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Sintusek P, Khunsri S, Chansaenroj J, Thongmee T, Poovorawan Y. Prevalence and the impact of hepatitis E infection in pediatric liver transplanted recipients with hepatitis in Thailand. Pediatr Transplant 2024; 28:e14642. [PMID: 37947005 DOI: 10.1111/petr.14642] [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: 06/14/2023] [Revised: 09/13/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The hepatitis E virus (HEV) infection typically causes acute and self-limiting hepatitis. However, chronic infection can occur in immunocompromised hosts. This study determined the prevalence and impact of HEV infection in liver transplanted (LT) children who had transaminitis. METHODS The demographic data, anti-HEV IgM/IgG, serum/stool HEV RNA, and management for LT children with acute or persistent transaminitis from 2003 to 2020 were retrospectively reviewed. HEV serology was tested by ELISA, and HEV RNA was detected by semi-nested PCR. RESULTS Seventy-two children with LT with persistent transaminitis with a median age of 4.41 (1.32, 9.14) years (55.6% female) and one with acute hepatitis were investigated for HEV infection. Anti-HEV IgM, anti-HEV IgG, serum, or stool HEV RNA was investigated in 95.8% (N = 69), 93.1% (N = 67), 43.1% (N = 31), and 37.5% (N = 27) of patients, respectively. The prevalence of HEV infection was 37.5% (N = 27). There was no significant difference in characteristics between the HEV-infected and HEV-non-infected patients. Moreover, 22.2% (N = 16) and 15.3% (N = 11) of patients had past HEV infection and HEV-related acute or chronic infection, respectively. Most of the patients had primary treatment as the presumed graft rejection without improvement. In two patients, detectable HEV RNA in serum turned undetectable in approximately 2 weeks and 2 months, and liver enzyme levels normalized after reducing immunosuppressive therapy. CONCLUSIONS The prevalence of HEV infection among pediatric LT recipients with hepatitis was high. Chronic HEV infection was evidenced in two patients. Investigations of HEV infection in pediatric LT recipients with persistent transaminitis should guide proper management.
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Affiliation(s)
- Palittiya Sintusek
- Thai Pediatric Gastroenterology, Hepatology and Immunology (TPGHAI) Research Unit, Department of Pediatrics, Division of Gastroenterology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand
| | - Siriporn Khunsri
- Thai Pediatric Gastroenterology, Hepatology and Immunology (TPGHAI) Research Unit, Department of Pediatrics, Division of Gastroenterology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand
| | - Jira Chansaenroj
- Center of Excellence in Clinical Virology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Thanunrat Thongmee
- Center of Excellence in Clinical Virology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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Capai L, Masse S, Hozé N, Decarreaux D, Canarelli J, Simeoni MH, de Lamballerie X, Falchi A, Charrel R. Seroprevalence of anti-HEV IgG in children: very early exposure in young children in a hyperendemic region. Front Public Health 2023; 11:1293575. [PMID: 38026418 PMCID: PMC10680972 DOI: 10.3389/fpubh.2023.1293575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objectives Hepatitis E virus (HEV) can be considered an emerging zoonotic pathogen and is an important cause of acute viral hepatitis in high-income countries. Corsica has been identified as a hyperendemic region for HEV. We aimed to characterize the prevalence of IgG among children and estimate the annual force of infection of HEV. Methods From April 2020 to June 2021, we collected 856 "residual sera" in 13 medical biology laboratories. Sera were tested using the Wantaï HEV IgG assay. Data were weighted according to the distribution by sex and age of the real Corsican population. Serocatalytic models were applied to assess the annual force of infection of HEV. Results The weighted seroprevalence was 30.33% [27.15-34.0]. The seroprevalence was only associated with increasing age (7.25-40.52%; p < 0.001). The annual probability of infection was 5.4% for adults and children above 10-year-old and 2.2% for children under 10 yo. Conclusion Our study demonstrates that in the hyperendemic island of Corsica, (i) exposure of the population to HEV is homogeneous at the spatial level with no difference between genders; (ii) HEV exposure occurs from birth, resulting in 7.4% seropositivity at the age of 4 years; and (iii) super exposure is observed after the age of 9 years. Accordingly, specific studies should be conducted to determine the breadth of the situation identified in our study. The role of the environment and its contamination by domestic or wild swine excreta should be investigated using a One Health approach.
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Affiliation(s)
- Lisandru Capai
- UR 7310, Université de Corse, Corte, France
- AG Junglen, Institute of Virology, University of Charité, Berlin, Germany
| | | | - Nathanaël Hozé
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Dorine Decarreaux
- UR 7310, Université de Corse, Corte, France
- Unité des Virus Émergents, Aix-Marseille University, Marseille, France
| | | | | | | | | | - Rémi Charrel
- Unité des Virus Émergents, Aix-Marseille University, Marseille, France
- Comité de Lutte contre les infections Nosocomiales, APHM HOPITAUX Universitaires de Marseille, Marseille, France
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Santos-Silva S, da Silva Dias Moraes DF, López-López P, Rivero-Juarez A, Mesquita JR, Nascimento MSJ. Hepatitis E Virus in the Iberian Peninsula: A Systematic Review. FOOD AND ENVIRONMENTAL VIROLOGY 2023; 15:193-211. [PMID: 37434079 PMCID: PMC10499749 DOI: 10.1007/s12560-023-09560-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
One of the most frequent causes of acute viral hepatitis is hepatitis E virus (HEV) causing 20 million infections worldwide each year and 44,000 deaths. Studies on HEV in the Iberian Peninsula have been increasing through time with HEV infection being identified in humans and animals. The aim of the present systematic review was to compile and evaluate all the published data on HEV from studies performed in humans, animals and environmental samples in the Iberian Peninsula. The electronic databases Mendeley, PubMed, Scopus, and Web of Science were thoroughly searched, and research published up until February 01, 2023 were included. Resulting in a total of 151 eligible papers by full reading and application of PRISMA exclusion/inclusion criteria. Overall, the present review shows that several HEV genotypes, namely HEV-1, 3, 4, and 6 as well as Rocahepevirus, are circulating in humans, animals, and in the environment in the Iberian Peninsula. HEV-3 was the most common genotype circulating in humans in Portugal and Spain, as expected for developed countries, with HEV-1 only being detected in travelers and emigrants from HEV endemic regions. Spain is the biggest pork producer in Europe and given the high circulation of HEV in pigs, with HEV-3 being primarily associated to zoonotic transmission through consumption of swine meat and meat products, in our opinion, the introduction of an HEV surveillance system in swine and inclusion of HEV in diagnostic routines for acute and chronic human hepatitis would be important. Additionally, we propose that establishing a monitoring mechanism for HEV is crucial in order to gain a comprehensive understanding of the prevalence of this illness and the various strains present in the Iberian Peninsula, as well as their potential impact on public health.
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Affiliation(s)
- Sérgio Santos-Silva
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | | | - Pedro López-López
- Grupo de Virología Clínica y Zoonosis, Unidad de Enfermedades Infecciosas, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - António Rivero-Juarez
- Grupo de Virología Clínica y Zoonosis, Unidad de Enfermedades Infecciosas, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - João R Mesquita
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
- Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
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Berzosa Sánchez A, de Ángeles Fernandez C, Callejas Caballero I, Illán Ramos M, Vecino López R, Bodas Pinedo A, Ramos Amador JT. Acute Hepatitis in an Adolescent Without Travel History. Pediatr Infect Dis J 2022; 41:272-273. [PMID: 34260482 DOI: 10.1097/inf.0000000000003183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Arantxa Berzosa Sánchez
- From the Infectious Diseases Unit, Department Paediatrics, Departamento de Salud Pública y Materno-Infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Cristina de Ángeles Fernandez
- Spain Gastroenterology Unit, Department Paediatrics, Departamento de Salud Pública y Materno-Infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid
| | - Ignacio Callejas Caballero
- From the Infectious Diseases Unit, Department Paediatrics, Departamento de Salud Pública y Materno-Infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marta Illán Ramos
- From the Infectious Diseases Unit, Department Paediatrics, Departamento de Salud Pública y Materno-Infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Raquel Vecino López
- Spain Gastroenterology Unit, Department Paediatrics, Departamento de Salud Pública y Materno-Infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid
| | - Andrés Bodas Pinedo
- Spain Gastroenterology Unit, Department Paediatrics, Departamento de Salud Pública y Materno-Infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid
| | - José Tomás Ramos Amador
- From the Infectious Diseases Unit, Department Paediatrics, Departamento de Salud Pública y Materno-Infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Mbachu CNP, Ebenebe JC, Okpara HC, Chukwuka JO, Mbachu II, Elo-Ilo JC, Ndukwu CI, Egbuonu I. Hepatitis e prevalence, knowledge, and practice of preventive measures among secondary school adolescents in rural Nigeria: a cross-sectional study. BMC Public Health 2021; 21:1655. [PMID: 34507564 PMCID: PMC8434741 DOI: 10.1186/s12889-021-11702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, there is a paucity of data on the knowledge and practice of preventive measures for Hepatitis E infection in Nigerian populations. This study provided data on the prevalence, knowledge and practices of prevention in an adolescent population from Nigeria. METHODS This cross-sectional study was conducted over 3 months among rural Nigerian secondary school adolescents. An interviewer-based questionnaire was used to collect data on sociodemographic profile, knowledge, and practice of preventive measures for Hepatitis E infection. Blood samples collected from participants were analysed for Hepatitis E IgG using Elisa Kits (Sigma Diagnostics, USA). Data were analysed using SPSS software version 20.0. Tests of association were done with a level of significance set at 5%. RESULTS A total of 9 out of the 414 participants tested positive for Hepatitis E IgG antibodies giving a prevalence of 2.2%. Significant factors for Hepatitis E infection were male gender {P = 0.004} and school {P < 0.001, however logistic regression gave infinite value. Most participants (98.6%) had poor knowledge of Hepatitis E infection, 239(57.7%) had good preventive practices, while 175(42.3%) had average preventive practices. CONCLUSION A low prevalence of HEV infection was recorded among study participants. There was poor knowledge of Hepatitis E, and association could not be established between HEV infection and individual preventive practices.
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Affiliation(s)
| | - Joy Chinelo Ebenebe
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Anambra State Nigeria
| | - Henry Chima Okpara
- Department of Chemical Pathology, Nnamdi Azikiwe University, Awka, Anambra State Nigeria
| | - John Onuora Chukwuka
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Anambra State Nigeria
| | | | | | | | - Ifeoma Egbuonu
- Department of Paediatrics, Chukwuemeka Odumegwu Ojukwu University, Awka, Anambra State Nigeria
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Thakur V, Ratho RK, Kumar S, Saxena SK, Bora I, Thakur P. Viral Hepatitis E and Chronicity: A Growing Public Health Concern. Front Microbiol 2020; 11:577339. [PMID: 33133046 PMCID: PMC7550462 DOI: 10.3389/fmicb.2020.577339] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Hepatitis E viral infection recently emerges as a global health concern. Over the last decade, the understanding of hepatitis E virus (HEV) had changed with the discovery of new genotypes like genotype-7 and genotype-8 with associated host and mode of infection. Diversification in the mode of hepatitis E infection transmission through blood transfusion, and organ transplants in contrast to classical feco-oral and zoonotic mode is the recent medical concern. The wide spectrum of infection ranging from self-limiting to acute liver failure is now overpowered by HEV genotype-specific chronic infection especially in transplant patients. This concern is further escalated by the extra-hepatic manifestations of HEV targeting the central nervous system (CNS), kidney, heart, and pancreas. However, with the development of advanced efficient cell culture systems and animal models simulating the infection, much clarity toward understanding the pathogenetic mechanism of HEV has been developed. Also this facilitates the development of vaccines research or therapeutics. In this review, we highlight all the novel findings in every aspect of HEV with special emphasis on recently emerging chronic mode of infection with specific diagnosis and treatment regime with an optimistic hope to help virologists and/or liver specialists working in the field of viral hepatitis.
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Affiliation(s)
- Vikram Thakur
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha Kanta Ratho
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swatantra Kumar
- Centre for Advanced Research, Faculty of Medicine, King George's Medical University, Lucknow, India
| | - Shailendra K Saxena
- Centre for Advanced Research, Faculty of Medicine, King George's Medical University, Lucknow, India
| | - Ishani Bora
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pryanka Thakur
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abi Nader E, Girard M, Leruez-Ville M, Sissaoui S, Lacaille F, Roque-Afonso AM, Debray D. Seroprevalence of Hepatitis E virus infection in children after liver transplantation: A single-center experience in France. Clin Res Hepatol Gastroenterol 2020; 44:174-180. [PMID: 31266724 DOI: 10.1016/j.clinre.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/26/2019] [Accepted: 06/05/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hepatitis E virus (HEV) is a major cause of acute viral hepatitis worldwide, usually asymptomatic in children. However, a growing number of publications over the last decade have documented cases of chronic hepatitis related to HEV-genotype 3 infection, and progressing to cirrhosis in immuno-compromised patients, particularly in adult kidney transplant recipients. The aim of our study was to evaluate the prevalence and severity of HEV infection among pediatric liver transplant (PLT) recipients managed in our center. MATERIAL AND METHODS Between November 1st 2014 and January 1st 2016, PLT recipients (less than 18 years-old) were screened for HEV infection [determined by HEV serology, HEV- immunoglobulin M (IgM) and immunoglobulin G (IgG), and HEV-ribonucleic acid (RNA) by reverse transcriptase polymerase chain reaction] at their annual follow-up visit. RESULTS Eighty children were tested for HEV infection a mean of 5.4±5.3 years after liver transplantation (LT). The main indication for LT was biliary atresia (n=47, 59%). The prevalence of HEV-IgG was 8% (n=6; age range 1.3 to 14.2 years-old at the time of HEV testing). Prevalence increased to 30% when considering only the 20 children with a past history of an unexplained episode of elevated transaminases since LT. None had HEV IgM, serum HEV-RNA, or increased transaminases at the time of HEV testing. Among the six IgG seropositive children, two had received intravenous immunoglobulins prior to screening and four children had a negative control (seroreversion) 3 to 42 months after the first testing. CONCLUSION The prevalence of HEV infection in our cohort is low and similar to other pediatric reports. We saw no cases of chronic hepatitis or fibrosis attributable to HEV. The lower immunosuppressive regimen used in PLT children compared to other solid organ transplant recipients may account for this good outcome.
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Affiliation(s)
- Elie Abi Nader
- Unit of Pediatric Hepatology, Reference Center for Rare Pediatric Liver Diseases, Necker-Enfants-Malades University Hospital, AP-HP, 149, Sèvres Street, 75015 Paris, France; University of Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France.
| | - Muriel Girard
- Unit of Pediatric Hepatology, Reference Center for Rare Pediatric Liver Diseases, Necker-Enfants-Malades University Hospital, AP-HP, 149, Sèvres Street, 75015 Paris, France; University of Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France
| | - Marianne Leruez-Ville
- Department of Virology, Necker-Enfants-Malades University Hospital, AP-HP, 75015 Paris, France
| | - Samira Sissaoui
- Unit of Pediatric Hepatology, Reference Center for Rare Pediatric Liver Diseases, Necker-Enfants-Malades University Hospital, AP-HP, 149, Sèvres Street, 75015 Paris, France
| | - Florence Lacaille
- Unit of Pediatric Hepatology, Reference Center for Rare Pediatric Liver Diseases, Necker-Enfants-Malades University Hospital, AP-HP, 149, Sèvres Street, 75015 Paris, France
| | - Anne-Marie Roque-Afonso
- Inserm U1993, Department of Virology, National Reference Center for Hepatitis A and Hepatitis E, Paul-Brousse Hospital, AP-HP, 94800 Villejuif, France; University of Paris-Sud, 91405 Paris, France
| | - Dominique Debray
- Unit of Pediatric Hepatology, Reference Center for Rare Pediatric Liver Diseases, Necker-Enfants-Malades University Hospital, AP-HP, 149, Sèvres Street, 75015 Paris, France; University of Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France
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Meta-Analysis of Human IgG anti-HEV Seroprevalence in Industrialized Countries and a Review of Literature. Viruses 2019; 11:v11010084. [PMID: 30669517 PMCID: PMC6357031 DOI: 10.3390/v11010084] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 12/11/2022] Open
Abstract
Although Hepatitis E is increasingly described as a major cause of liver disease in industrialized countries, the epidemiology is far from being fully elucidated. We provide here a comprehensive review of documented clusters of cases, and of serological studies conducted in populations with distinct types of exposure. Seroprevalence rates range from <5% to >50% depending on the countries and the groups of population. Such discrepancies can be attributed to the type of serological assay used, but this solves only a part of the problem. We performed a meta-analysis of studies performed with the broadly used Wantai HEV-IgG ELISA and found striking differences that remain difficult to understand with the current knowledge of transmission pathways.
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Abstract
BACKGROUND Hepatitis E virus (HEV) has become a growing public health concern in industrialized countries. Most of the HEV seroprevalence studies have focused on adult populations, and reports regarding HEV seroepidemiology among children are scarce in these countries. The aims of this work were to perform a nationwide seroprevalence study on HEV infection in Portuguese children and to compare the HEV seropositivity in this 2015 children cohort with results in sera performed 20 years earlier. METHODS Sera (N = 352) from children collected in 2015 from all regions of Portugal were screened for anti-HEV IgG and IgM using the commercial enzyme-linked immunosorbent assay recomWell HEV IgG/IgM (2015 version; Mikrogen, Neuried, Germany), and positive samples were retested by immunodot assay recomLine HEV IgG/IgM (2015 version; Mikrogen, Neuried, Germany). For the comparative assessment of HEV seropositivity of the 2 children cohorts, children's sera (N = 71) archived since 1995 were screened for anti-HEV IgG and results were compared with that of the 2015 cohort, matched by sex, age and region. RESULTS Anti-HEV antibodies were detected in 4 children giving an overall HEV seroprevalence in the 2015 cohort of 1.1%. A healthy 10-15-year-old female was found positive for anti-HEV IgM indicating a current or recent HEV infection. No statistically significant difference was observed in HEV seroprevalence regarding gender, age group and region of residence. Comparison of the HEV seropositivity of the 2 children cohorts showed a statistical significant decrease with time (P = 0.024). CONCLUSIONS This is the first national study of HEV seroprevalence in Portuguese children and the first to demonstrate a decrease of anti-HEV antibodies in this age group over time.
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Pathogens of Food Animals: Sources, Characteristics, Human Risk, and Methods of Detection. ADVANCES IN FOOD AND NUTRITION RESEARCH 2017; 82:277-365. [PMID: 28427535 DOI: 10.1016/bs.afnr.2016.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pathogens associated with food production (livestock) animals come in many forms causing a multitude of disease for humans. For the purpose of this review, these infectious agents can be divided into three broad categories: those that are associated with bacterial disease, those that are associated with viruses, and those that are parasitic in nature. The goal of this chapter is to provide the reader with an overview of the most common pathogens that cause disease in humans through exposure via the food chain and the consequence of this exposure as well as risk and detection methods. We have also included a collection of unusual pathogens that although rare have still caused disease, and their recognition is warranted in light of emerging and reemerging diseases. These provide the reader an understanding of where the next big outbreak could occur. The influence of the global economy, the movement of people, and food makes understanding production animal-associated disease paramount to being able to address new diseases as they arise.
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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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Hartl J, Wehmeyer MH, Pischke S. Acute Hepatitis E: Two Sides of the Same Coin. Viruses 2016; 8:E299. [PMID: 27827877 PMCID: PMC5127013 DOI: 10.3390/v8110299] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/04/2016] [Accepted: 10/17/2016] [Indexed: 12/12/2022] Open
Abstract
The relevance of acute hepatitis E virus (HEV) infections has been underestimated for a long time. In the past, HEV infection had been interpreted falsely as a disease limited to the tropics until the relevance of autochthonous HEV infections in the Western world became overt. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections (predominantly genotype 3) in industrialized countries has risen within the last decade. The main source of infections in industrialized countries seems to be infected swine meat, while infections with the tropical HEV genotypes 1 and 2 usually are mainly transmitted fecal-orally by contaminated drinking water. In the vast majority of healthy individuals, acute HEV infection is either clinically silent or takes a benign self-limited course. In patients who develop a symptomatic HEV infection, a short prodromal phase with unspecific symptoms is followed by liver specific symptoms like jaundice, itching, uncoloured stool and darkened urine. Importantly, tropical HEV infections may lead to acute liver failure, especially in pregnant women, while autochthonous HEV infections may lead to acute-on-chronic liver failure in patients with underlying liver diseases. Immunosuppressed individuals, such as transplant recipients or human immunodeficiency virus (HIV)-infected patients, are at risk for developing chronic hepatitis E, which may lead to liver fibrosis and cirrhosis in the long term. Importantly, specific treatment options for hepatitis E are not approved by the regulation authorities, but off-label ribavirin treatment seems to be effective in the treatment of chronic HEV-infection and may reduce the disease severity in patients suffering from acute liver failure.
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Affiliation(s)
- Johannes Hartl
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246 Hamburg, Germany.
| | - Malte H Wehmeyer
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246 Hamburg, Germany.
| | - Sven Pischke
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246 Hamburg, Germany.
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Bayhan Gİ, Demiören K, Güdücüoğlu H. Epidemiology of hepatitis E virus in children in the province of Van, Turkey. Turk Arch Pediatr 2016; 51:148-151. [PMID: 27738399 PMCID: PMC5047363 DOI: 10.5152/turkpediatriars.2016.4119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/20/2016] [Indexed: 01/21/2023]
Abstract
AIM Hepatitis E virus is an etiological agent of hepatitis which is transmitted enterically and may lead to water-born outbreaks. Although it is mainly transmitted by the fecal-oral route, it is estimated that many cases are associated with zoonotic transmission in developing countries. In this study, we aimed to investigate the seroprevalence of hepatitis E in the childhood age group in the province of Van and to demonstrate the relationship between seroprevalence and demographic properties, residential house/region, water supply used at home, dealing with livestock and history of surgery. MATERIAL AND METHODS In this study, hepatitis E virus IgG antibody was studied by ELISA method in children aged between 2 months and 18 years between June 2014 and September 2014 in the province of Van. RESULTS A total of 408 children and adolescents were enrolled in the study. Hepatitis E IgG was found to be positive in 4.2% of the subjects. 179 (43.8%) of the subjects were female and 229 (56.2%) were male. The mean age was 123 months±56.6 months (minimum 2 months, maximum 214 months). When the seropositivity rates were compared by age groups and gender, no difference was found. No correlation was found between hepatitis E seropositivity and the variables of residence, dealing with livestock and water resources. No correlation was found between anti-hepatits E virus seropositivity and parental education level, number of cohabitants and history of surgery. CONCLUSION In our study, hepatitis E virus seropositivity was found to be lower compared to the mean seropositivity in Turkey. Hepatitis E infection does not constitute a serious problem in children in the province of Van in accordance with the results reported from different parts of our country. Livestock dealing and usage of well water are not considered risk factors for Hepatitis E infection.
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Affiliation(s)
- Gülsüm İclal Bayhan
- Department of Pediatrics, Pediatric Infection Clinic, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Kaan Demiören
- Clinic of Gastroenterology, Dörtçelik Children's Hospital, Bursa, Turkey
| | - Hüseyin Güdücüoğlu
- Department of Microbiology, Yüzüncü Yıl University School of Medicine, Van, Turkey
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Abstract
BACKGROUND Hepatitis E virus (HEV) is endemic in large parts of the developing world. Waterborne transmission of genotypes 1 or 2 commonly causes acute hepatitis, which is usually self-limited in healthy individuals. In addition, acute HEV infections also occur outside endemic areas, mostly related to foodborne transmission of HEV genotype 3. A growing number of publications in the last decade have reported chronic infection progressing to cirrhosis in immunosuppressed patients. It has also been suggested that HEV transmission may occur via contaminated blood products. This publication aims to provide recommendations for diagnosis, prevention, and treatment of HEV infection, particularly in children after solid organ transplantation. METHODS A systematic PubMed literature search on HEV infection from 1990 to January 2016 was performed focusing on pediatric studies. The existing body of evidence was reviewed and recommendations were agreed upon following discussion and unanimous agreement by all members of the ESPGHAN Hepatology Committee during a consensus meeting in January 2016. In the absence of randomized controlled studies these recommendations were considered to be expert opinions. KEY RECOMMENDATIONS Immunocompetent children with increased transaminases and/or extrahepatic manifestations should be considered for testing for evidence of HEV infection. Immunocompromised children with increased aminotransferases should be repeatedly tested for HEV and may require therapeutic intervention.
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Laverdure N, Scholtès-Brunel C, Rivet C, Heissat S, Restier L, Bacchetta J, Boillot O, Dumortier J, Lachaux A. Paediatric liver transplanted patients and prevalence of hepatitis E virus. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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16
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Petrik J, Lozano M, Seed CR, Faddy HM, Keller AJ, Prado Scuracchio PS, Wendel S, Andonov A, Fearon M, Delage G, Zhang J, Shih JWK, Gallian P, Djoudi R, Tiberghien P, Izopet J, Dreier J, Vollmer T, Knabbe C, Aggarwal R, Goel A, Ciccaglione AR, Matsubayashi K, Satake M, Tadokoro K, Jeong SH, Zaaijer HL, Zhiburt E, Chay J, Teo D, Chua SS, Piron M, Sauleda S, Echevarría JM, Dalton H, Stramer SL. Hepatitis E. Vox Sang 2015. [PMID: 26198159 DOI: 10.1111/vox.12285] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Sayed IM, Vercauteren K, Abdelwahab SF, Meuleman P. The emergence of hepatitis E virus in Europe. Future Virol 2015. [DOI: 10.2217/fvl.15.29] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
ABSTRACT Hepatitis E virus (HEV) infections appear to be an emerging problem in Europe. Infections are mainly caused by viruses of genotype 3. Pigs and wild boar are the main reservoirs of HEV in Europe and most autochthonous infections are probably caused by the consumption of uncooked or undercooked infected meat. Nevertheless, transfusion-associated transmission has been described in different European countries but the efficiency of this route of transmission need to be further investigated. Most acute infections are asymptomatic or the induced symptoms are rather nonspecific. Although people that are otherwise completely healthy can spontaneously clear an HEV infection, people with underlying liver disease and/or suffering from immune deficiencies may require treatment to avoid chronicity and exacerbation of liver disease. In this review, we give an epidemiological overview of HEV in Europe and the potential complications.
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Affiliation(s)
- Ibrahim M Sayed
- Center for Vaccinology, Ghent University, Ghent University Hospital, B-9000 Gent, Belgium
- Microbiology & Immunology Department, Faculty of Medicine, Assuit University, Assuit 71515, Egypt
| | - Koen Vercauteren
- Center for Vaccinology, Ghent University, Ghent University Hospital, B-9000 Gent, Belgium
| | - Sayed F Abdelwahab
- Microbiology and Immunology Department, Faculty of Medicine, Minia University, Minia 61511, Egypt
| | - Philip Meuleman
- Center for Vaccinology, Ghent University, Ghent University Hospital, B-9000 Gent, Belgium
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18
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Meng QF, You HL, Wang WL, Zhou N, Dong W, Cong W. Seroprevalence and risk factors of hepatitis E virus infection among children in China. J Med Virol 2015; 87:1573-7. [PMID: 25940435 DOI: 10.1002/jmv.24203] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Qing-Feng Meng
- Jilin Entry-Exit Inspection and Quarantine Bureau; Changchun Jilin Province PR China
| | - Hai-Long You
- First Hospital of Jilin University; Changchun Jilin Province PR China
| | - Wei-Li Wang
- Jilin Entry-Exit Inspection and Quarantine Bureau; Changchun Jilin Province PR China
| | - Na Zhou
- Affilliated Hospital of Medical College; Qingdao University; Qingdao Shandong Province PR China
| | - Wei Dong
- Weihaiwei People's Hospital; Weihai Shandong Province PR China
| | - Wei Cong
- College of Animal Science and Technology; Jilin Agricultural University; Changchun Jilin Province PR China
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19
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Echevarría JM, Fogeda M, Avellón A. Epidemiología de la infección por el virus de la hepatitis E en España. Enferm Infecc Microbiol Clin 2015; 33:281-6. [DOI: 10.1016/j.eimc.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/04/2013] [Accepted: 11/08/2013] [Indexed: 02/08/2023]
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20
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Sauleda S, Ong E, Bes M, Janssen A, Cory R, Babizki M, Shin T, Lindquist A, Hoang A, Vang L, Piron M, Casamitjana N, Koppelman M, Danzig L, Linnen JM. Seroprevalence of hepatitis E virus (HEV) and detection of HEV RNA with a transcription-mediated amplification assay in blood donors from Catalonia (Spain). Transfusion 2014; 55:972-9. [PMID: 25403913 DOI: 10.1111/trf.12929] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/17/2014] [Accepted: 09/20/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hepatitis E virus (HEV) is an emerging threat to the safety of blood transfusion. The aim of this study was to determine HEV immunoglobulin (Ig)G and RNA prevalence in Catalan blood donors. STUDY DESIGN AND METHODS Nearly 10,000 samples were collected from anonymized, unpaid donors at the Banc de Sang i Teixits (Barcelona, Spain) from June to December 2013. For the serology study, a subset of 1082 donations was tested in parallel for HEV IgG using Wantai and Mikrogen enzyme-linked immunosorbent assay tests. Samples were tested individually (individual-donation nucleic acid test [ID-NAT]) for HEV RNA using the Procleix HEV assay (95% limit of detection 7.9 IU/mL). Procleix repeat-reactive donations were confirmed by an in-house real-time polymerase chain reaction (PCR) test. RESULTS The prevalences of IgG anti-HEV in Catalan blood donors were 19.96% (Wantai assay) and 10.72% (Mikrogen assay). Screening of 9998 samples with the Procleix HEV assay yielded three real-time PCR-confirmed and IgM and IgG anti-HEV-positive donations with viral loads of 250, 564, and 2755 IU/mL. The donation with highest viral load was genotype 3f. HEV RNA positivity rate was one per 3333 donations (0.03%; 95% confidence interval, 0.01%-0.09%). CONCLUSION The Procleix HEV ID-NAT screening system has provided evidence of HEV RNA presence in Catalan blood donors. Further data are needed to assess the impact of HEV infection in at-risk patients to design the best strategy to increase blood safety.
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Affiliation(s)
- Sílvia Sauleda
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Institut Català de la Salut, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Edgar Ong
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
| | - Marta Bes
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Institut Català de la Salut, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Alanna Janssen
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
| | - Robin Cory
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
| | - Maria Babizki
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
| | - Tim Shin
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
| | - Andre Lindquist
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
| | - Anh Hoang
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
| | - Lee Vang
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
| | - Maria Piron
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Institut Català de la Salut, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Natàlia Casamitjana
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Institut Català de la Salut, Barcelona, Spain
| | - Marco Koppelman
- Sanquin Diagnostics, National Screening Laboratory of Sanquin (NSS), Amsterdam, the Netherlands
| | - Lisa Danzig
- Grifols (formerly Novartis Diagnostics), Emeryville, California
| | - Jeffrey M Linnen
- Hologic, Inc. (formerly Gen-Probe Incorporated), San Diego, California
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21
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Verghese VP, Robinson JL. A systematic review of hepatitis E virus infection in children. Clin Infect Dis 2014; 59:689-97. [PMID: 24846637 DOI: 10.1093/cid/ciu371] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A systematic review was conducted, seeking all literature relevant to the epidemiology, clinical and laboratory features, and outcome of hepatitis E virus (HEV) infection in children. Transmission is thought to be primarily from fecal-oral transmission, with the role of transmission from animal reservoirs not being clear in children. Worldwide, seroprevalence is <10% up to 10 years of age, with the exception of 1 of 5 studies from India and the sole study from Egypt. Seroprevalence increases with age, but it is not clear if it is increasing over time. The clinical presentation of HEV infection has broad similarities to hepatitis A virus (HAV) infection, with most cases being subclinical. However, HEV differs from HAV in that infectivity is lower, perinatal transmission can result in neonatal morbidity and even mortality, and a chronic carrier state exists, accounting for chronic hepatitis in some pediatric solid organ transplant recipients.
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Affiliation(s)
| | - Joan L Robinson
- Stollery Children's Hospital and University of Alberta, Edmonton, Canada
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22
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Echevarría JM. Autochthonous Hepatitis E Virus Infection in Europe: A Matter of Concern for Public Health? J Clin Transl Hepatol 2014; 2:7-14. [PMID: 26357613 PMCID: PMC4521255 DOI: 10.14218/jcth.2013.00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 12/26/2013] [Accepted: 01/03/2014] [Indexed: 12/19/2022] Open
Abstract
Human hepatitis E virus (HHEV) is the proposed name for a diverse group of RNA viruses from the family Hepeviridae that cause acute hepatitis among humans. Waterborne strains are regularly imported into Europe by international travelers, and virus transmission of zoonotic strains via contaminated aliments is involved in autochthonous cases. Therefore, in Europe, hepatitis E displays a unique dual character, having features of both imported and autochthonous infections. Environmental involvement of waterborne and zoonotic diseases puts alimentary safety at risk. In addition, it may lead to serious health problems derived from persistent infection among patients with immune impairment due to organ transplant, cancer, or human immunodeficiency virus infection. Although the European health authorities know at present that HHEV represents a problem worthy of consideration, the actual incidence of the disease in Europe is unknown, and attempts to ascertain the prevalence of the infection is hampered by unresolved technical issues. In order to determine the burden of hepatitis E in Europe, the World Health Organization Regional Office and the European Centre for Disease Prevention and Control should pay specific attention to hepatitis E, and research efforts in the continent should be transnational and collaborative. Development of a specific European network for hepatitis E would help to achieve these goals.
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Affiliation(s)
- José-Manuel Echevarría
- Department of Virology, National Centre of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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23
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Echevarría JM. Light and Darkness: Prevalence of Hepatitis E Virus Infection among the General Population. SCIENTIFICA 2014; 2014:481016. [PMID: 24672733 PMCID: PMC3941225 DOI: 10.1155/2014/481016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/25/2013] [Indexed: 05/05/2023]
Abstract
Human hepatitis E virus (HHEV) spreads early in life among the population in areas endemic for genotype 1 and infects mainly adults in areas endemic for genotype 3, where it would be responsible for about 10% of cases of suspected acute viral hepatitis of unknown etiology and for a number of subclinical, unrecognized infections. The overall prevalence of antibody to HHEV is high in most of the former areas and low in most of the later ones, but wide regional differences have been recorded in both cases. "Hot spots" of HHEV infection would exist for both types of strains in particular regions or among particular populations of the world. Studies on pork derivatives, shellfish bivalves, and vegetables for HHEV contamination at the sale point need to be extended for evaluating the impact of the agent on food safety, and the meaning of the finding of HHEV genotype 1 genomes in urban sewage from developed countries should be established through active surveillance. Consensus about technical issues in regard to anti-HEV testing would improve the knowledge of the HHEV epidemiology. Studies in particular regions and populations, and introduction of molecular diagnosis in the clinical setting as a routine tool, would also be required.
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Affiliation(s)
- José-Manuel Echevarría
- Department of Virology, National Centre of Microbiology, Instituto de Salud Carlos III, Road Majadahonda-Pozuelo, Km2, Majadahonda, 28220 Madrid, Spain
- *José-Manuel Echevarría:
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24
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Riveiro-Barciela M, Buti M, Homs M, Campos-Varela I, Cantarell C, Crespo M, Castells L, Tabernero D, Quer J, Esteban R, Rodriguez-Frías F. Cirrhosis, liver transplantation and HIV infection are risk factors associated with hepatitis E virus infection. PLoS One 2014; 9:e103028. [PMID: 25068388 PMCID: PMC4113416 DOI: 10.1371/journal.pone.0103028] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 06/26/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute and chronic hepatitis E have been associated with high mortality and development of cirrhosis, particularly in solid-organ recipients and patients infected by human immunodeficiency virus. However, data regarding the epidemiology of hepatitis E in special populations is still limited. AIMS Investigate seroprevalence and possible factors associated with HEV infection in a large cohort of immunosuppressed patients. METHODS Cross-sectional study testing IgG anti-HEV in serum samples from 1373 consecutive individuals: 332 liver-transplant, 296 kidney-transplant, 6 dual organ recipients, 301 non-transplanted patients with chronic liver disease, 238 HIV-infected patients and 200 healthy controls. RESULTS IgG anti-HEV was detected in 3.5% controls, 3.7% kidney recipients, 7.4% liver transplant without cirrhosis and 32.1% patients who developed post-transplant cirrhosis (p<0.01). In patients with chronic liver disease, IgG anti-HEV was also statistically higher in those with liver cirrhosis (2% vs 17.5%, p<0.01). HIV-infected patients showed an IgG anti-HEV rate of 9.2%, higher than those patients without HIV infection (p<0.03). Multivariate analysis showed that the factors independently associated with anti-HEV detection were liver cirrhosis, liver transplantation and HIV infection (OR: 7.6, 3.1 and 2.4). HCV infection was a protective factor for HEV infection (OR: 0.4). CONCLUSIONS HEV seroprevalence was high in liver transplant recipients, particularly those with liver cirrhosis. The difference in anti-HEV prevalence between Liver and Kidney transplanted cases suggests an association with advanced liver disease. Further research is needed to ascertain whether cirrhosis is a predisposing factor for HEV infection or whether HEV infection may play a role in the pathogeneses of cirrhosis.
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Affiliation(s)
- Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - María Buti
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain
- * E-mail:
| | - María Homs
- Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Isabel Campos-Varela
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmen Cantarell
- Nephrology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Manuel Crespo
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - David Tabernero
- Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Josep Quer
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael Esteban
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Francisco Rodriguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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25
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Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol 2013; 58:593-608. [PMID: 23419824 DOI: 10.1016/j.jhep.2012.12.005] [Citation(s) in RCA: 877] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 12/14/2022]
Abstract
To survey the burden of liver disease in Europe and its causes 260 epidemiological studies published in the last five years were reviewed. The incidence and prevalence of cirrhosis and primary liver cancer are key to understand the burden of liver disease. They represent the end-stage of liver pathology and thus are indicative of the associated mortality. About 0.1% of Hungarian males will die of cirrhosis every year compared with 0.001% of Greek females. WHO estimate that liver cancer is responsible for around 47,000 deaths per year in the EU. Harmful alcohol consumption, viral hepatitis B and C and metabolic syndromes related to overweight and obesity are the leading causes of cirrhosis and primary liver cancer in Europe. Chronic hepatitis B affects 0.5-0.7% of the European population. In the last decade the prevalence of chronic hepatitis C was 0.13-3.26%. It is of great concern that about 90% of people in Europe infected by viral hepatitis are unaware of their status. Available data suggest the prevalence rate of NAFLD is 2-44% in the general European population (including obese children) and 42.6-69.5% in people with type 2 diabetes. Each of these four major causes of liver disease is amenable to prevention and treatment, reducing the burden of liver disease in Europe and saving lives. Further surveys are urgently needed to implement cost-effective prevention programmes and novel treatments to tackle this problem.
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Affiliation(s)
- Martin Blachier
- Department of Public Health, Hôpital Henri Mondor, Université Paris-Est Créteil, France
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26
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Riveiro-Barciela M, Rodríguez-Frías F, Buti M. [Hepatitis E: scale of the problem in Spain]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:719-24. [PMID: 22608490 DOI: 10.1016/j.gastrohep.2012.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 02/07/2023]
Abstract
Hepatitis E virus (HEV) infection is one of the most frequent causes of acute hepatitis worldwide. However, in Spain, HEV causes only a tiny number of cases of acute hepatitis, the most prevalent cause being hepatitis A. Most cases of HEV in Spain are "imported", being acquired through travel to areas where this infection is endemic. Nevertheless, in the last few years a growing number of "autochthonous cases" have been reported in persons with no history of travelling to HEV-endemic areas. The prevalence of IgG antibodies against HEV, indicating exposure to this virus, is approximately 0.6-7.3% in the general population in Spain and is 19% in persons with risk factors such as exposure to pigs.
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Affiliation(s)
- Mar Riveiro-Barciela
- Departamento de Medicina Interna, Hospital Universitario Vall d'Hebron, Barcelona, España
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27
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Hoerning A, Hegen B, Wingen AM, Cetiner M, Lainka E, Kathemann S, Fiedler M, Timm J, Wenzel JJ, Hoyer PF, Gerner P. Prevalence of hepatitis E virus infection in pediatric solid organ transplant recipients--a single-center experience. Pediatr Transplant 2012; 16:742-7. [PMID: 22738211 DOI: 10.1111/j.1399-3046.2012.01740.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
HEV infection appears to be an emerging disease in industrialized countries. The aim of this study was to evaluate the prevalence of HEV infection in pediatric solid organ transplant recipients. One hundred and twenty-four pediatric recipients of liver (n = 41) or kidney (n = 83) transplants aged between one and 18 yr were screened for anti-HEV IgG antibodies. Patients were tested for fecal HEV RNA excretion if they showed anti-HEV seropositivity. As a control group, 108 immunocompetent pediatric patients without liver disease aged between three and 18 yr were screened for anti-HEV IgG. HEV seroprevalence was 2.4% in renal Tx (2/83), 4.9% in liver Tx patients (2/41), and 3.2% overall (4/124). Three of these four patients were HEV RNA-negative. In one renal transplant patient, HEV genotype 3 RNA excretion persisted and liver enzymes were elevated, indicating chronic hepatitis. In the control group, eight patients (7.4%) were HEV IgG-positive without biochemical evidence of hepatitis. The prevalence of HEV infection in pediatric renal or liver transplant recipients is not higher compared with immunocompetent children. Chronic HEV infection with long-term carriage of the virus may develop in pediatric transplant recipients. Autochthonous HEV infection needs to be considered in uncertain cases of hepatitis in immunosuppressed as well as immunocompetent children.
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Affiliation(s)
- André Hoerning
- Pediatrics II, Department for Pediatric Nephrology, Gastroenterology, Endocrinology and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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28
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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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Wedemeyer H, Pischke S, Manns MP. Pathogenesis and treatment of hepatitis e virus infection. Gastroenterology 2012; 142:1388-1397.e1. [PMID: 22537448 DOI: 10.1053/j.gastro.2012.02.014] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 02/14/2012] [Accepted: 02/14/2012] [Indexed: 12/14/2022]
Abstract
Hepatitis E has been considered to be a travel-associated, acute, self-limiting liver disease that causes fulminant hepatic failure in specific high-risk groups only. However, hepatitis E virus (HEV) infection can also be acquired in industrialized countries-HEV genotype 3 infection is a zoonosis, with pigs and rodents serving as animal reservoirs. In recent years, cases of chronic HEV infection that were associated with progressive liver disease have been described in several cohorts of immunocompromised individuals, including recipients of organ transplants. The topic of hepatitis E is therefore re-emerging and has raised the following important questions: what is the risk for HEV infection in Western countries (eg, from eating uncooked meat)? How frequently does chronic hepatitis E develop among human immunodeficiency virus-infected patients and recipients of organ transplants? What are the treatment options? What is the current status of vaccine development? What do we know about the pathogenesis of HEV infection, and why does it have a more severe course in pregnant women? This review summarizes the current knowledge on the pathogenesis and treatment of HEV infection.
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Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
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Motte A, Roquelaure B, Galambrun C, Bernard F, Zandotti C, Colson P. Hepatitis E in three immunocompromized children in southeastern France. J Clin Virol 2011; 53:162-6. [PMID: 22177988 DOI: 10.1016/j.jcv.2011.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 11/09/2011] [Accepted: 11/16/2011] [Indexed: 12/17/2022]
Abstract
Hepatitis E virus (HEV) causes an emerging autochthonous disease in developed countries where links with a viral porcine reservoir have been evidenced. Moreover, chronic HEV infection and associated-cirrhosis have been described in severely immunocompromized patients. Nonetheless, only few studies have focused on pediatric HEV infections worldwide and only four autochthonous cases have been reported in children in developed countries. We describe here acute hepatitis E in three immunocompromized children. Case no. 1 was a 9-year-old liver transplant recipient girl in whom H1N1 2009 flu infection was diagnosed concurrently with hepatitis E. Case no. 2 was a 12-year-old boy presenting early medullar relapse of lymphoblastic leukemia of type B and in whom HEV RNA was detected over a 29-week period. Case no. 3 was a 9-year-old boy with a rare primary immunodeficiency due to XIAP deficiency. HEV infections were all autochthonously acquired and involved different viruses classified as subtype f, c, and e of genotype 3, which are those described in autochthonous cases in Europe. These three observations prompt to consider HEV as a causative agent of hepatitis in children in developed countries, and to perform particularly HEV testing in those severely immunocompromized who may develop chronic hepatitis E.
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Affiliation(s)
- Anne Motte
- Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre, 13385 Marseille CEDEX 05, France
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Fogeda M, Avellón A, Echevarría J. Prevalence of specific antibody to hepatitis E virus in the general population of the community of Madrid, Spain. J Med Virol 2011; 84:71-4. [DOI: 10.1002/jmv.22270] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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