Prevalence of hepatitis E virus viremia and antibodies among healthy blood donors in India
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Hepatitis E Virus
Viremia
Subclinical infection
Hepatitis E
Hepatitis E is a viral hepatitis that the hepatitis E virus (HEV) causes. In the early 1980s, the hepatitis E virus was first discovered and identified, and it is one of the important pathogens that cause acute viral hepatitis globally. HEV infection is usually self-limiting, but in some groups of populations, such as pregnant women, patients with chronic liver disease, and the elderly, the prognosis is poor and may result in acute or subacute liver failure or even death. In addition, HEV infection can occur in chronically immunocompromised populations. At present, some regions and countries are not paying enough attention to hepatitis E prevention, diagnosis, and treatment, which suggests that we should study the epidemiology of HEV infection.戊型肝炎是由戊型肝炎病毒（HEV）引起的病毒性肝炎。HEV在二十世纪八十年代初被首次发现鉴定，是在世界范围内引发急性病毒性肝炎的重要病原体之一。HEV感染通常具有自限性，但部分人群如妊娠期妇女、慢性肝病患者、老年人等感染HEV后预后较差，可能发展为急性或亚急性肝衰竭，甚至造成患者死亡。免疫抑制人群还有可能发生慢性HEV感染。目前在部分地区和国家，关于戊型肝炎的预防、诊断与治疗并未得到足够重视，这提示我们应当评估其的流行情况。.
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Hepatitis E virus (HEV), the sole member of the unassigned Genus Hepevirus , caused several largeepidemic outbreaks of acute hepatitis in Asia, Africa and in Mexico. Many of the hepatitis E cases in CentralEurope (2007 in Germany: 72 notified cases) are infections imported from the endemic regions; however,there is increasing evidence of sporadic infections without a history of travel. HEV is mainly transmitted byfaecally contaminated water, but also by contaminated food. HEV strains closely related to human isolateshave been detected in several animal species, especially in pigs, indicating that HEV is a zoonotic virus.Using three different RT-PCR protocols, HEV-RNA was detected in 10 out of 189 serum samplescollected in 1995/1996 from wild boars in Germany. Sequence analysis indicates a close relationship withgenotype 3 isolates of pigs and humans from the Netherlands and Japan. The results indicate that HEV ispresent in Germany since more than 10 years and that wild boar may function as a reservoir for HEV
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Abstract Background Hepatitis E virus (HEV) is among the leading causes of viral hepatitis in most developing countries. Zoonotic acquisition of HEV genotype 3 from swine has come into focus more recently. Available studies on HEV in Ghana and other countries in the region do not provide enough information towards understanding the epidemiology of HEV in human and animal populations. Towards this end, we conducted a comparative cross-sectional study to determine the seroprevalence and risk factors associated with HEV exposure, both in swine and humans working on pig farms in typical local settings. The presence of viral RNA in human and swine samples was also evaluated, along with classification of viral sequences from HEV-positive samples. Methods Structured questionnaires soliciting information on pigs reared, as well as socio-demographic information including age, sex and educational background of humans was collected. A total of 10 ml and 5 ml of whole blood was collected from pigs and human participants respectively. ELISA and real-time RT-PCR were performed on the sera for the qualitative detection of IgG antibodies to hepatitis E virus and viral RNA, respectively. Results Five hundred and forty-four (544) human participants including 264 swine contacts and 280 swine non-contacts were enrolled in the study. Although the proportion of HEV IgG antibodies was higher in contact groups (114; 54.3%) than non-contact groups (96; 45.7%), a multivariate analysis did not show any significant difference. No HEV RNA was detected in human samples. Similarly, 720 pigs were sampled from 18 farms located in five regions in Ghana. Twenty-three (23) of the pigs (3.2, 95%CI = 2.0–4.8) were positive for HEV RNA by real-time RT-PCR testing. Sequences obtained from HEV-positive samples were found to share high sequence identities with each other and clustered with other genotype 3 viruses indicating the existence of circulating zoonotic genotype 3 viruses on farms. Although we did not find evidence of pig to human transmission of HEV genotype 3, the presence of this genotype in pigs shows the potential for possible zoonotic transmission in African farm settings and buttresses the importance of active surveillance for the infection among at risk populations.
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Human hepatitis E virus (HEV) is considered an emerging pathogen in industrialized countries. The aim of the present study was to contribute to the body of knowledge available on the molecular epidemiology of acute hepatitis E in Italy. Three sets of HEV-specific primers targeting the ORF1 and ORF2 were used to examine serum samples collected from acute hepatitis patients positive for anti-HEV IgG and/or IgM, between 2007 and 2010. Seventeen patients (39.5%) tested HEV RNA-positive: 12 infections, due to genotype 1, were associated with travel to endemic areas (Bangladesh, India and Pakistan), while five infections, due to genotype 3, were presumably autochthonous. Risk factors identified in this group included exposure to raw seafood, pork liver sausages and wild boar. Results from the present study confirm that human HEV infection in Italy is caused by different genotypes, depending on whether the infection is travel-related or autochthonous.
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Hepatitis E was classically considered as a waterborne outbreak of acute hepatitis with jaundice in the tropics and subtropics. It was even regarded that most, if not all, hepatitis E cases observed in industrialized countries, including Japan, were most likely “imported.” Over the last few years, however, autochthonous hepatitis E infection has been reported from economically developed countries such as the USA, Japan, Europe and Australia.1–3 The hepatitis E virus (HEV) is the sole member of the genus Hepevirus in the family Hepeviridae, remotely related to Caliciviridae viruses.4 The interstrain sequence diversity of its genome allows four convenient groupings to be made. These include: genotype 1, which is regularly identified in human cases of hepatitis E in hyperendemic areas; genotype 2, characterized from human cases in an outbreak in Mexico and more recently in Nigeria; genotype 3, which is detected in humans with non-imported disease and in pigs of economically developed countries, such as the US and Japan; and genotype 4, found among humans and pigs in east Asia.5,6 In 2001, an HEV strain of genotype 3 was isolated from a Japanese patient with acute hepatitis who had never been abroad.2 Consequent studies revealed that a Japanese indigenous strain might be circulating in the country.7,8 Furthermore, a zoonotic transmission of HEV has been suggested, with both indirect9–11 and direct12,13 evidence provided. However, the extent and impact of zoonotic transmission of acute hepatitis E occurrence has not yet been elucidated. Anti-HEV IgG has been detected among pigs in nonendemic countries such as Australia, Canada, Germany, New Zealand, the US and Japan.11,14,15 Other than in pigs, a presence of antibody to HEV and/or HEV-RNA has been proven in mice, rats, cats, monkeys, goats, cows, deer, mongooses and chickens.16–20 The zoonotic infection of HEV was first confirmed between deer and humans.12 The genomic sequence of HEV from patients of hepatitis E was identical to that found in a leftover portion of deer meat which the patients had eaten before the onset of hepatitis. Shortly after the report, two and 11 cases of hepatitis E possibly associated to wild boar ingestion were reported.21,22 Accordingly, pigs, boar and deer have been considered as important reservoirs in Japan and, naturally, pigs are considered to be the likely primary reservoir among these three. Indeed, in Hokkaido, where pig meat consumption is relatively high in comparison to other parts of Japan, a higher incidence of hepatitis E has been noted.7,8,23 On the other hand, sporadic cases or small outbreaks of hepatitis E reported in western Japan are often associated with boar ingestion.13,21,22,24–26 Therefore, information on the prevalence of anti-HEV and HEV-RNA among wild boar in western Japan appears to be of importance. Sonoda et al.27 reported that antibody to HEV was detected in 9% of 35 wild boar and in 2% of 117 wild deer tested, and HEV-RNA was detected in a boar, thus indicating an HEV-RNA prevalence of 1/35 (2.86%) among wild boar. It was not clear from Sonoda’s data whether the prevalence of HEV among boar was higher in (a) particular part(s) of Japan, probably because of limitations in the sample size. In contrast, in this issue of this journal, Michitaka et al.28 report a high prevalence of anti-HEV both in wild-caught (25.5%) and bred boar (71.4%) in the Ehime prefecture of Japan, where a case of hepatitis E in a woman who had cooked and eaten wild boar meat has recently been reported.26 The positive rates of anti-HEV showed a significant difference between wild-caught boar and bred boar (25.5% vs. 71.4%, P < 0.001). Interestingly, despite the high rate of anti-HEV, none of the bred boar was positive for HEV-RNA, and these findings were similar to the reported case of bred swine, in which viremia was recognized only within 6 months of birth.11 Furthermore, in some of the anti-HEV-positive boar, the genotype 3 HEV was detected, suggesting that genotype 3 HEV is prevalent among the boar in Ehime prefecture. Interestingly, most cases of sporadic hepatitis E in western Japan are associated with the HEV of genotype 3. Such accumulated evidence therefore seems to indicate that wild boar are one of the major reservoirs of HEV in western Japan. This assumption may be biased by patients’ memories, for example pork ingestion, which is usual in Japan, is less memorable than boar ingestion, which does not appear to be a usual food item, even for those who like eating wild animals. It is possible, therefore, that the wild boar-borne transmission of HEV is overestimated, while pig-borne transmission remains underrepresented due to such a recall bias. Indeed, it has been shown that over 50% of Japanese hepatitis E patients have an unknown mode of transmission.29 Nevertheless, there is no doubt that the consumption of boar meat puts individuals at a high risk of developing hepatitis E infection in western Japan. As Michitaka et al. concluded, boar should be regarded as an important reservoir of HEV and caution is therefore required in cooking and eating boar meat.
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