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Tang ZM, Wen GP, Ying D, Wang SL, Liu C, Tian WK, Wang YB, Fang MJ, Zhou YL, Ge YS, Wu T, Zhang J, Huang SJ, Zheng ZZ, Xia NS. Profile of clinical characteristics and serologic markers of sporadic hepatitis E in a community cohort study. Emerg Microbes Infect 2023; 12:2140613. [PMID: 36314245 PMCID: PMC9769141 DOI: 10.1080/22221751.2022.2140613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hepatitis E virus (HEV) is a pathogen of global significance, but the value of HEV-related markers in the diagnosis of hepatitis E remains controversial. Previous studies on hepatitis E profiles have been mainly cross-sectional and conducted among inpatients in large hospitals, and hepatitis E cases have been primarily defined by limited partial markers. In this community-based study, 4,110 active hepatitis cases from a population of nearly 600,000 were followed over 48 months and serial serum samples were collected. Both HEV pathogen (HEV RNA and antigen) and anti-HEV antibody markers were used to determine HEV infection status and the relationship between hepatitis and HEV infection. In total, 98 hepatitis E patients were identified and all available isolates from 58 patients belonged to HEV genotype 4. The mean age of the patients was 58.14 years, with an overwhelming proportion of males (70.4%). Hepatitis E accounted for 22.86% of active hepatitis cases with alanine aminotransferase levels ≥15.0-fold the upper limit of normal, suggesting the need to include HEV in routine testing for these patients. Ninety-two hepatitis E patients were positive for at least 2 of HEV antigen, anti-HEV IgM, and HEV RNA markers at presentation, and 90.22% of them were positive for HEV antigen and anti-HEV IgM. HEV antigen, HEV RNA, and anti-HEV IgM positivity were observed in 89.80%, 82.65%, and 93.88% of hepatitis E patients at presentation, respectively. However, only 57.14% of anti-HEV IgM positivity occurred in hepatitis E patients. These findings will advance our understanding of hepatitis E and improve diagnosis.
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Affiliation(s)
- Zi-Min Tang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China,NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Gui-Ping Wen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China,United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Dong Ying
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China,School of Life Sciences, Xiamen University, Xiamen, PR People’s Republic of China
| | - Si-Ling Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Chang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Wei-Kun Tian
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Ying-Bin Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Mu-Jin Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China,NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Yu-Lin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Yun-Sheng Ge
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China
| | - Shou-Jie Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China, Shou-Jie Huang ; Zi-Zheng Zheng ; Ning-Shao Xia National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiangan South Road, Xiamen, Fujian, 361102, China
| | - Zi-Zheng Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China, Shou-Jie Huang ; Zi-Zheng Zheng ; Ning-Shao Xia National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiangan South Road, Xiamen, Fujian, 361102, China
| | - Ning-Shao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China,NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, School of Public Health, Xiamen University, Xiamen, PR People’s Republic of China,School of Life Sciences, Xiamen University, Xiamen, PR People’s Republic of China, Shou-Jie Huang ; Zi-Zheng Zheng ; Ning-Shao Xia National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiangan South Road, Xiamen, Fujian, 361102, China
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Belei O, Ancusa O, Mara A, Olariu L, Amaricai E, Folescu R, Zamfir CL, Gurgus D, Motoc AG, Stânga LC, Strat L, Marginean O. Current Paradigm of Hepatitis E Virus Among Pediatric and Adult Patients. Front Pediatr 2021; 9:721918. [PMID: 34660485 PMCID: PMC8515027 DOI: 10.3389/fped.2021.721918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 12/26/2022] Open
Abstract
Hepatitis E virus (HEV) infection is a polymorphic condition, present throughout the world and involving children and adults. Multiple studies over the last decade have contributed to a better understanding of the natural evolution of this infection in various population groups, several reservoirs and transmission routes being identified. To date, acute or chronic HEV-induced hepatitis has in some cases remained underdiagnosed due to the lower accuracy of serological tests and due to the evolutionary possibility with extrahepatic manifestations. Implementation of diagnostic tests based on nucleic acid analysis has increased the detection rate of this disease. The epidemiological and clinical features of HEV hepatitis differ depending on the geographical areas studied. HEV infection is usually a self-limiting condition in immunocompetent patients, but in certain categories of vulnerable patients it can induce a sudden evolution toward acute liver failure (pregnant women) or chronicity (immunosuppressed patients, post-transplant, hematological, or malignant diseases). In acute HEV infections in most cases supportive treatment is sufficient. In patients who develop chronic hepatitis with HEV, dose reduction of immunosuppressive medication should be the first therapeutic step, especially in patients with transplant. In case of unfavorable response, the initiation of antiviral therapy is recommended. In this review, the authors summarized the essential published data related to the epidemiological, clinical, paraclinical, and therapeutic aspects of HEV infection in adult and pediatric patients.
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Affiliation(s)
- Oana Belei
- First Pediatric Clinic, Disturbance of Growth and Development on Children Research Center, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Oana Ancusa
- Fifth Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Adelina Mara
- Department of Internal Medicine, Emergency City Hospital, Timisoara, Romania
| | - Laura Olariu
- First Pediatric Clinic, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Elena Amaricai
- Department of Rehabilitation Physical Medicine and Rheumatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Roxana Folescu
- Department of Balneology, Medical Recovery and Rheumatology, Family Discipline, Center for Preventive Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Carmen Lacramioara Zamfir
- Department of Morpho-Functional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Daniela Gurgus
- Department of Balneology, Medical Recovery and Rheumatology, Family Discipline, Center for Preventive Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrei G Motoc
- Department of Anatomy and Embriology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Livia Claudia Stânga
- Department of Microbiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Liliana Strat
- Department of Mother and Child Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Otilia Marginean
- First Pediatric Clinic, Disturbance of Growth and Development on Children Research Center, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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Phylogenetic analysis and epidemiological history of Hepatitis E virus 3f and 3c in swine and wild boar, Italy. Heliyon 2020; 6:e05110. [PMID: 33088938 PMCID: PMC7567929 DOI: 10.1016/j.heliyon.2020.e05110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/11/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022] Open
Abstract
Background Hepatitis E virus (HEV) genotype 3 has a worldwide distribution. The food-borne transmission of HEV associated with the consumption of products derived from domestic pig, wild boar has been reported in various countries. In this study the genetic diversity, evolutionary rates of HEV 3f, 3c among swine and wild boar in Italy were estimated. Methods Sampling was performed on a wild boar population living in an area located in Abruzzo region. The HEV RNA amplification was performed by real-time RT-PCR. Nested RT-PCR and sequencing of the ORF2 region were carried out by the Super Script III First-Strand Synthesis System. Sequencing of purified PCR products was carried out by the Genome Lab Dye Terminator Cycle Sequencing (DTCS) Quick Start Kit. The maximum likelihood trees were generated by using Phyml. The mean evolutionary rates and the dated trees were co-estimated by BEAST. Results The phylogenetic analysis showed that the HEV ORF2 isolates from Abruzzo region belonged to 3f subtype. The prevalent subtypes in Italy were those belonging to 3f and 3c. The estimated mean values of the HEV ORF2 capsid gene evolutionary rates were 1.915 × 10−2 substitutions/site/year (95% HPD: 1.64 × 10−3 – 3.97 × 10−2) and 2.81 × 10−2 substitutions/site/year (1.83 × 10−2 - 3.8 × 10−2) for 3f and 3c subtype datasets, respectively. The HEV 3f dated back to 1985 (1960–2000), whereas the 3c subtype entered in Italy during the year 2006 (2005–2006). The majority of the HEV 3f sequences collected from swine didn't appear intermixed, except in two cases. The HEV 3c population circulating in Italy remained segregated without significant transfer to swine. Conclusion Our study provide insight into the evolution, circulation of HEV 3f and 3c in Italy. Continued genomic surveillance of HEV in animal reservoir, as well as improving sanitary control measures are required.
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Zaki MES, Alsayed MAL, Abbas HRR, Ahmed DM, Ashry AYE. Prevalence of hepatitis E virus in children with acute hepatitis: one Egyptian center study. Germs 2020; 10:88-94. [PMID: 32656105 PMCID: PMC7330519 DOI: 10.18683/germs.2020.1189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The objective of the present study was to evaluate the prevalence of hepatitis E virus in acute hepatitis in pediatric patients. METHODS This was a cross-sectional study including 180 children with acute hepatitis. Blood samples were obtained and subjected to study the serological markers of hepatitis B surface antigen (HBsAg), hepatitis B core IgM (HBc IgM), hepatitis C IgG (HCV IgG) and hepatitis A IgM (HAV IgM), hepatitis E IgM and IgG, cytomegalovirus IgM (CMV IgM) and specific antibodies IgM for Epstein Barr virus by ELISA. Also ELISA attempted the laboratory diagnosis of autoantibodies by performing assay of antinuclear and anti-smooth muscle antibodies. Real time PCR was used for determination of HEV-RNA in samples positive for HEV serological markers. RESULTS From a total of 180 children with acute jaundice 69.4% were males and 39.6% were females with mean age ± standard deviation 5.8±3.5 years. Positive HEV markers were found in 47 patients (26.1%). A comparison between demographic, clinical and laboratory findings in children with positive HEV markers and children negative for HEV markers, revealed significant association with contact of animals (p=0.001), rural residence (p=0.001), presence of positive autoantibodies (p=0.001) and positive HAV IgM (p=0.001). The markers of hepatitis E virus showed significantly higher prevalence in children below age of 6 years (p=0.04). CONCLUSIONS HEV infection is more common in preschool age. There is a significant association between contact with animals, rural residence and other hepatitis affection like autoimmune hepatitis and other viral hepatitis viruses such as hepatitis A.
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Affiliation(s)
- Maysaa El Sayed Zaki
- MD, Clinical Pathology Department, Faculty of Medicine, Mansoura University, El Gomhoria street, Mansoura, Egypt
| | - Mona Abdel Latif Alsayed
- MD, Pediatric Medicine Department, Faculty of Medicine, Mansoura University, El Gomhoria Street, Mansoura, Egypt
| | - Hoda Ramadan Ryad Abbas
- Titles?, Medical Biochemistry Department, Faculty of Medicine, Beni-Suef University, Mohamed Hassan Street, Beni-Suef, Egypt
| | - Doaa Mabrouk Ahmed
- MD, Medical Microbiology and Immunology Department, Faculty of Medicine, Beni-Suef University, Mohamed Hassan Street, Beni-Suef, 6251, Egypt
| | - Amany Yusif El Ashry
- MD, Clinical Pathology Department, Faculty of Medicine, Mansoura University, El Gomhoria street, Mansoura, Egypt
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Tarantino G, Ortolani A, Marinelli K, Benedetti A, Marconi G, Calzolari M, Dalton HR, Marzioni M, Schiadà L, Fava G, Chiodera A, Amadio G, Fiorentini A, Riva A, Fraticelli P, Menzo S, Bagnarelli P. Locally acquired hepatitis E virus in Marche Italy: Clinical/laboratory features and outcome. Dig Liver Dis 2020; 52:434-439. [PMID: 31874836 DOI: 10.1016/j.dld.2019.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/23/2019] [Accepted: 11/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Hepatitis E Virus is endemic in Europe with increasing numbers of cases in recent years, also in Italy where this phenomenon has hitherto been modest. The aim of this study was to document the clinical features/natural history of locally acquired hepatitis E in our territory and explore factors which determine adverse outcome. METHODS Retrospective study of patients with locally-acquired HEV (hepatitis E virus) in Marche, Italy (2011-2019). RESULTS 1189 patients were tested for HEV with 89 confirmed cases. 81 (6.8%) had locally acquired infection; 54 (66%) were male (mean age 55.5 years) and 32 (39.5%) had active co-morbidities. 41 cases were viraemic (all HEV-3 (HEV genotype 1,2,3,4)); acute infection was found in 79 and chronic infection in 2. Forty-five cases (55%) required admission to hospital, for a total of 785 days. 4 patients developed acute on-chronic liver failure, 6 developed acute kidney injury and 8 died: all had active comorbidities. Univariate analysis showed that bilirubin, INR, immunosuppression, cirrhosis and diabetes were associated with death. On multivariant analysis the only predictor of death was the presence of diabetes (p = 0.04). CONCLUSIONS Hepatitis E in Marche Italy is mostly locally acquired and caused by HEV-3 that impacts on the morbidity and mortality particularly for fragile patients.
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Affiliation(s)
- Giuseppe Tarantino
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy.
| | - Alessio Ortolani
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Katia Marinelli
- Department of Biomedical Sciences and Public Health, Virology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Antonio Benedetti
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Giulia Marconi
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Manuela Calzolari
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | | | - Marco Marzioni
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Laura Schiadà
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Giammarco Fava
- Department of Gastroenterology and Transplants, Clinic of Gastroenterology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | | | | | - Alessandro Fiorentini
- Units of Infective diseases Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Alessandra Riva
- Units of Infective diseases Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Paolo Fraticelli
- Department of Internal Medicine, Unit of Medical Clinic, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Stefano Menzo
- Department of Biomedical Sciences and Public Health, Virology, Hospital of Ancona, Università Politecnica delle Marche, Italy
| | - Patrizia Bagnarelli
- Department of Biomedical Sciences and Public Health, Virology, Hospital of Ancona, Università Politecnica delle Marche, Italy
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Bonardi S, Filipello V, Pavoni E, Carta V, Bolzoni L, Corradi M, Gilioli S, Losio MN. Geographical restriction of Hepatitis E virus circulation in wild boars ( Sus scrofa) in Emilia-Romagna region, Northern Italy. Ital J Food Saf 2020; 9:8463. [PMID: 32300568 PMCID: PMC7154598 DOI: 10.4081/ijfs.2020.8463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 12/03/2019] [Indexed: 12/04/2022] Open
Abstract
Hepatitis E virus (HEV) is a singlestrand RNA virus that causes an acute viral hepatitis in humans. Among its eight recognized genotypes, HEV-3 and HEV-4 are zoonotic, infecting humans, pigs and wild boars. Recently, HEV-3 has been also detected in red deer, which represents another reservoir of HEV. Consumption of raw pork products (mainly liver sausages), undercooked wild boar meat, raw wild boar liver and deer meat has been responsible for foodborne HEV human worldwide. From November 2018 to March 2019, liver samples collected from 97 wild boars hunted in Emilia-Romagna region (Northern Italy) were tested for HEV RNA. The hunting area included two territories for an extension of 33 km2, named A (about 13 km2,natural park, deciduous wood) and B (about 20 km2, cultivated fields in proximity of a river) areas. Distance between the two areas ranged between 8 to 10 km. A total of 73 wild boars were hunted in area A, and 24 in area B. HEV RNA was detected by Real-time RT- PCR in 23/73 liver samples of wild boars living in area A only (31.5% - 95% CI: 22.0-42.8%). The HEV sequences (n=13) clustered within genotype 3. The majority of positives belonged to animals < 12 months (12/25; 48%), followed by subadults (13-24 months) (7/16; 43.8%) and adults (4/32; 12.5%). This difference was found to be statistically significant (p=0.0024). In absence of pig farms, the restriction of HEV-positive animals to a well-defined territory of 13 km2 (Boschi di Carrega Regional Park) could hypothetically be related to the presence of red deer (Cervus elaphus), which lived in area A at the beginning of the hunting season. Further studies are needed to confirm or deny our hypothesis.
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Affiliation(s)
- Silvia Bonardi
- Department of Veterinary Science, Unit of Food Inspection, University of Parma
| | - Virginia Filipello
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna (IZSLER), Section of Brescia
| | - Enrico Pavoni
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna (IZSLER), Section of Brescia
| | - Valentina Carta
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna (IZSLER), Section of Brescia
| | - Luca Bolzoni
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna (IZSLER), Risk Analysis and Genomic Epidemiology Unit, Parma
| | - Margherita Corradi
- Management Body for Parks and Biodiversity “Emilia Occidentale”, Sala Baganza, Italy
| | - Stefano Gilioli
- Management Body for Parks and Biodiversity “Emilia Occidentale”, Sala Baganza, Italy
| | - Marina Nadia Losio
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna (IZSLER), Section of Brescia
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De Sabato L, Di Bartolo I, Lapa D, Capobianchi MR, Garbuglia AR. Molecular Characterization of HEV Genotype 3 in Italy at Human/Animal Interface. Front Microbiol 2020; 11:137. [PMID: 32117156 PMCID: PMC7014918 DOI: 10.3389/fmicb.2020.00137] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022] Open
Abstract
Hepatitis E virus (HEV) is an emerging public health issue in industrialized countries. In the last decade the number of autochthonous human infections has increased in Europe. Genotype 3 (HEV-3) is typically zoonotic, being foodborne the main route of transmission to humans, and is the most frequently detected in Europe in both humans and animals (mainly pigs and wild boars). In Italy, the first autochthonous human case was reported in 1999; since then, HEV-3 has been widely detected in both humans and animals. Despite the zoonotic characteristic of HEV-3 is well established, the correlation between animal and human strains has been poorly investigated in Italy. In the present study, we compared the subtype distribution of HEV-3 in humans and animals (swine and wild boar) in the period 2000-2018 from Italy. The dataset for this analysis included a total of 96 Italian ORF2 sequences (300 nt long), including both NCBI database-derived (n = 64) and recent sequences (2016-2018, n = 32) obtained in this study. The results show that subtype 3f is the most frequent in humans and pigs, followed by the HEV-3e, HEV-3c and other unassignable HEV-3 strains. Diversely, in wild boar a wider group of HEV-3 subtypes have been detected, including HEV-3a, which has also been detected for the first time in a human patient in Central Italy in 2017, and a wide group of unassignable HEV-3 strains. The phylogenetic analysis including, besides Italian strains, also sequences from other countries retrieved from the NCBI database, indicated that human Italian sequences, in particular those of HEV-3f and HEV-3e, form significant clusters mainly with sequences of animal origin from the same country. Nevertheless, for HEV-3c, rarely detected in Italian pigs, human sequences from Italy are more correlated to human sequences from other European countries. Furthermore, clusters of near-identical human strains identified in a short time interval in Lazio Region (Central Italy) can be recognized in the phylogenetic tree, suggesting that multiple infections originating from a common source have occurred, and confirming the importance of sequencing support to HEV surveillance.
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Affiliation(s)
- Luca De Sabato
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Di Bartolo
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Lapa
- Laboratory of Virology, “L. Spallanzani” National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, “L. Spallanzani” National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, “L. Spallanzani” National Institute for Infectious Diseases, IRCCS, Rome, Italy
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Di Profio F, Melegari I, Palombieri A, Sarchese V, Arbuatti A, Fruci P, Marsilio F, Martella V, Di Martino B. High prevalence of hepatitis E virus in raw sewage in Southern Italy. Virus Res 2019; 272:197710. [PMID: 31415790 DOI: 10.1016/j.virusres.2019.197710] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 12/27/2022]
Abstract
Hepatitis E virus (HEV) infections constitute a significant health problem worldwide. The burden of hepatitis E in Italy seems low when compared with other European countries. In recent years, improved surveillance activities in Italy have revealed marked geographical differences in HEV epidemiology, with some regions characterised by higher seroprevalence rates. Abruzzo Region (Southern Italy) is currently recognised as a high-risk area for HEV infection. In this study, we investigated the epidemiology of HEV in Teramo Province by monitoring four wastewater treatment plants (WWTPs). Out of 56 influent sewage specimens collected during 2016-2017, HEV RNA was detected in 13/56 (23.2%) sewage samples from all the four WWTPs. Upon sequence analysis of the partial ORF2 gene, four strains showed the highest nucleotide identity to Gt3 subtype c, being more closely related to other HEVs previously identified in human and animal hosts in Abruzzo. For one strain, sequence data were generated only for a short region of the ORF1 gene, revealing the highest identity to HEVs Gt3 of subtype f. Altogether, the findings of this study confirm that HEV largely circulates in the setting investigated.
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Affiliation(s)
| | - Irene Melegari
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, Italy
| | - Andrea Palombieri
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, Italy
| | - Vittorio Sarchese
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, Italy
| | - Alessio Arbuatti
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, Italy
| | - Paola Fruci
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, Italy
| | - Fulvio Marsilio
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, Italy
| | - Vito Martella
- Department of Veterinary Medicine, Università Aldo Moro di Bari, Valenzano, Italy
| | - Barbara Di Martino
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, Italy.
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Abdelmawla D, Moemen D, Darwish A, Mowafy W. Hepatitis E virus prevalence in Egyptian children with transfusion-dependent thalassemia. Braz J Infect Dis 2019; 23:40-44. [PMID: 30826379 PMCID: PMC9427812 DOI: 10.1016/j.bjid.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/22/2018] [Accepted: 01/03/2019] [Indexed: 11/23/2022] Open
Abstract
Hepatitis E virus (HEV) infection is one of the major public health problems in developing countries. HEV can cause chronic infections in immunocompromised individuals e.g. thalassemic patients with increased risk of morbidity and mortality. In addition there is possibility of HEV transmission through blood transfusion. Therefore, the present study aimed to investigate the seroprevalence and risk factors of HEV infection in β-thalassemic children. Methods This cross-sectional study was conducted on 140 Egyptian children suffering from β-thalassemia, attending the hematology outpatient clinic from April to October 2016. Serum samples from patients were collected and anti-HEV antibodies; Immunoglobulin G (IgG) and Immunoglobulin M (IgM) were measured by enzyme-linked immunosorbent assay (ELISA). Results The seroprevalence of HEV in β-thalassemic chidren was relatively high (27.15%). Anti-HEV IgG prevalence was 24.29% while that of IgM was 2.86%. There was significant association between HEV infection and age, residence, liver enzymes and amount of blood transfusion per year. Conclusions Thalasemic patients are vulnerable to chronicity and increased risk of morbidity and mortality from HEV infection. Frequent assessment of liver enzymes in thalassemic patients to monitor subclinical HEV is recommended. Close monitoring and HEV screening of blood donations should be taken in consideration. Public awareness about HEV endemicity, modes of transmission, and risk hazards especially in high risk group should be done to reduce the disease burden.
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Affiliation(s)
- Doaa Abdelmawla
- Mansoura University, Faculty of Medicine, Department of Medical Microbiology and Immunology, Mansoura, Egypt
| | - Dalia Moemen
- Mansoura University, Faculty of Medicine, Department of Medical Microbiology and Immunology, Mansoura, Egypt.
| | - Ahmad Darwish
- Mansoura University, Faculty of Medicine, Department of Pediatrics, Mansoura, Egypt
| | - Wafaa Mowafy
- Mansoura University, Faculty of Medicine, Department of Medical Microbiology and Immunology, Mansoura, Egypt
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10
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Seroprevalence of hepatitis E virus among blood donors in northern Italy (Sondrio, Lombardy) determined by three different assays. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 15:502-505. [PMID: 29059041 DOI: 10.2450/2017.0089-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/20/2017] [Indexed: 02/08/2023]
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11
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Weigand K, Weigand K, Schemmerer M, Müller M, Wenzel JJ. Hepatitis E Seroprevalence and Genotyping in a Cohort of Wild Boars in Southern Germany and Eastern Alsace. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:167-175. [PMID: 29214558 DOI: 10.1007/s12560-017-9329-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/01/2017] [Indexed: 06/07/2023]
Abstract
In the last few years it has been realized that the hepatitis E virus (HEV) is endemic in most industrialized countries and that it is a zoonotic disease. Potential reservoirs for HEV have been identified to be wild boars and deers, but HEV has also been found in domestic pigs and other animals. Due to the probable spread of the virus via contaminated food or contact to infected animals, HEV antibodies are present in more than 16% of the German adult population and rates are increasing with age. We collected blood from 104 wild boars in southern Germany and the border region of Alsace. We found an anti-HEV seroprevalence of 11.5% in our cohort, using ELISA. Furthermore, we observed active infection in 3.85% of the animals by positive HEV PCR in the sera of the boars. In our cohort, no regional differences of seroprevalence or active infection were seen. Sequencing revealed rather close homology of some detected HEV sequences to genotypes isolated from patients in Germany. Hence wild boars are a potential source of HEV infection in Middle Europe and the rate of infectious animals is quite high.
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Affiliation(s)
- Kilian Weigand
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Kurt Weigand
- Department of Internal Medicine, Stauferklinikum Schwaebisch Gmuend, Mutlangen, Germany
| | - Mathias Schemmerer
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Juergen J Wenzel
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
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12
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Obaidat MM, Roess AA. Seroprevalence and risk factors of Hepatitis E infection in Jordan’s population: First report. Int J Infect Dis 2018; 66:121-125. [DOI: 10.1016/j.ijid.2017.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 12/16/2022] Open
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Mauceri C, Grazia Clemente M, Castiglia P, Antonucci R, Schwarz KB. Hepatitis E in Italy: A silent presence. J Infect Public Health 2017; 11:1-8. [PMID: 28864359 DOI: 10.1016/j.jiph.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/03/2017] [Accepted: 08/04/2017] [Indexed: 01/18/2023] Open
Abstract
Hepatitis E virus (HEV) was discovered in the 1980s and has been considered as being confined to developing countries. The purpose of this critical review was to determine the reported HEV seroprevalence rates in Italy, to identify predisposing factors and individuals at risk and to assess possible importation of HEV by immigrants. A critical review of 159 articles published in PubMed from 1994 to date was done. Only 27 original reports of 50 or more subjects, written in the English or Italian language, were included. Over three decades, the HEV seroprevalence varied from 0.12% to 49%, with the highest rates being reported from the central region of Italy. Risk factors included ingestion of raw pork or potentially contaminated food. The seroprevalence among immigrants ranged from 15.3% to 19.7% in Apulia. Italy has a population of 60656000; the total number of individuals surveyed was only 21.882 (0.036%). A national epidemiological survey program is needed to capture more comprehensive seroprevalence data.
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Affiliation(s)
- Carlo Mauceri
- Pediatric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari Medical School, 07100 Sassari, Italy.
| | - Maria Grazia Clemente
- Pediatric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari Medical School, 07100 Sassari, Italy.
| | - Paolo Castiglia
- Department of Biomedical Sciences-Hygiene and Preventive Medicine Unit, University-AOU of Sassari, 07100 Sassari, Italy.
| | - Roberto Antonucci
- Pediatric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari Medical School, 07100 Sassari, Italy.
| | - Kathleen B Schwarz
- Pediatric Liver Center, Johns Hopkins University School of Medicine, Baltimore 21287, MD, USA.
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La Rosa G, Della Libera S, Brambilla M, Bisaglia C, Pisani G, Ciccaglione AR, Bruni R, Taffon S, Equestre M, Iaconelli M. Hepatitis E Virus (Genotype 3) in Slurry Samples from Swine Farming Activities in Italy. FOOD AND ENVIRONMENTAL VIROLOGY 2017; 9:219-229. [PMID: 27853931 DOI: 10.1007/s12560-016-9270-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
Hepatitis E virus (HEV) is an emergent causative agent of acute hepatitis, transmitted by fecal-oral route. Infection with HEV is a global cause for morbidity and mortality throughout the world: it mainly causes large outbreaks in endemic areas and sporadic autochthonous cases in industrialized countries where HEV infections seem to be an emergent zoonotic disease. Infection of porcine livestock and its relationship with the human cases have been demonstrated. The present study describes an investigation on the prevalence and diversity of HEV in pig slurry in Italy. Slurry samples (24) were collected from ten farms located in North Italy during 2015 and analyzed for HEV, using four broad-range nested PCR assays targeting ORF1 (MTase), ORF2 (capsid) genes, and ORF2/3 regions. Overall, 18 samples (75%) were positive for HEV RNA, and characterized as genotype 3. Nine samples could be subtyped by ORF2 sequencing: Eight belonged to subtype 3f, while one sequence could not be characterized by blast analysis and phylogenetic analysis and may actually represent a new subtype. Furthermore, similarity of 99% was found between 3f Italian HEV sequences of human and swine origins. Real-Time PCR assay was also performed, in order to obtain quantitative data on positive samples. Two swine slurry samples were positive, containing 600 and 1000 UI per mL of sewage. The results of this study show that HEV strains belonging to zoonotic genotype 3 are widely present in swine excreta, and have high degree of identity with strains detected in autochthonous HEV cases. Improving swine farming operations safety and increasing operators' awareness of the zoonotic potential connected with the handling of swine effluents turn out to be key points in order to reduce the environmental and sanitary problem represented by the possible dissemination of HEV to water bodies.
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Affiliation(s)
- G La Rosa
- Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - S Della Libera
- Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - M Brambilla
- Laboratorio di Treviglio, Consiglio per la Ricerca in Agricoltura e l'analisi dell'Economia Agraria (CREA), Unità di Ricerca per l'Ingegneria Agraria (CREA-ING), Treviglio, BG, Italy
| | - C Bisaglia
- Laboratorio di Treviglio, Consiglio per la Ricerca in Agricoltura e l'analisi dell'Economia Agraria (CREA), Unità di Ricerca per l'Ingegneria Agraria (CREA-ING), Treviglio, BG, Italy
| | - G Pisani
- National Center for Immunobiologicals Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - A R Ciccaglione
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - R Bruni
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - S Taffon
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M Equestre
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - M Iaconelli
- Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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Bradanini L, Youkee D, Fabris P, Romanò L, Brunetti E, Giordani MT. Acute hepatitis E virus infection in a migrant population in North East Italy: A retrospective analysis. Travel Med Infect Dis 2017; 20:37-42. [PMID: 28411095 DOI: 10.1016/j.tmaid.2017.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To study the epidemiological and clinical features of Hepatitis E Virus (HEV) infection in a migrant population. METHODS We performed a retrospective chart review, identifying a cohort of 21 symptomatic patients of migrant origin with confirmed HEV infection admitted in the period between January 1995-November 2014. RESULTS 20 (95%) patients came from South Asian countries highly endemic for HEV, all positive for HEV genotype 1. Recent travel to a highly endemic country was the most consistent risk factor identified in 90% of cases, duration from return to Italy to hospitalization ranged from 10 to 120 days. Nausea and vomiting (100%), jaundice (95.2%), and anorexia (85.7%) were the most common reported symptoms. Fever was present in 57.1% of cases. Transaminase values were elevated in all patients and serum bilirubin was raised in 86% of patients. We found no statistically significant differences between clinical symptoms, laboratory results or duration of hospitalization in patients with co-morbidities compared to those without. We also report a secondary case of HEV genotype 1 transmitted within Italy. CONCLUSION Our study highlights the epidemiological risk factors and clinical features of HEV infection in a migrant population in Italy and should stimulate further research regarding the prevalence and morbidity of HEV within migrant populations in Europe.
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Affiliation(s)
- Lucia Bradanini
- Infectious and Tropical Diseases Unit, San Bortolo Hospital, Vicenza, Italy
| | - Daniel Youkee
- King's Centre for Global Health, King's College London, London, UK.
| | - Paolo Fabris
- Infectious and Tropical Diseases Unit, San Bortolo Hospital, Vicenza, Italy
| | - Luisa Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Enrico Brunetti
- Department of Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy
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16
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Zuin M, Caserta C, Romanò L, Mele A, Zanetti A, Cannatelli R, Giorgini A, Tagliacarne C, Amante A, Marcucci F, Battezzati PM. Seroepidemiology of HEV and HAV in two populations with different socio-economic levels and hygienic/sanitary conditions. Eur J Clin Microbiol Infect Dis 2016; 36:479-485. [PMID: 27785638 DOI: 10.1007/s10096-016-2821-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/16/2016] [Indexed: 01/18/2023]
Abstract
The epidemiological scenarios of hepatitis E virus (HEV) and hepatitis A virus (HAV) infections have changed in the last few decades, but precise epidemiological data on the prevalence of anti-HEV and anti-HAV, alone or in combination, in the general population are scanty. We investigated HEV and HAV seroprevalence comparing two population samples living in Northern (Abbiategrasso, Milan) and Southern Italy (Cittanova, Reggio Calabria), the latter being characterized by a poorer socio-economic level and hygienic/sanitary conditions. Based on census records, we randomly enrolled and tested 3,365 subjects (Abbiategrasso, n = 2,489; Cittanova, n = 876) aged 18-75 years for anti-HAV and anti-HEV. Anti-HAV (71.3 % vs 52.5 %) and anti-HEV (17.8 % vs 9.0 %) prevalence rates were higher in Southern Italy (both p < 0.001). Most anti-HEV-positive subjects also had anti-HAV. Subjects testing positive for anti-HAV, alone or with anti-HEV, were older (p < 0.001 in both populations) and showed a trend toward declining prevalence in the youngest birth cohorts. The prevalence of subjects with a positive result for anti-HEV alone did not change in birth cohorts in the two towns. Detection of anti-HEV was independently associated with anti-HAV, town, birth cohort, and education level in multivariate analysis. Low socio-economic level and hygienic/sanitary conditions are associated with high HAV and HEV seroprevalence rates in Italy. Recent improvements, especially in the South, have led to a declining prevalence of anti-HAV, alone or with anti-HEV. Seroprevalence of HEV alone is uniformly low and does not change in birth cohorts born between 1938 and 1993.
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Affiliation(s)
- M Zuin
- Division of Internal Medicine and Liver Unit, Department of Health Sciences, School of Medicine Ospedale San Paolo, Università degli Studi di Milano, via di Rudinì, 8, 20143, Milan, Italy
| | - C Caserta
- Calabria Association of Hepatology, Reggio Calabria, Italy
| | - L Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Mele
- Calabria Association of Hepatology, Reggio Calabria, Italy
| | - A Zanetti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - R Cannatelli
- Division of Internal Medicine and Liver Unit, Department of Health Sciences, School of Medicine Ospedale San Paolo, Università degli Studi di Milano, via di Rudinì, 8, 20143, Milan, Italy
| | - A Giorgini
- Azienda Socio-sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - C Tagliacarne
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Amante
- Calabria Association of Hepatology, Reggio Calabria, Italy
| | - F Marcucci
- Calabria Association of Hepatology, Reggio Calabria, Italy.,Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - P M Battezzati
- Division of Internal Medicine and Liver Unit, Department of Health Sciences, School of Medicine Ospedale San Paolo, Università degli Studi di Milano, via di Rudinì, 8, 20143, Milan, Italy.
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17
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Freitas NRD, Santana EBRD, Silva ÁMDCE, Silva SMD, Teles SA, Gardinali NR, Pinto MA, Martins RMB. Hepatitis E virus infection in patients with acute non-A, non-B, non-C hepatitis in Central Brazil. Mem Inst Oswaldo Cruz 2016; 111:692-696. [PMID: 27759769 PMCID: PMC5125053 DOI: 10.1590/0074-02760160256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/08/2016] [Indexed: 12/17/2022] Open
Abstract
Hepatitis E virus (HEV) infection has a worldwide distribution and represents an
important cause of acute hepatitis. This study aims to investigate the occurrence of
HEV infection and factors associated with this infection in patients with acute
non-A, non-B, non-C hepatitis in Central Brazil. From April 2012 to October 2014, a
cross-sectional study was conducted among 379 patients with acute non-A, non-B, non-C
hepatitis in the City of Goiania, Central Brazil. Serum samples of all patients were
tested for serological markers of HEV infection (anti-HEV IgM and IgG) by ELISA.
Positive samples were confirmed using immunoblot test. Anti-HEV IgM and IgG positive
samples were tested for HEV RNA. Of the 379 serum samples, one (0.3%) and 20 (5.3%)
were positive for anti-HEV IgM and IgG, respectively. HEV RNA was not found in any
sample positive for IgM and/or IgG anti-HEV. After multivariate analysis, low
education level was independently associated with HEV seropositivity (p = 0.005), as
well as living in rural area, with a borderline p-value (p = 0.056). In conclusion,
HEV may be responsible for sporadic self-limited cases of acute hepatitis in Central
Brazil.
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Affiliation(s)
- Nara Rubia de Freitas
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
| | | | | | - Sueli Meira da Silva
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
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Hasan G, Assiri A, Marzuuk N, Daef E, Abdelwahab S, Ahmed A, Mohamad I, Al-Eyadhy A, Alhaboob A, Temsah MH. Incidence and characteristics of hepatitis E virus infection in children in Assiut, Upper Egypt. J Int Med Res 2016; 44:1115-1122. [PMID: 27688687 PMCID: PMC5536550 DOI: 10.1177/0300060516659575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/22/2016] [Indexed: 02/05/2023] Open
Abstract
Objective To describe the characteristics of hepatitis E virus (HEV) infection in a cohort of children from Upper Egypt using data from a large multicentre prospective study of acute viral hepatitis (AVH). Methods Data from subjects aged 2-18 years with AVH or close contacts of those with AVH found to have asymptomatic AVH were included in the analysis. Information concerning medical history, clinical examination, liver function tests and screening for hepatotropic viruses was recorded and analysed. Results A total of 123 patients (73 boys, 50 girls) were included in the analysis. Of these, 33 (26.8%) had HEV infection, 17 (13.8%) had hepatitis A virus infection, 10 (8.1%) had hepatitis B virus infection, 14 (11.4%) had cytomegalovirus hepatitis, five (4.1%) had autoimmune hepatitis, 11 (8.9%) had hepatitis due to mixed viral infections and 33 (26.8%) had non A-E hepatitis. Overall, 38 (30.9%) had infection with HEV. HEV infection was significantly higher among those using underground wells as a water source compared with tap water. Liver enzymes were significantly raised in patients with non-HEV infection compared with those with HEV infection. Conclusions HEV is a significant cause of AVH among children in Upper Egypt. Contamination of drinking water appears to be a major source of infection. Screening for HEV should be considered in all Egyptian children with AVH.
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Affiliation(s)
- Gamal Hasan
- Department of Paediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Paediatrics, King Khaled University Hospital and College of Medicine, King Saud University, Saudi Arabia
| | - Asaad Assiri
- Prince Abdullah Bin Khaled Coeliac Disease Research Chair, Department of Paediatrics, King Khaled University Hospital and College of Medicine, King Saud University, Saudi Arabia
| | - Naglaa Marzuuk
- Department of Gastroenterology and Hepatology, Assiut Police Hospital, Assiut, Egypt
| | - Enas Daef
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sayed Abdelwahab
- Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Ahmed
- Department of Paediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ismail Mohamad
- Department of Paediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayman Al-Eyadhy
- Department of Paediatrics, King Khaled University Hospital and College of Medicine, King Saud University, Saudi Arabia
| | - Ali Alhaboob
- Department of Paediatrics, King Khaled University Hospital and College of Medicine, King Saud University, Saudi Arabia
| | - Mohamad-Hani Temsah
- Department of Paediatrics, King Khaled University Hospital and College of Medicine, King Saud University, Saudi Arabia
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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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20
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Caruso C, Peletto S, Rosamilia A, Modesto P, Chiavacci L, Sona B, Balsamelli F, Ghisetti V, Acutis PL, Pezzoni G, Brocchi E, Vitale N, Masoero L. Hepatitis E Virus: A Cross-Sectional Serological and Virological Study in Pigs and Humans at Zoonotic Risk within a High-Density Pig Farming Area. Transbound Emerg Dis 2016; 64:1443-1453. [PMID: 27380833 DOI: 10.1111/tbed.12533] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Indexed: 01/01/2023]
Abstract
An increase in autochthonous hepatitis E virus (HEV) infections has been recorded in Italy suspected to be zoonotically transmitted from pigs; this study was carried out to determinate the seroprevalence and risk factors associated with hepatitis HEV exposition, both in swine and humans working in pig farms, located within a high-density pig farming area in Piedmont region, north-western Italy. The presence of viral RNA in human and swine samples was also evaluated, and phylogenetic analysis was performed on HEV-positive samples. Forty-two swine farms were sampled; 142 workers were enrolled in the study and classified into two groups: (i) 69 workers with occupational contact with swine (including veterinarians and farmers) recruited in the 42 sampled farms; (ii) 73 without occupational contact with swine. Forty-one of 42 (97%) swine farms resulted positive to enzyme-linked immunosorbent assay test for HEV antibodies (Abs). Overall seroprevalence in swine was 50% (441/879), with seropositivity rate higher in sows (333/469, 71%). HEV RNA in stool samples was detected in animals from 13 of 42 tested farms (31%), and a higher positivity resulted in weaners (40/246, 16.3%). Phylogenetic analysis classified all HEV isolates within genotype 3 (subtypes 3f, 3e, 3c). All humans were negative for HEV viral genome in blood. Five of 142 sera were positive for IgG anti-HEV with an overall prevalence of 3.52% with no statistically significant differences in prevalence rates between workers at zoonotic risk and the control group (5.7% versus 1.3%). In contrast, a significant difference (OR 10.1) was observed within the subgroup including subjects exposed for short periods (veterinarians) compared with those who worked for long periods (farmers) suggesting a correlation between the time of exposure and the likelihood of HEV infection. Reporting HEV infection is not mandatory in Italy, but a constant epidemiological surveillance should be ensured to clarify the epidemiology of this disease.
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Affiliation(s)
- C Caruso
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valled' Aosta, Turin, Italy
| | - S Peletto
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valled' Aosta, Turin, Italy
| | | | - P Modesto
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valled' Aosta, Turin, Italy
| | - L Chiavacci
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valled' Aosta, Turin, Italy
| | - B Sona
- Azienda Sanitaria Locale CN1, Cuneo, Italy
| | - F Balsamelli
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valled' Aosta, Turin, Italy
| | - V Ghisetti
- Ospedale Amedeo di Savoia, Università di Torino, Turin, Italy
| | - P L Acutis
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valled' Aosta, Turin, Italy
| | - G Pezzoni
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Brescia, Italy
| | - E Brocchi
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Brescia, Italy
| | - N Vitale
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valled' Aosta, Turin, Italy
| | - L Masoero
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valled' Aosta, Turin, Italy
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Erez-Granat O, Lachish T, Daudi N, Shouval D, Schwartz E. Hepatitis E in Israel: A nation-wide retrospective study. World J Gastroenterol 2016; 22:5568-5577. [PMID: 27350735 PMCID: PMC4917617 DOI: 10.3748/wjg.v22.i24.5568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/11/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the epidemiology, risk factors and clinical course of acute hepatitis E virus (HEV) infection in Israel, an industrialized country.
METHODS: A retrospective analysis of acute HEV cases diagnosed in Israel from 1993 to 2013. Acute HEV was defined by ALT/AST elevation and a positive HEV PCR test or positive anti-HEV-IgM serology. HEV RNA was tested by quantitative reverse transcription PCR. Antibodies to HEV were tested retrospectively using an ELISA assay. HEV-RNA was sequenced using RT-PCR of ORF1 and ORF2 regions to diagnose genotype of the virus. Epidemiologic and clinical data were collected by reviewing the clinical files and through a telephone interview according to a structured questionnaire.
RESULTS: Acute HEV was diagnosed in 68 patients. Among the 59 patients who gave an informed consent and were interviewed, 41% of infections were autochthonous (acquired in Israel), 44% travel-related and 15% imported by foreign workers. Autochthonous patients were mainly females (62.5%), more than half of them pregnant, 26% recalled consuming food or water in areas with poor sanitation, 44% ate non-kosher meat. Fulminant hepatitis developed in 3 patients (5%), all of them were females, two of them with post-partum infection, all acquired the disease in Israel (autochthonous). Israeli travelers with imported infection were predominantly males (73%), acquired the disease in the Indian subcontinent (81%), with 100% reporting having consumed fresh vegetables and drinks with ice cubes abroad. Six patients’ sera were tested for genotype and revealed HEV genotype 1 (all cases acquired in the Indian subcontinent).
CONCLUSION: This is the first report which highlights the existence of hepatitis E as an autochthonous infection in Israel. Imported HEV originates mostly from the Indian subcontinent.
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Ram D, Manor Y, Gozlan Y, Schwartz E, Ben-Ari Z, Mendelson E, Mor O. Hepatitis E Virus Genotype 3 in Sewage and Genotype 1 in Acute Hepatitis Cases, Israel. Am J Trop Med Hyg 2016; 95:216-20. [PMID: 27246446 DOI: 10.4269/ajtmh.15-0925] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 03/06/2016] [Indexed: 01/13/2023] Open
Abstract
Hepatitis E virus (HEV) is an emerging infectious agent in developed countries. HEV genotypes 1 (G1) and 3 (G3) have been identified in environmental and clinical samples in Europe. In Israel, the overall prevalence of anti-HEV IgG antibodies was found to be 10.6%; however, reports of HEV infection are scarce. In this study, the presence of HEV in Israel was investigated using 169 sewage samples from 32 treatment facilities and 49 samples from acute hepatitis patients, all collected between 2013 and 2015. Fourteen sewage samples, from Haifa (11/18 samples), Tel Aviv (2/29 samples), and Beer Sheva (1/17 samples), regions with good sanitary conditions and middle-high socioeconomic populations, were HEV positive. Among the patient samples, 6.1% (3/49) were HEV positive, all returning travelers from India. Genotype analysis revealed G1 HEV in patients and G3 HEV sequences in sewage. Evidence that HEV could be establishing itself in our region may justify more active surveillance to monitor its spread.
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Affiliation(s)
- Daniela Ram
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Yossi Manor
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Gozlan
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Eli Schwartz
- Center for Geographic Medicine and Tropical Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ziv Ben-Ari
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Liver Diseases Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ella Mendelson
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Orna Mor
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel.
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Ricco G, Bonino F, Lanza M, Scatena F, Alfieri CM, Messa P, Marchisio E, Mascolo G, Romanò L, Galli C, Li TC, Wakita T, Miyamura T, Brunetto MR. New immunoassays for total, IgA and IgM antibodies against hepatitis E virus: Prevalence in Italian blood donors and patients with chronic liver or kidney diseases. Dig Liver Dis 2016; 48:536-541. [PMID: 26936342 DOI: 10.1016/j.dld.2016.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) is a zoonotic agent that causes acute hepatitis in humans with sporadic infections and outbreaks in developing countries worldwide. The global spread of HEV remains underestimated because of subclinical infections and lack of sensitive diagnostic assays. AIMS To study the prevalence of HEV antibodies (anti-HEV) in sera of blood-donors and patients with chronic-liver-disease and chronic-renal-disease, using newly developed anti-HEV assays. METHODS 396 sera from 199 blood-donors, 109 chronic-liver-disease patients and 88 chronic-renal-disease patients and three standard reference serum panels were tested in parallel with a sensitive reference anti-HEV assay and newly developed assays for IgA, IgM and total anti-HEV based on HEV-like-particles produced by recombinant baculo-viruses. RESULTS Overall, total anti-HEV was detected in 12.9% (7.0% blood-donors, 9.2% and 30.7% chronic-liver-disease patients and chronic-renal-disease patients, respectively). We observed a higher anti-HEV prevalence in older subjects and in chronic-renal-disease patients in relation with degree on immune-depression (p<0.001). Results from reference serum panels showed an optimal and slightly better performance of the new assay over the commercially available assay. CONCLUSIONS Newly developed anti-HEV assays using recombinant HEV-like-particles showed optimal diagnostic performances assessing that HEV-infection is endemic in Italy with seroprevalence ranging from 7% to 30% in blood donors and immune-compromised hosts, respectively.
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Affiliation(s)
- Gabriele Ricco
- Hepatology Unit, University Hospital of Pisa, Pisa, Italy
| | - Ferruccio Bonino
- General Medicine 2 Unit and Gastroenterology Chair, University Hospital of Pisa, Italy
| | - Maria Lanza
- Blood Bank Unit, University Hospital of Pisa, Italy
| | | | - Carlo M Alfieri
- Nephrology, Dialysis and Kidney Transplantation Unit, Foundation IRCCS "Cà Granda Ospedale Maggiore" Policlinic of Milan, Milan, Italy
| | - Piergiorgio Messa
- Nephrology, Dialysis and Kidney Transplantation Unit, Foundation IRCCS "Cà Granda Ospedale Maggiore" Policlinic of Milan, Milan, Italy
| | | | | | - Luisa Romanò
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Tian-Cheng Li
- Department of Virology II, National Institute of Infectious Diseases, Musashi-Murayama, Tokyo, Japan
| | - Takaji Wakita
- Department of Virology II, National Institute of Infectious Diseases, Musashi-Murayama, Tokyo, Japan
| | - Tatsuo Miyamura
- Department of Virology II, National Institute of Infectious Diseases, Musashi-Murayama, Tokyo, Japan
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Montesano C, Giovanetti M, Ciotti M, Cella E, Lo Presti A, Grifoni A, Zehender G, Angeletti S, Ciccozzi M. Hepatitis E Virus Circulation in Italy: Phylogenetic and Evolutionary Analysis. HEPATITIS MONTHLY 2016; 16:e31951. [PMID: 27226798 PMCID: PMC4875568 DOI: 10.5812/hepatmon.31951] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV), a major cause of acute viral hepatitis in developing countries, has been classified into four main genotypes and a number of subtypes. New genotypes have been recently identified in various mammals, including HEV genotype 3, which has a worldwide distribution. It is widespread among pigs in developed countries. OBJECTIVES This study investigated the genetic diversity of HEV among humans and swine in Italy. The date of origin and the demographic history of the HEV were also estimated. MATERIALS AND METHODS A total of 327 HEV sequences of swine and humans from Italy were downloaded from the national centre for biotechnology information. Three different data sets were constructed. The first and the second data set were used to confirm the genotype of the sequences analyzed. The third data set was used to estimate the mean evolutionary rate and to determine the time-scaled phylogeny and demographic history. RESULTS The Bayesian maximum clade credibility tree and the time of the most common recent ancestor estimates showed that the root of the tree dated back to the year 1907 (95% HPD: 1811 - 1975). Two main clades were found, divided into two subclades. Skyline plot analysis, performed separately for human and swine sequences, demonstrated the presence of a bottleneck only in the skyline plot from the swine sequences. Selective pressure analysis revealed only negatively selected sites. CONCLUSIONS This study provides support for the hypothesis that humans are probably infected after contact with swine sources. The findings emphasize the importance of checking the country of origin of swine and of improving sanitary control measures from the veterinary standpoint to prevent the spread of HEV infection in Italy.
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Affiliation(s)
- Carla Montesano
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Marta Giovanetti
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Marco Ciotti
- Laboratory of Molecular Virology, Polyclinic Tor Vergata Foundation, Rome, Italy
| | - Eleonora Cella
- Molecular Epidemiology and Microbial Evolution (FEMEM)/Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Institute Superiore di Sanita, Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Lo Presti
- Molecular Epidemiology and Microbial Evolution (FEMEM)/Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Institute Superiore di Sanita, Rome, Italy
| | | | - Gianguglielmo Zehender
- Laboratory of Infectious Diseases and Tropical Medicine, University of Milan, Milan, Italy
| | - Silvia Angeletti
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico, Rome, Italy
| | - Massimo Ciccozzi
- Molecular Epidemiology and Microbial Evolution (FEMEM)/Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Institute Superiore di Sanita, Rome, Italy
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico, Rome, Italy
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25
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Evaluation of rapid tests for diagnosis of acute hepatitis E. J Clin Virol 2016; 78:4-8. [PMID: 26930580 DOI: 10.1016/j.jcv.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/28/2016] [Accepted: 02/10/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hepatitis E virus diagnosis still presents difficulties due to discordant results among diagnostic tests. OBJECTIVES The aim of this study was to evaluate the performance of two rapid tests for detection of anti-HEV IgM antibodies. STUDY DESIGN The rapid tests were compared with three commercial anti-HEV ELISA assays and one Real-Time PCR assay on 59 sera from patients with acute viral non-AC hepatitis. RESULTS The presence of anti-HEV IgM antibodies was evaluated by two rapid tests (Wantai and Assure) on 25 HEV RNA positive samples. Anti-HEV IgM antibodies were detected in 24/25 and 23/25 samples respectively. The sensitivity and specificity of Wantai and Assure Rapid tests were evaluated using the 25 HEV RNA positive samples and 50 HEV RNA negative samples (including sera from acute-phase HAV and HBV infections and blood donors). Overall, the sensitivity of Wantai Rapid and Assure Rapid tests was 96.1% and 92.6% respectively; the specificity of the 2 tests was 100%. CONCLUSION Our data suggest the potential use of anti-HEV IgM rapid assays as a first line test in primary health care settings, particularly useful for patients with chronic liver disease or pregnant women who urgently need an antiviral treatment.
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26
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Di Bartolo I, Angeloni G, Monini M, Maione E, Marrone R, Ostanello F, Ruggeri FM. Complete genome sequencing of a genotype 3 hepatitis E virus strain identified in a swine farm in Italy. Virus Res 2016; 211:89-95. [DOI: 10.1016/j.virusres.2015.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 01/19/2023]
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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 2016; 110:93-130. [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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28
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De Paschale M, Ceriani C, Romanò L, Cerulli T, Cagnin D, Cavallari S, Ndayake J, Zaongo D, Diombo K, Priuli G, Viganò P, Clerici P. Epidemiology of hepatitis E virus infection during pregnancy in Benin. Trop Med Int Health 2015; 21:108-113. [PMID: 26523476 DOI: 10.1111/tmi.12632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Hepatitis E virus (HEV) is the cause of enterically transmitted non-A, non-C hepatitis (an infection that is particularly severe during pregnancy) in tropical and subtropical countries. As there are no published data concerning the prevalence of HEV antibodies in Benin, their presence was investigated in pregnant women undergoing routine HIV screening in a rural area in northern Benin and in pregnant women with acute non-A, non-C hepatitis. METHODS A total of 278 serum samples were collected from asymptomatic pregnant women in 2011 were tested for HEV and hepatitis A virus (HAV) antibodies, and the HEV IgM-positive samples were further tested for HEV-RNA. A further seven samples of pregnant women with acute non-A, non-C hepatitis collected during episodes of acute hepatitis in 2005 were also analysed. RESULTS Of the 278 samples collected in 2011, 16.19% were positive for HEV IgG and 1.44% for HEV IgM (none positive for HEV-RNA), and 99.64% were positive for total HAV antibodies (none positive for HAV IgM). Six of the seven samples collected in 2005 were positive for HEV IgG and IgM, and two were also positive for HEV-RNA. CONCLUSIONS The circulation of HEV infection is significant among pregnant women in Benin, in whom the consequences may be fatal.
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Affiliation(s)
| | | | - Luisa Romanò
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Debora Cagnin
- Microbiology Unit, Hospital of Legnano, Milan, Italy
| | | | | | | | | | | | - Paolo Viganò
- Infectious Diseases Department, Hospital of Legnano, Milan, Italy
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29
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Lapa D, Capobianchi MR, Garbuglia AR. Epidemiology of Hepatitis E Virus in European Countries. Int J Mol Sci 2015; 16:25711-43. [PMID: 26516843 PMCID: PMC4632823 DOI: 10.3390/ijms161025711] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/12/2015] [Accepted: 10/16/2015] [Indexed: 12/22/2022] Open
Abstract
Over the last decade the seroprevalence of immunoglobulin (IgG) anti hepatitis E virus (HEV) has been increasing in European countries and shows significant variability among different geographical areas. In this review, we describe the serological data concerning the general population and risk groups in different European countries. Anti-HEV antibody prevalence ranged from 1.3% (blood donors in Italy) to 52% (blood donors in France). Various studies performed on risk groups in Denmark, Moldova and Sweden revealed that swine farmers have a high seroprevalence of HEV IgG (range 13%-51.1%), confirming that pigs represent an important risk factor in HEV infection in humans. Subtypes 3e,f are the main genotypes detected in the European population. Sporadic cases of autochthonous genotype 4 have been described in Spain, France, and Italy. Although most HEV infections are subclinical, in immune-suppressed and transplant patients they could provoke chronic infection. Fulminant hepatitis has rarely been observed and it was related to genotype 3. Interferon and ribavirin treatment was seen to represent the most promising therapy.
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Affiliation(s)
- Daniele Lapa
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, Via Portuense 292, Rome 00149, Italy.
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, Via Portuense 292, Rome 00149, Italy.
| | - Anna Rosa Garbuglia
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, Via Portuense 292, Rome 00149, Italy.
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Serologic and molecular survey for hepatitis E virus in wild boar (Sus scrofa) in Central Italy. New Microbes New Infect 2015. [PMID: 26199731 DOI: 10.1016/j.nmni.2015.05.008.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to further investigate the role of wild boar (Sus scrofa) as a reservoir for hepatitis E virus (HEV). Sixty-four blood and faecal samples collected from wild boar hunted in Central Italy in 2011-2012 were examined by indirect enzyme-linked immunosorbent assay and RT-PCR analysis. Positive RT-PCR samples were further examined by nucleotide sequence determination and subsequent phylogenetic analysis. Thirty-six sera (56.2%) were positive for HEV-specific antibodies, and six (9.4%) faecal samples scored RT-PCR-positive results. Four animals were positive by both enzyme-linked immunosorbent assay and RT-PCR. Phylogenetic analysis showed that the detected wild boar-derived HEV sequences clustered within genotype 3, with similarity to sequences of human origin collected in a nearby area in 2012. Our data confirm that HEV is endemic in the wild boar population in the research area and that these wild animals could play an important role in the epidemiology of HEV infection.
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Mazzei M, Nardini R, Verin R, Forzan M, Poli A, Tolari F. Serologic and molecular survey for hepatitis E virus in wild boar (Sus scrofa) in Central Italy. New Microbes New Infect 2015. [PMID: 26199731 PMCID: PMC4506981 DOI: 10.1016/j.nmni.2015.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to further investigate the role of wild boar (Sus scrofa) as a reservoir for hepatitis E virus (HEV). Sixty-four blood and faecal samples collected from wild boar hunted in Central Italy in 2011–2012 were examined by indirect enzyme-linked immunosorbent assay and RT-PCR analysis. Positive RT-PCR samples were further examined by nucleotide sequence determination and subsequent phylogenetic analysis. Thirty-six sera (56.2%) were positive for HEV-specific antibodies, and six (9.4%) faecal samples scored RT-PCR-positive results. Four animals were positive by both enzyme-linked immunosorbent assay and RT-PCR. Phylogenetic analysis showed that the detected wild boar–derived HEV sequences clustered within genotype 3, with similarity to sequences of human origin collected in a nearby area in 2012. Our data confirm that HEV is endemic in the wild boar population in the research area and that these wild animals could play an important role in the epidemiology of HEV infection.
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Affiliation(s)
- M Mazzei
- Department of Veterinary Science, University of Pisa, Pisa, Italy
| | - R Nardini
- Department of Veterinary Science, University of Pisa, Pisa, Italy
| | - R Verin
- Department of Veterinary Science, University of Pisa, Pisa, Italy
| | - M Forzan
- Department of Veterinary Science, University of Pisa, Pisa, Italy
| | - A Poli
- Department of Veterinary Science, University of Pisa, Pisa, Italy
| | - F Tolari
- Department of Veterinary Science, University of Pisa, Pisa, Italy
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Stroffolini T, Rapicetta M, Chionne P, Esvan R, Madonna E, Lombardo F, Toccaceli F, Pisani G, Ciccaglione A, Bortolotti F. Evidence for the presence of autochthonous (locally acquired) cases of acute hepatitis E virus infections in Italy since the 80s. Eur J Intern Med 2015; 26:348-50. [PMID: 25887055 DOI: 10.1016/j.ejim.2015.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/18/2015] [Accepted: 03/29/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Autochthonous (locally acquired) cases of acute hepatitis E virus have been recently reported in several developed countries. AIM To evidence cases, if any, and characteristics of acute hepatitis E virus infections in North-East of Italy several years ago. METHODS In 2014, stored sera of 165 nonA-nonB acute hepatitis referred to the hospital of Padua during the period 1978-1991 were tested for hepatitis C virus antibodies by EIA III and for anti-hepatitis E virus IgM by Wantai HEV IgM ELISA. Anti-hepatitis E virus IgM positive sera were tested by Real Star HEV RT-PCR kit (Altona Diagnostics, Hamburg, Germany). RESULTS Ninety-six (58.1%) sera resulted anti-HCV positive, and thus classified as acute C hepatitis. None of these subjects was anti-HEV IgM positive. Out of the 69 anti-HCV negative cases, 4 (5.8%) resulted anti-HEV IgM positive (one case hepatitis E virus-RNA positive), with an increasing trend from 2.8% during the years 1978-1984 to 9.1% during the years 1985-1991. All cases occurred in Italian patients with no travel abroad history. CONCLUSIONS There is evidence for the presence of autochthonous cases of acute hepatitis E virus infections in Italy since 80s.
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Affiliation(s)
- Tommaso Stroffolini
- Department of Infectious and Tropical Diseases, Policlinico Umberto I, Rome, Italy
| | - Maria Rapicetta
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Paola Chionne
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Rozenn Esvan
- Department of Infectious and Tropical Diseases, Policlinico Umberto I, Rome, Italy
| | - Elisabetta Madonna
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Lombardo
- National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Fabrizio Toccaceli
- Department of Infectious and Tropical Diseases, Policlinico Umberto I, Rome, Italy
| | - Giulio Pisani
- Center for Immunobiological Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Annarita Ciccaglione
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Bortolotti
- Department of Experimental and Clinical Medicine, University of Padua, Italy
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Pavoni E, Barbieri I, Bertasi B, Lombardi G, Giangrosso G, Cordioli P, Losio MN. Detection and Molecular Characterisation of Swine Hepatitis E Virus in Brescia Province, Italy. Ital J Food Saf 2015; 4:4587. [PMID: 27800394 PMCID: PMC5076652 DOI: 10.4081/ijfs.2015.4587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 01/15/2023] Open
Abstract
Hepatitis E virus (HEV) is an important public health concern in many developing countries and it occurs in sporadic forms in industrialized areas. With the discovery of swine HEV in pigs, which is genetically closely related to human HEV, hepatitis E is considered to be a zoonotic disease. To investigate the circulation of HEV within a distinct area of Lombardy region (Northern Italy), 17 pig farms were subjected to monitoring study by collection of fresh stool samples each represented by ground-pooled specimens. In particular, three distinct types of breeding farms were focused, represented by farrow to weaning, farrow to finish and fattening farms, respectively. Epidemiological data confirm that in Europe the seroprevalence in pigs, more than 9 month of age, ranges from 51.4 to 75%, while in 3-9 months fatteners is about 38%. In France and Italy, the positivity among farms is respectively 30 and 97.4% and the seroprevalence in Italy is 50.2%. Since HEV viremia was typically observed in the early period of life in swine, faeces were collected in boxes containing weaning pigs. For the study, 183 stool samples were collected and amplifications were performed with universal primers specific for the ORF2 region of genome. Twentyeight samples resulted positive to HEV RNA and genotyping demonstrated that they were closely related to HEV strains belonging to genotype 3 and circulating in Europe. Comparison with reference strains from GenBank excluded their similarity to genotype 1, 2 or 4 confirming that genotype 3 strains are circulating in Europe. Since it was demonstrated that swine act as a reservoir for HEV, and since many strains into HEV genotype 3 share a strong molecular similarity to human HEV, it was important to detect the presence of HEV in a restricted area with a very high density of pigs.
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Affiliation(s)
- Enrico Pavoni
- Veterinary Public Health Institute of Lombardy and Emilia-Romagna, Brescia, Italy
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Montagnaro S, De Martinis C, Sasso S, Ciarcia R, Damiano S, Auletta L, Iovane V, Zottola T, Pagnini U. Viral and Antibody Prevalence of Hepatitis E in European Wild Boars (Sus scrofa) and Hunters at Zoonotic Risk in the Latium Region. J Comp Pathol 2015; 153:1-8. [PMID: 26025105 DOI: 10.1016/j.jcpa.2015.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 12/16/2022]
Abstract
Hepatitis E virus (HEV) is a member of the genus Hepevirus within the family Hepeviridae. Hepatitis E is recognized as a zoonosis, and swine and wild boars (Sus scrofa) are known reservoirs of HEV infection. The aim of this study was to investigate the presence of HEV in wild boars and hunters exposed to infection in central Italy (Latium region). During the hunting season, blood samples were collected from 228 wild boars and 20 hunters. The seroprevalence of HEV infection was determined using a commercial enzyme-linked immunosorbent assay, previously validated for use in man, pigs and wild boars. The estimated HEV seroprevalence in wild boars and in hunters was 40.7% (93/228; 95% confidence interval [CI] 34.4-47.1%) and 25% (5/20; 95% CI 6.1-43.9%), respectively. Liver samples were collected from the boars and HEV RNA was detected by nested reverse transcriptase polymerase chain reaction. Fifty-five of 164 tested wild boar liver samples (33.5%; 95% CI 26.2-40.7%) and three of 20 (15.0%; 95% CI 1.3-28.7%) tested human serum samples were positive for HEV RNA. Phylogenetic analysis of the nucleotide sequences obtained from PCR products indicated that the HEV strains present in wild boars and the human population all belonged to genotype 3, supporting the zoonotic role of wild boars in the spread of HEV infection.
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Affiliation(s)
- S Montagnaro
- Department of Veterinary Medicine and Animal Production, University of Naples 'Federico II', Via Delpino 1, Naples, Italy.
| | - C De Martinis
- Department of Veterinary Medicine and Animal Production, University of Naples 'Federico II', Via Delpino 1, Naples, Italy
| | - S Sasso
- Department of Veterinary Medicine and Animal Production, University of Naples 'Federico II', Via Delpino 1, Naples, Italy
| | - R Ciarcia
- Department of Veterinary Medicine and Animal Production, University of Naples 'Federico II', Via Delpino 1, Naples, Italy
| | - S Damiano
- Department of Veterinary Medicine and Animal Production, University of Naples 'Federico II', Via Delpino 1, Naples, Italy
| | - L Auletta
- Istituto di Ricerca Diagnostica e Nucleare, IRCCS-SDN, Via E. Gianturco 113, Naples, Italy
| | - V Iovane
- Department of Veterinary Medicine and Animal Production, University of Naples 'Federico II', Via Delpino 1, Naples, Italy
| | - T Zottola
- Experimental Zooprophylactic Institute of Lazio e Toscana Regions, Diagnostic Section of Latina, Italy
| | - U Pagnini
- Department of Veterinary Medicine and Animal Production, University of Naples 'Federico II', Via Delpino 1, Naples, Italy
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Di Bartolo I, Ponterio E, Angeloni G, Morandi F, Ostanello F, Nicoloso S, Ruggeri FM. Presence of Hepatitis E Virus in a RED Deer (Cervus elaphus) Population in Central Italy. Transbound Emerg Dis 2015; 64:137-143. [PMID: 25892400 DOI: 10.1111/tbed.12353] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Indexed: 12/11/2022]
Abstract
Hepatitis E is an acute human disease caused by the hepatitis E virus (HEV). In addition to humans, HEV has been detected in several animal species and is recognized as a zoonotic pathogen. Pigs, wild boar and deer can be reservoir. In this study, we evaluated HEV prevalence in a free-living red deer (Cervus elaphus) population in central Italy by detecting virus-specific antibodies and RNA in sera. A total of 35 of 251 red deer sera were positive for anti-HEV IgG. HEV RNA was detected in 10 of 91 sera examined. Two genomic fragments targeted by diagnostic PCRs in the capsid region were sequenced, both matching with genotype 3 HEV. Overall results confirmed the occurrence of HEV infection in deer also in Italy.
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Affiliation(s)
- I Di Bartolo
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Italy
| | - E Ponterio
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Italy
| | - G Angeloni
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Italy
| | - F Morandi
- Monti Sibillini National Park, Visso, MC, Italy
| | - F Ostanello
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, BO, Italy
| | | | - F M Ruggeri
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Italy
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36
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Jia Z, Yi Y, Liu J, Cao J, Zhang Y, Tian R, Yu T, Wang H, Wang X, Su Q, Zhou W, Cui F, Liang X, Bi S. Epidemiology of hepatitis E virus in China: results from the Third National Viral Hepatitis Prevalence Survey, 2005-2006. PLoS One 2014; 9:e110837. [PMID: 25360522 PMCID: PMC4215996 DOI: 10.1371/journal.pone.0110837] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/29/2014] [Indexed: 12/20/2022] Open
Abstract
In China, hepatitis E virus (HEV) is prevalent and causes disease, but its epidemiological profile is not well understood. We used a commercial enzyme-linked immunosorbent assay to detect total antibodies to hepatitis E virus in 15,862 serum samples collected during the Third National Viral Hepatitis Prevalence Survey. The results were analyzed to calculate estimates of HEV seroprevalence and to examine the effects of some putative risk factors. The seroprevalence of HEV in the general Chinese population during the period from 2005 through 2006 was 23.46% (95% confidence interval [CI], 18.41%–28.50%). The farming population, the age group of 15–60 year olds, and those living in the Midwest or Mideast region and in Xinjiang province had the highest seroprevalence estimates. The prevalence of HEV is high in China. The seroprevalence rate of HEV shows an unbalanced distribution among areas with different geographic location and economic development levels. The characteristics of the distribution associated may be due to the route of HEV transmission (via contaminated water or animal reservoirs). Within the same region, the seroprevalence of HEV is generally increased with age.
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Affiliation(s)
- Zhiyuan Jia
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yao Yi
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianhua Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jingyuan Cao
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Zhang
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ruiguang Tian
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Yu
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hao Wang
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinying Wang
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiudong Su
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenting Zhou
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fuqiang Cui
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shengli Bi
- National Institute of Virology Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
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Garbuglia AR, Alessandrini AI, Pavio N, Tessé S, Grignolo S, Viscoli C, Lapa D, Capobianchi MR. Male patient with acute hepatitis E in Genoa, Italy: figatelli (pork liver sausage) as probable source of the infection. Clin Microbiol Infect 2014; 21:e4-6. [PMID: 25636944 DOI: 10.1016/j.cmi.2014.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 11/17/2022]
Affiliation(s)
- A R Garbuglia
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
| | - A I Alessandrini
- Clinica Malattie Infettive IRCCS Azienda Ospedaliera San Martino, Genova, Italy
| | - N Pavio
- UMR Virology, Animal Health Laboratory, Anses, Maisons-Alfort, France
| | - S Tessé
- Hôpital des Armées Val de Grâce, National Reference Laboratory of Hepatitis E, Paris, France
| | - S Grignolo
- Clinica Malattie Infettive IRCCS Azienda Ospedaliera San Martino, Genova, Italy
| | - C Viscoli
- University of Genoa, IRCCS AOU San Martino-IST Genoa, Italy
| | - D Lapa
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - M R Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
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Hepatitis E: an old infection with new implications. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:6-17. [PMID: 25369613 DOI: 10.2450/2014.0063-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/18/2014] [Indexed: 12/24/2022]
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39
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Giordani MT, Fabris P, Brunetti E, Goblirsch S, Romanò L. Hepatitis E and lymphocytic leukemia in Man, Italy. Emerg Infect Dis 2014; 19:2054-6. [PMID: 24274068 PMCID: PMC3840850 DOI: 10.3201/eid1912.130521] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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40
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Festa S, Garbuglia AR, Baccini F, Panzuto F, Capobianchi MR, Santino I, Purchiaroni F, Orgera G, Delle Fave G, Marignani M. Acute fulminant hepatitis E virus genotype 3e infection: Description of the first case in Europe. ACTA ACUST UNITED AC 2014; 46:727-31. [DOI: 10.3109/00365548.2014.928417] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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41
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La Rosa G, Fratini M, Muscillo M, Iaconelli M, Taffon S, Equestre M, Chionne P, Madonna E, Pisani G, Bruni R, Ciccaglione AR. Molecular characterisation of human hepatitis E virus from Italy: comparative analysis of five reverse transcription-PCR assays. Virol J 2014; 11:72. [PMID: 24755361 PMCID: PMC4002560 DOI: 10.1186/1743-422x-11-72] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/04/2014] [Indexed: 11/25/2022] Open
Abstract
Background Hepatitis E (HEV) is an important public-health concern as a major cause of enterically transmitted hepatitis worldwide. In industrialised countries it is considered rare, and largely confined to travellers returning from endemic areas. However, autochthonous (locally acquired) HEV infection is also emerging in these regions. The infection is caused by different genotypes, depending on whether it is travel-related or autochthonous. Conventional RT-PCR followed by sequencing of PCR products can identify HEV genotype and, depending on the region, the subtype, thus helping in defining the origin of infection and tracing the source of contamination. Methods We re-analysed a collection of serum samples previously confirmed as hepatitis E positive by anti-HEV IgM and IgG assays as well as by Real-Time PCR, with the aim to compare the performances of five different broad range RT-PCR assays that could be provided for molecular characterisation of HEV. This approach is certainly valuable to investigate the molecular epidemiology of acute hepatitis E in countries where co-circulation of different genotypes occurs, like Italy. Results Samples were analyzed by five assays targeting the ORF1, ORF2, and ORF2/3 regions. The sensitivity of these assays varied significantly, depending on the target region. Only 46% of samples tested positive by nested PCR; moreover, no single method was able to detect all positive samples. Most sequences originated from patients who had travelled to endemic areas (genotype 1), while the minority originated from Italian patients with no travel history (genotype 3). Conclusion Broad range methods for molecular characterization of HEV still need to be improved to detect all circulating strains.
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Affiliation(s)
- Giuseppina La Rosa
- Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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42
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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: 0.6] [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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43
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Rahman S, Mamun-Al-Mahtab, Jahan M, Tabassum S, Fazle Akbar SM. Epidemiology of Hepatitis E Virus in an Urban Community in Dhaka City. Euroasian J Hepatogastroenterol 2014; 4:4-6. [PMID: 29264310 PMCID: PMC5736947 DOI: 10.5005/jp-journals-10018-1087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 01/05/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction Hepatitis E virus (HEV) is endemic in Bangladesh and sporadic and epidemic outbreaks of acute hepatitis E occur in this country almost regularly. Although the real magnitude of HEV prevalence has not been documented in Bangladesh, HEV infections and HEV-related acute hepatitis of Bangladeshi origin have been reported from different parts of the world. Methods The study was conducted in Mirpur area of Dhaka city, which is a major residential area of the capital of Bangladesh. Three hundred adults were randomly included in the study. None had any history of jaundice or complains of liver diseases. Results The study revealed 30% prevalence of HEV in this population. The prevalence increased with age, but there was no gender difference. Conclusion HEV is a highly prevalent disease in Bangladesh as elsewhere in the developing world. Since there is no specific treatment for HEV, improvement of personal hygiene and ensuring supply of safe food and drinking water remain most important approach to sustain the virus. How to cite this article: Rahman S, Mahtab MA, Jahan M, Tabassum S, Akbar SMF. Epidemiology of Hepatitis E Virus in an Urban Community in Dhaka City. Euroasian J Hepato-Gastroenterol 2014; 4(1):4-6.
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Affiliation(s)
- Salimur Rahman
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mamun-Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Munira Jahan
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shahina Tabassum
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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44
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Unzueta A, Rakela J. Hepatitis E infection in liver transplant recipients. Liver Transpl 2014; 20:15-24. [PMID: 24123928 DOI: 10.1002/lt.23764] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/25/2013] [Indexed: 01/01/2023]
Abstract
Hepatitis E virus (HEV) infection (genotype 3) has been described in developed countries as a cause of chronic hepatitis in recipients of solid organ transplantation (SOT), with the first cases reported in 2008. Immunosuppression seems to play a major role in the pathogenesis of chronic infections. The current gold standard for the diagnosis of HEV infection is the detection of HEV RNA in serum, stools, or both. In liver transplant recipients, HEV infection is considered an uncommon disease; however, a high index of suspicion is needed for patients with graft hepatitis of an unclear etiology. Liver transplant recipients seem more likely to develop chronic HEV after an acute infection, and there is accelerated progression to advanced fibrosis and cirrhosis. A decrease in immunosuppression is considered the first line of treatment, and pegylated interferon can be considered the second line of treatment for liver transplant recipients. At the present time, there are not enough data to recommend treatment with ribavirin for adult liver transplant recipients, although this has been tried in other SOT populations.
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45
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Song YJ, Park WJ, Park BJ, Lee JB, Park SY, Song CS, Lee NH, Seo KH, Kang YS, Choi IS. Hepatitis E virus infections in humans and animals. Clin Exp Vaccine Res 2013; 3:29-36. [PMID: 24427760 PMCID: PMC3890447 DOI: 10.7774/cevr.2014.3.1.29] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/20/2013] [Accepted: 09/30/2013] [Indexed: 11/15/2022] Open
Abstract
Hepatitis E has traditionally been considered an endemic disease of developing countries. It generally spreads through contaminated water. However, seroprevalence studies have shown that hepatitis E virus (HEV) infections are not uncommon in industrialized countries. In addition, the number of autochthonous hepatitis E cases in these countries is increasing. Most HEV infections in developed countries can be traced to the ingestion of contaminated raw or undercooked pork meat or sausages. Several animal species, including pigs, are known reservoirs of HEV that transmit the virus to humans. HEVs are now recognized as an emerging zoonotic agent. In this review, we describe the general characteristics of HEVs isolated from humans and animals, the risk factors for human HEV infection, and the current status of human vaccine development.
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Affiliation(s)
- Young-Jo Song
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Woo-Jung Park
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Byung-Joo Park
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Joong-Bok Lee
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Seung-Yong Park
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Chang-Seon Song
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Nak-Hyung Lee
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Kun-Ho Seo
- Department of Public Health, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Young-Sun Kang
- Department of Biomedical Science and Technology, SMART Institute of Advanced Biomedical Science, Konkuk University, Seoul, Korea
| | - In-Soo Choi
- Department of Infectious Diseases, College of Veterinary Medicine, Konkuk University, Seoul, Korea. ; Veterinary Science Research Institute, College of Veterinary Medicine, Konkuk University, Seoul, Korea
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46
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Peri AM, Milazzo L, Meroni L, Antinori S. Radiculoneuropathy associated with acute hepatitis E. Dig Liver Dis 2013; 45:963-4. [PMID: 23796551 DOI: 10.1016/j.dld.2013.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/23/2013] [Accepted: 05/02/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Maria Peri
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, L. Sacco Hospital, Milan, Italy
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47
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Harun-Or-Rashid M, Akbar SMF, Takahashi K, Al-Mahtab M, Khan MSI, Alim MA, Ekram ARMS, Khan MMR, Arai M, Mishiro S. Epidemiological and molecular analyses of a non-seasonal outbreak of acute icteric hepatitis E in Bangladesh. J Med Virol 2013; 85:1369-1376. [PMID: 23703666 DOI: 10.1002/jmv.23601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/08/2022]
Abstract
Acute hepatitis due to hepatitis E virus (HEV) is endemic in Bangladesh, but its epidemiological characteristics and virological features remain obscure. An outbreak of acute icteric hepatitis E occurred in Rajshahi, Bangladesh during 2010 when 200 patients with visible jaundice visited physicians within a period of 1 month (January-February). Clinical and epidemiological data were collected from these patients using questionnaires. Nucleic acids were isolated from 15 patients who were selected at random to ascertain their HEV genotypes. Near-complete nucleotide sequences of the HEV genome were detected in two patients and partial ORF2 regions in the other 13 patients. All patients tested positive for IgM antibodies to HEV but negative for other hepatitis viruses. Most patients were icteric and complained of vomiting, fever, itching, and abdominal pain. All 15 HEV sequences formed a single cluster within genotype 1a. Two of the 7,186-nt HEV sequences were 99.8% identical. This is the first study to report the clinical, epidemiological, and molecular characterization of an outbreak of acute hepatitis E in Bangladesh.
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48
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Drobeniuc J, Greene-Montfort T, Le NT, Mixson-Hayden TR, Ganova-Raeva L, Dong C, Novak RT, Sharapov UM, Tohme RA, Teshale E, Kamili S, Teo CG. Laboratory-based surveillance for hepatitis E virus infection, United States, 2005-2012. Emerg Infect Dis 2013; 19:218-22; quiz 353. [PMID: 23347695 PMCID: PMC3563276 DOI: 10.3201/eid1902.120961] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Clinicians should consider this virus in the differential diagnosis of hepatitis, regardless of patient travel history.
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Affiliation(s)
- Jan Drobeniuc
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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49
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Garbuglia AR, Scognamiglio P, Petrosillo N, Mastroianni CM, Sordillo P, Gentile D, La Scala P, Girardi E, Capobianchi MR. Hepatitis E virus genotype 4 outbreak, Italy, 2011. Emerg Infect Dis 2013; 19:110-4. [PMID: 23260079 PMCID: PMC3558000 DOI: 10.3201/eid1901.120983] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
During 2011, 5 persons in the area of Lazio, Italy were infected with a monophyletic strain of hepatitis E virus that showed high sequence homology with isolates from swine in China. Detection of this genotype in Italy parallels findings in other countries in Europe, signaling the possible spread of strains new to Western countries.
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Affiliation(s)
- Anna R Garbuglia
- Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
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50
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Idolo A, Serio F, Lugoli F, Grassi T, Bagordo F, Guido M, Privitera G, Lobreglio G, De Donno A. Identification of HEV in symptom-free migrants and environmental samples in Italy. J Viral Hepat 2013; 20:438-43. [PMID: 23647961 DOI: 10.1111/jvh.12038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/15/2012] [Indexed: 12/22/2022]
Abstract
Hepatitis E virus (HEV) is considered an emerging pathogen in industrialized countries. The occurrence of HEV genotypes in samples of faeces from asymptomatic migrants arriving on the coasts of South Italy and environmental samples was investigated. Analyses of sequences were used to compare human and environmental genotypes. A total of 40 stool specimens, 12 samples of untreated urban sewage, 12 samples of treated urban sewage and 12 samples of surface water were analysed. Viruses were concentrated from water samples by the tangential flow ultrafiltration technique. The presence of HEV RNA was detected by nested RT-PCR. Viral isolates were sequenced and phylogenetically characterized. Two (5%) of the 40 faecal samples tested were found to be positive for HEV RNA (G1 and G3 genotypes). The virus was detected in 25% (3/12) of the untreated sewage samples and 25% (3/12) of the surface water samples: all isolates belonged to G3 genotype. None of the treated sewage samples were found to be HEV RNA positive. The virus was detected in the faeces of two asymptomatic subjects, suggesting a potential role for symptom-free HEV carriers as a human reservoir. G3 HEV strains were detected in the untreated sewage, as observed in similar studies conducted in other European countries but differing from another study conducted in Italy recently. Moreover, our results show the first case of HEV isolated from fresh surface waters.
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Affiliation(s)
- A Idolo
- Department of Biological and Environmental Science and Technology Di.STe.B.A., University of the Salento, 73100- Lecce, Italy
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