Hepatitis E Virus Epidemiology in Industrialized Countries

To determine the prevalence of Hepatitis E virus (HEV) in industrialized nations, we analyzed the excretion of HEV strains by the populations of Spain, France, Greece, Sweden, and the United States. Twenty of 46 (43.5%) urban sewage samples collected in Barcelona from 1994 to 2002 tested positive for HEV. We identified 15 HEV strains, which were similar to two HEV isolates previously described in Barcelona in clinical samples and to strains from diverse geographic HEV-nonendemic areas. We also identified two HEV strains in sewage samples from Washington, D.C., and Nancy, France; these samples were also positive for Hepatitis A virus. In addition, we studied the role of pigs as a reservoir for HEV and identified one new swine HEV strain. Our results suggest that HEV may be more prevalent than previously considered in industrialized countries and that variants of the virus circulate simultaneously in one region

Dynamics of HEV viremia, fecal shedding and its relationship with transaminases and antibody response in patients with sporadic acute hepatitis E

<p>Abstract</p> <p>Background</p> <p>There is paucity of data regarding duration of fecal excretion and viremia on sequential samples from individual patients and its correlation with serum transaminases and antibody responses in patients with acute hepatitis E. This prospective study was undertaken at a tertiary care center in Northern India over 15 months. Only those patients of sporadic acute hepatitis E who were in their first week of illness and followed up weekly for liver function tests, IgM anti HEV antibody and HEV RNA in sera and stool were included. HEV RNA was done by RT - nPCR using two pairs of primers from RdRp region of ORF 1 of the HEV genome.</p> <p>Results</p> <p>Over a period of 15 months 60 patients met the inclusion criterion and were enrolled for the final analysis. The mean age of the patients was 29.2 ± 8.92 years, there were 39 males. The positivity of IgM anti HEV was 80% at diagnosis and 18.3% at 7th week, HEV RNA 85% at diagnosis and 6.6% at 7th week and fecal RNA 70% at the time of diagnosis and 20% at 4th week. The maximum duration of viremia detected was 42 days and fecal viral shedding was 28 days after the onset of illness.</p> <p>Conclusion</p> <p>Present study reported HEV RNA positivity in sera after normalization of transaminases. Fecal shedding was not seen beyond normalization of transaminases. However, viremia lasted beyond normalization of transaminases suggesting that liver injury is independent of viral replication.</p

A Single Amino Acid Substitution Changes Antigenicity of ORF2-Encoded Proteins of Hepatitis E Virus

Extensive genomic diversity has been observed among hepatitis E virus (HEV) strains. However, the implication of the genetic heterogeneity on HEV antigenic properties is uncertain. In this study, monoclonal antibodies (Mabs) against truncated ORF2-encoded proteins (aa452–617, designated p166 proteins) derived from HEV strains of Burma (genotype 1a, p166Bur), Pakistan (1b, p166Pak) and Morocco (1c, p166Mor) were raised and used for identification of HEV antigenic diversity. Six Mabs reacted to these 3 p166 proteins as well as p166 proteins constructed from strains derived from Mexico (genotype 2), US (genotype 3) and China (genotype 4), indicating the existence of pan-genotypic epitopes. Two Mabs, 1B5 and 6C7, reacted with p166Bur and p166Mor, but not p166Pak or p166s derived from genotypes 2, 3, and 4, indicating that these 2 Mabs recognized strain-specific HEV epitopes. Both the common and specific epitopes could not be mapped by 23 synthetic peptides spanning the p166Bur sequence, suggesting that they are confirmation-dependent. Comparative sequence analysis showed that p166Bur and p166Mor shared an identical aa sequence along their entire lengths, whereas for p166Pak the aas occupying positions 606 and 614 are different from aas at corresponding positions of p166Bur and p166Mor. Reactivity between 1B5 and p166Bur was abrogated with mutation of p166Bur/A606V, whereas p166Pak acquired the reactivity to 1B5 with mutation of p166Pak/V606A. However, mutations of p166Bur/L614M and P166Pak/M614L did not affect the immunoreactivity. Therefore, the aa occupying position 606 plays a critical role in maintaining the antigenicity of the HEV p166 proteins

Sources of Hepatitis E Virus Genotype 3 in the Netherlands

Four subtypes have been detected, and pathogenicity, zoonotic potential, or stability may vary between subtypes

Molecular characterization of hepatitis E virus in three acute liver failure cases in children in Argentina

Fil: Munné, María Silvina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Vladimirsky, Sara. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Otegui, Lucio. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Brajterman, Leonardo. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Castro, Raúl. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Soto, Sonia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Moreiro, Rita. Hospital Nacional de Pediatría J. P. Garrahan. Laboratorio; Argentina.Fil: Ciocca, Mirta. Hospital Nacional de Pediatría J. P. Garrahan. Unidad de Hígado; Argentina.Fil: Cuarterolo, Miriam. Hospital Nacional de Pediatría J. P. Garrahan. Unidad de Hígado; Argentina.Fil: Buamscha, Daniel. Hospital Nacional de Pediatría J. P. Garrahan. Terapia Intensiva de Transplante Hepático; Argentina.Fil: Giannivelli, Silvina. Hospital Nacional de Pediatría J. P. Garrahan. Terapia Intensiva de Transplante Hepático; Argentina.Fil: Sasbón, Jorge. Hospital Nacional de Pediatría J. P. Garrahan. Terapia Intensiva de Transplante Hepático; Argentina.Fil: Schlauder, George. Abbott Laboratories; Estados Unidos.Fil: González, Jorge E. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Las cepas de virus de hepatitis E (HEV) encontradas en casos esporádicos humanos y en cerdos en Argentina corresponden al genotipo 3. Se han descripto variantes de este genotipo asociadas a fallas hepáticas fulminantes (FHF) en adultos de Japón e Inglaterra. En Argentina el 30% de las FHF en adultos y en niños es de etiología desconocida. Para estudiar si el HEV podría ser el agente etiológico asociado a FHF en niños se analizaron el suero y/o la materia fecal de 35 niños (edad media 6 años, 20 mujeres, 15 varones) durante 2003 y 2004. El HEV RNA fue detectado por RT-nested PCR con cebadores dirigidos a las regiones ORF 1 y ORF 2. El HEV RNA pudo detectarse en 3 casos. Dos eran varones de 12 años residentes en la provincia de Buenos Aires y el tercero, una niña de 3 años de la provincia de Corrientes. El análisis de las secuencias muestra que las 3 variantes son distintas, pero pertenecen todas al genotipo 3 y están muy relacionadas a las cepas encontradas previamente en casos esporádicos en humanos y en cerdos de Argentina. Estos datos sugieren una posible relación entre FHF y HEV en niños de Argentina e indican la necesidad de considerar la infección con HEV en el diagnóstico diferencial de las FHF. Se necesitan más estudios que demuestren el verdadero impacto de esta infección y el beneficio potencial de una vacuna para HEV, actualmente en fase III

Molecular characterization of hepatitis E virus in three acute liver failure cases in children in Argentina

Fil: Munné, María Silvina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Vladimirsky, Sara. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Otegui, Lucio. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Brajterman, Leonardo. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Castro, Raúl. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Soto, Sonia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Fil: Moreiro, Rita. Hospital Nacional de Pediatría J. P. Garrahan. Laboratorio; Argentina.Fil: Ciocca, Mirta. Hospital Nacional de Pediatría J. P. Garrahan. Unidad de Hígado; Argentina.Fil: Cuarterolo, Miriam. Hospital Nacional de Pediatría J. P. Garrahan. Unidad de Hígado; Argentina.Fil: Buamscha, Daniel. Hospital Nacional de Pediatría J. P. Garrahan. Terapia Intensiva de Transplante Hepático; Argentina.Fil: Giannivelli, Silvina. Hospital Nacional de Pediatría J. P. Garrahan. Terapia Intensiva de Transplante Hepático; Argentina.Fil: Sasbón, Jorge. Hospital Nacional de Pediatría J. P. Garrahan. Terapia Intensiva de Transplante Hepático; Argentina.Fil: Schlauder, George. Abbott Laboratories; Estados Unidos.Fil: González, Jorge E. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Laboratorio Nacional de Referencia para Hepatitis Virales; Argentina.Las cepas de virus de hepatitis E (HEV) encontradas en casos esporádicos humanos y en cerdos en Argentina corresponden al genotipo 3. Se han descripto variantes de este genotipo asociadas a fallas hepáticas fulminantes (FHF) en adultos de Japón e Inglaterra. En Argentina el 30% de las FHF en adultos y en niños es de etiología desconocida. Para estudiar si el HEV podría ser el agente etiológico asociado a FHF en niños se analizaron el suero y/o la materia fecal de 35 niños (edad media 6 años, 20 mujeres, 15 varones) durante 2003 y 2004. El HEV RNA fue detectado por RT-nested PCR con cebadores dirigidos a las regiones ORF 1 y ORF 2. El HEV RNA pudo detectarse en 3 casos. Dos eran varones de 12 años residentes en la provincia de Buenos Aires y el tercero, una niña de 3 años de la provincia de Corrientes. El análisis de las secuencias muestra que las 3 variantes son distintas, pero pertenecen todas al genotipo 3 y están muy relacionadas a las cepas encontradas previamente en casos esporádicos en humanos y en cerdos de Argentina. Estos datos sugieren una posible relación entre FHF y HEV en niños de Argentina e indican la necesidad de considerar la infección con HEV en el diagnóstico diferencial de las FHF. Se necesitan más estudios que demuestren el verdadero impacto de esta infección y el beneficio potencial de una vacuna para HEV, actualmente en fase III

First Isolation of Hepatitis E Virus Genotype 4 in Europe through Swine Surveillance in the Netherlands and Belgium

Hepatitis E virus (HEV) genotypes 3 and 4 are a cause of human hepatitis and swine are considered the main reservoir. To study the HEV prevalence and characterize circulating HEV strains, fecal samples from swine in the Netherlands and Belgium were tested by RT-PCR. HEV prevalence in swine was 7–15%. The Dutch strains were characterized as genotype 3, subgroups 3a, 3c and 3f, closely related to sequences found in humans and swine earlier. The HEV strains found in Belgium belonged to genotypes 3f and 4b. The HEV genotype 4 strain was the first ever reported in swine in Europe and an experimental infection in pigs was performed to isolate the virus. The genotype 4 strain readily infected piglets and caused fever and virus shedding. Since HEV4 infections have been reported to run a more severe clinical course in humans this observation may have public health implications

Inactivation of infectious hepatitis E virus present in commercial pig livers sold in local grocery stores in the United States

Hepatitis E virus (HEV) is a zoonotic pathogen and pigs are a known reservoir. Recently we showed that approximately 11% of commercial pig livers sold in local U.S. grocery stores for food consumptions are contaminated by infectious HEV. In this study, a swine bioassay was used to determine if the infectious HEV in contaminated commercial pig livers could be inactivated by traditional cooking methods. Group 1 pigs (n=5) were each inoculated intravenously (I.V.) with a HEV-negative liver homogenate as negative controls, group 2 pigs (n=5) were each inoculated I.V. with a pool of two HEV-positive pig liver homogenates as positive controls, groups 3, 4 and 5 pigs (n=5, each group) were each inoculated I.V. with a pool of homogenates of two HEV-positive livers incubated at 56°C for 1 hr, stir-fried at 191°C for 5 min or boiled in water for 5 min, respectively. As expected, the group 2 positive control pigs all became infected whereas the group 1 negative control pigs remained negative. Four of the five pigs inoculated with HEV-positive liver homogenates incubated at 56°C for 1 hr also became infected. However, pigs in groups 4 and 5 did not become infected. The results indicated that HEV in contaminated commercial pig livers can be effectively inactivated if cooked properly, although incubation at 56°C for 1 hr cannot inactivate the virus. Thus, to reduce the risk of food-borne HEV transmission, pig livers must be thoroughly cooked