus (HEV) strains from rabbits indicate that these mammals may be a reservoir for HEVs that cause infection in humans. To determine HEV prevalence in rabbits and the strains’ genetic characteristics, we tested bile, liver, and additional samples from farmed and wild rabbits in France. We detected HEV RNA in 7% (14/200) of bile samples from farmed rabbits (in 2009) and in 23% (47/205) of liver samples from wild rabbits (in 2007–2010). Full-length genomic sequences indicated that all rabbit strains belonged to the same clade (nucleotide sequences 72.2%–78.2% identical to HEV genotypes 1–4). Comparison with HEV sequences of human strains and reference sequences identified a human strain closely related to rabbit strain HEV. We found a 93-nt insertion in the X domain of open reading frame 1 of the human strain and all rabbit HEV strains. These findings indicate that the host range of HEV in Europe is expanding and that zoonotic transmission of HEV from rabbits is possible.
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Affiliation(s)
- Jacques Izopet
- Institut National de la Santé et de la Recherche Médicale, Toulouse, France.
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39
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Abstract
We report an autochthonous hepatitis E virus (HEV)-hepatitis B virus co-primary infection in a 41-year-old man having sex with men and infected with human immunodeficiency virus (HIV). This case prompts testing for HEV in HIV-infected patients with acute hepatitis even if primary infection with another hepatitis virus is diagnosed.
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40
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ROUX CHRISTIANH, ANTY RODOLPHE, PATOURAUX STEPHANIE, EULLER-ZIEGLER LIANA. Hepatitis E: Are Rheumatic Patients at Risk? J Rheumatol 2013; 40:99. [DOI: 10.3899/jrheum.120599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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41
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Kokkinos P, Kozyra I, Lazic S, Bouwknegt M, Rutjes S, Willems K, Moloney R, de Roda Husman AM, Kaupke A, Legaki E, D'Agostino M, Cook N, Rzeżutka A, Petrovic T, Vantarakis A. Harmonised investigation of the occurrence of human enteric viruses in the leafy green vegetable supply chain in three European countries. FOOD AND ENVIRONMENTAL VIROLOGY 2012; 4:179-191. [PMID: 23412890 DOI: 10.1007/s12560-012-9087-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/31/2012] [Indexed: 06/01/2023]
Abstract
Numerous outbreaks have been attributed to the consumption of raw or minimally processed leafy green vegetables contaminated with enteric viral pathogens. The aim of the present study was an integrated virological monitoring of the salad vegetables supply chain in Europe, from production, processing and point-of-sale. Samples were collected and analysed in Greece, Serbia and Poland, from 'general' and 'ad hoc' sampling points, which were perceived as critical points for virus contamination. General sampling points were identified through the analysis of background information questionnaires based on HACCP audit principles, and they were sampled during each sampling occasion where as-ad hoc sampling points were identified during food safety fact-finding visits and samples were only collected during the fact-finding visits. Human (hAdV) and porcine (pAdV) adenovirus, hepatitis A (HAV) and E (HEV) virus, norovirus GI and GII (NoV) and bovine polyomavirus (bPyV) were detected by means of real-time (RT-) PCR-based protocols. General samples were positive for hAdV, pAdV, HAV, HEV, NoV GI, NoV GII and bPyV at 20.09 % (134/667), 5.53 % (13/235), 1.32 % (4/304), 3.42 % (5/146), 2 % (6/299), 2.95 % (8/271) and 0.82 % (2/245), respectively. Ad hoc samples were positive for hAdV, pAdV, bPyV and NoV GI at 9 % (3/33), 9 % (2/22), 4.54 % (1/22) and 7.14 % (1/14), respectively. These results demonstrate the existence of viral contamination routes from human and animal sources to the salad vegetable supply chain and more specifically indicate the potential for public health risks due to the virus contamination of leafy green vegetables at primary production.
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Affiliation(s)
- P Kokkinos
- Environmental Microbiology Unit, Department of Public Health, Medical School, University of Patras, 26500, Patras, Greece.
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42
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Izopet J, Dubois M, Bertagnoli S, Lhomme S, Marchandeau S, Boucher S, Kamar N, Abravanel F, Guérin JL. Hepatitis E virus strains in rabbits and evidence of a closely related strain in humans, France. Emerg Infect Dis 2012. [PMID: 22840216 DOI: 10.3201/eid1808.120057.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hepatitis E virus (HEV) strains from rabbits indicate that these mammals may be a reservoir for HEVs that cause infection in humans. To determine HEV prevalence in rabbits and the strains' genetic characteristics, we tested bile, liver, and additional samples from farmed and wild rabbits in France. We detected HEV RNA in 7% (14/200) of bile samples from farmed rabbits (in 2009) and in 23% (47/205) of liver samples from wild rabbits (in 2007-2010). Full-length genomic sequences indicated that all rabbit strains belonged to the same clade (nucleotide sequences 72.2%-78.2% identical to HEV genotypes 1-4). Comparison with HEV sequences of human strains and reference sequences identified a human strain closely related to rabbit strain HEV. We found a 93-nt insertion in the X domain of open reading frame 1 of the human strain and all rabbit HEV strains. These findings indicate that the host range of HEV in Europe is expanding and that zoonotic transmission of HEV from rabbits is possible.
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Affiliation(s)
- Jacques Izopet
- Institut National de la Santé et de la Recherche Médicale, Toulouse, France.
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43
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High hepatitis E virus seroprevalence in forestry workers and in wild boars in France. J Clin Microbiol 2012; 50:2888-93. [PMID: 22718947 DOI: 10.1128/jcm.00989-12] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hepatitis E virus (HEV) is a fecally and orally transmitted human pathogen of worldwide distribution. In industrial countries, HEV is observed in an increasing number of autochthonous cases and is considered to be an emerging pathogen. A growing body of evidence suggests that HEV is a zoonotic disease, and pig handlers and pig veterinarians have been reported to be high-risk groups for HEV infection. The aims of the present study were to establish the prevalence of anti-HEV in wild boars in France and to identify whether forestry workers are at a higher risk of HEV infection. Three different anti-HEV tests were used to compare their effectiveness in detecting anti-HEV in the general population. The most sensitive test was then used to investigate HEV seroprevalence in 593 forestry workers and 421 wild boars. Anti-HEV was detected in 31% of the forestry workers and 14% of the wild boars. Detection of anti-HEV in humans was correlated with age, geographical location, and occupational activity and in wild boars was correlated with geographical location. HEV infection is frequent in woodcutters in France, and it varies geographically. Further studies are needed to confirm these findings and to elucidate the transmission route and the exact virus reservoirs.
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44
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Candido A, Taffon S, Chionne P, Pisani G, Madonna E, Dettori S, Hamza A, Valdarchi C, Bruni R, Ciccaglione AR. Diagnosis of HEV infection by serological and real-time PCR assays: a study on acute non-A-C hepatitis collected from 2004 to 2010 in Italy. BMC Res Notes 2012; 5:297. [PMID: 22704073 PMCID: PMC3477083 DOI: 10.1186/1756-0500-5-297] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 05/16/2012] [Indexed: 02/07/2023] Open
Abstract
Background The impact of hepatitis E in developed countries, like Italy, still requires a clear definition. In the present study, we evaluated HEV infection in patients with acute non-A-C hepatitis by an approach comparing data from Real-time PCR and serological assays. Methods In a first analysis, sera from 52 patients hospitalized with a diagnosis of acute viral non-A-C hepatitis in Italy were tested by in-house Real-Time PCR assay for identification of Hepatitis E Virus (HEV) RNA and by anti-HEV IgM and IgG assays. In a subsequent analysis, selected samples were evaluated by additional IgM tests to confirm diagnosis. Results Among the 52 samples, 21 showed positive results for all three markers (IgM, IgG and HEV RNA). One patient showed HEV RNA as single marker. Uncertain results were found in 8 samples while the remaining 22 were negative for all markers. Further analysis of the 8 undefined samples by additional IgM tests confirmed HEV infection in 1 patient. Overall, acute HEV infections were reliably identified in 23 (44.2%) out of 52 patients. Conclusions In the present paper, we performed a study evaluating HEV infection in 52 sporadic non-A-C acute hepatitis cases. All samples were collected from 2004 to 2010 in Italy. By a diagnostic strategy based on genomic and serological assays we identified HEV infections in 23 out of 52 patients (44.2%), a percentage higher than previous estimates. Thus, the actual impact of HEV infections in Italy needs to be further evaluated on a national scale by a diagnostic strategy based on multiple and last generation assays.
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Affiliation(s)
- Angela Candido
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
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Mansuy JM, Bendall R, Legrand-Abravanel F, Sauné K, Miédouge M, Ellis V, Rech H, Destruel F, Kamar N, Dalton HR, Izopet J. Hepatitis E virus antibodies in blood donors, France. Emerg Infect Dis 2012; 17:2309-12. [PMID: 22172156 PMCID: PMC3311200 DOI: 10.3201/eid1712.110371] [Citation(s) in RCA: 282] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Using a validated sensitive assay, we found hepatitis E virus (HEV) IgG in 52.5% of voluntary blood donors in southwestern France. This finding suggests HEV is highly endemic to this region. The high HEV prevalence may reflect local dietary practices, such as eating uncooked pork and game products.
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Bouquet J, Tessé S, Lunazzi A, Eloit M, Rose N, Nicand E, Pavio N. Close similarity between sequences of hepatitis E virus recovered from humans and swine, France, 2008-2009. Emerg Infect Dis 2012; 17:2018-25. [PMID: 22099089 PMCID: PMC3311115 DOI: 10.3201/eid1711.110616] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Jérôme Bouquet
- Anses, Laboratoire de Santé Animale, Maisons-Alfort, France
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Nelson KE, Kmush B, Labrique AB. The epidemiology of hepatitis E virus infections in developed countries and among immunocompromised patients. Expert Rev Anti Infect Ther 2012; 9:1133-48. [PMID: 22114964 DOI: 10.1586/eri.11.138] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatitis E virus (HEV) is an important cause of acute hepatitis in humans worldwide, both as epidemic and sporadic disease. Since the virus was identified in 1983, epidemics have occurred regularly in many countries across South and Southeast Asia when seasonal floods have contaminated drinking water supplies and in Africa during humanitarian crises among refugee populations without access to clean water. In addition, sporadic cases and small clusters of HEV infections have been recognized throughout the world in developed countries over the past couple of decades. This review will focus on emerging evidence of HEV infection as an under-recognized pathogen in Europe, the USA and other industrialized countries. We will discuss some of the issues associated with the recognition, diagnosis and treatment of these sporadic cases. We will also summarize the recent literature on autochthonous HEV infection among populations in developed countries in industrialized Europe, the USA, Japan and other industrialized Asian countries. We will review recent reports of acute and chronic HEV infections among transplant recipients and other immunocompromised individuals including HIV/AIDS patients.
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Affiliation(s)
- Kenrad E Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Maylin S, Stephan R, Molina JM, Peraldi MN, Scieux C, Nicand E, Simon F, Delaugerre C. Prevalence of antibodies and RNA genome of hepatitis E virus in a cohort of French immunocompromised. J Clin Virol 2012; 53:346-9. [PMID: 22293627 DOI: 10.1016/j.jcv.2012.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 12/31/2011] [Accepted: 01/05/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recently, cases of chronic hepatitis E have been identified in immunocompromised patients. OBJECTIVES To evaluate the prevalence of anti-HEV IgG antibodies and the persistence of HEV-RNA in sera of immunocompromised patients with regular follow-up at Saint-Louis Hospital in Paris, France. STUDY DESIGN 307 samples collected from 261 HIV-infected patients and 46 kidney transplant (KT)-patients were retrospectively tested for the presence of the following hepatitis E virus (HEV) infection markers: anti-HEV IgM antibodies, anti-HEV IgG antibodies, anti-HEV IgG avidity index, and HEV-RNA. RESULTS Anti-HEV IgG positive serology was found in 4 HIV-infected patients (1.5%) and 3 KT-patients (6.5%), leading to an overall seroprevalence of 2.3%. HEV-RNA detection was not observed among 55 HIV-patients at higher risk of chronic HEV (<200 CD4 cells/mm(3), elevated alanine aminotransferase (ALT) levels, and/or positive anti-HEV antibodies) and among 44 KT-patients. None of the seven patients had anti-HEV IgM antibodies, thereby excluding any acute infection. The IgG avidity index confirmed past HEV infection among tested patients. CONCLUSIONS The low seroprevalence observed in the Paris region does not warrant a systematic evaluation of HEV infection in immunocompromised patients. However, HEV infection must be examined as a possibility if unexplained increases in ALT should occur and after more common viral hepatitis infections are excluded.
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Affiliation(s)
- Sarah Maylin
- Virology Dpt, Inserm U941-Paris 7 Diderot University, Saint-Louis Hospital-APHP, Paris, France.
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Seroprevalence of hepatitis E antibodies and risk profile of HEV seropositivity in The Netherlands, 2006–2007. Epidemiol Infect 2012; 140:1838-47. [DOI: 10.1017/s0950268811002913] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
SUMMARYHepatitis E virus (HEV) is now considered an endemic pathogen in industrialized countries, leading to acute and sometimes chronic hepatitis, mostly in vulnerable people. The endemic sources are unclear. A survey in The Netherlands in 2006–2007 showed a 1·9% seroprevalence of HEV antibodies measured by ELISA and confirmed by immunoblot in a nationwide sample. Overall, in 134/7072 (1·9%) seropositive individuals, older age (P<0·01), being male (P<0·01), working with patients (P=0·03), working with animals (P=0·07), recent diarrhoeal complaints (P=0·07) and adhering to a religion that considers pigs unclean (P<0·01) were independently associated with seropositivity in multivariate analysis. Sub-analysis of 59/4022 (1·5%) anti-HEV antibody-positive subjects with probable endemic exposure showed independent association with youngest household member being aged <5 years or between 19 and <65 years (P=0·05) in multivariate analysis. These findings may contribute to a better understanding of the sources of endemic HEV exposure, and also highlight the need for systematic epidemiological and serological evaluation of new cases.
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Rose N, Lunazzi A, Dorenlor V, Merbah T, Eono F, Eloit M, Madec F, Pavio N. High prevalence of Hepatitis E virus in French domestic pigs. Comp Immunol Microbiol Infect Dis 2011; 34:419-27. [PMID: 21872929 DOI: 10.1016/j.cimid.2011.07.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
Abstract
The importance of the domestic pig reservoir for Hepatitis E virus (HEV) was assessed by estimating the seroprevalence and prevalence of HEV contaminated livers in French slaughter-aged pigs. 6565 sera and 3715 livers were randomly sampled from 186 pig farms throughout the country. Taking the sampling design into account, the farm-level seroprevalence was 65% (95% CI 57-74) and 31% (95% CI 24-38) of the slaughter-aged pigs had antibodies against HEV. The individual prevalence of HEV RNA positive livers was 4% (95% CI 2-6) and 24% (95% CI 17-31) of the farms had at least 1 positive liver. Most isolates were of genotype 3f (76.7%) with smaller amounts of 3c (18.6%) and 3e (4.6%). The high prevalence of HEV in pigs and the similarities between HEV subtypes from pigs and humans corroborates the possible zoonotic origin of some HEV autochthonous infections.
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Affiliation(s)
- Nicolas Rose
- Anses, Laboratoire de Ploufragan/Plouzané, BP53, 22440 Ploufragan, France.
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