Data reported during recent years reveal the complex picture of the epidemiology of hepatitis E virus (HEV) infection in Latin America. Whereas in countries like Argentina and Brazil is almost identical to the characteristic of most countries from North America and Europe, HEV in the Caribbean and Mexico involves the water-borne, non-zoonotic viral genotypes responsible for epidemics in Asia and Africa. Nevertheless, Latin America has been considered a highly endemic region for hepatitis E in the scientific literature, a generalization that ignores the above complexity. In addition, reports from isolated Amerindian communities, which display well known, important and very specific epidemiological features for hepatitis B and D virus infections are neither taken into account when considering the epidemiology of hepatitis E in the region. This review updates compilation of the available information for the HEV infection, both among humans and other mammals, in Latin America, discusses the strengths and the weaknesses of our current knowledge, and identifies future areas of research.

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The first report of a human autochthonous in Brazil contributes with new information for hepatitis E epidemiology in Latin America and to considerate further broadly epidemiological studies.

Hepatitis E is an infectious disease which virus (HEV) is highly disseminated in swine herd populations. Sporadic acute human hepatitis E cases have been associated to genotype 3 and 4 strains of HEV also reported in swine populations of endemic and non-endemic areas. With the aim to evaluate the incidence of animals with current infection of HEV, 115 bile samples were collected from three slaughterhouses under inspection by Animal Sanitary Protection Agency of Rio de Janeiro, Brazil. In parallel, effluent samples were collected from six sewage pipe exit sites of two slaughterhouses. HEV RNA was detected in 11 out of 115 (9.6%) bile samples collected and three waste samples from one slaughterhouse. Viral loads observed for bile samples varied from 10(1)-10(5) genome copies/mL and for effluent samples mean load was 10(2) genome copies/mL. Sequencing and phylogenetic analysis classified samples within genotype 3 subtype 3b closely related to the sample obtained from the first reported autochthonous human case and samples from swine of commercial herds in Brazil. Our data demonstrates that although most animals achieve slaughter age (around 20 weeks old) already immune to HEV, a significant number of animals are with current infection at commercial age. Further studies should be addressed to consider risk analysis and possible evaluation of inspection regulations considering food safety measures regarding hepatitis E zoonotic aspect in Brazil.

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We investigated the seroprevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) infection in subjects living in the community of Manguinhos, Rio de Janeiro, Brazil, and assisted Key words: hepatitis A virus -hepatitis E virus -seroprevalence -epidemiology -Rio de Janeiro -Brazil Viral hepatitis is a public health problem worldwide. Two of the agents that cause viral hepatitis are enterically transmitted: hepatitis A virus (HAV) and hepatitis E virus (HEV).In the last years, improvements in environmental sanitation and hygienic conditions, such as piped water and sewage system, have been responsible for a decrease in the endemicity level of hepatitis A in several developing countries. In Brazil, although hepatitis A is considered an endemic disease (Pannuti et al. 1985, Abuzwaida et al. 1987, Bensabath et al. 1987, Queiroz et al. 1995, data published in recent investigations carried out in the State of Rio de Janeiro revealed a shift in the hepatitis A epidemiological pattern. Improvements in life standards of some urban populations are responsible for a decrease in antibody prevalence among children and adolescents (Vitral et al. 1998a,b).HEV infection is quite common in some geographic areas like India, Africa and Southeast Asia, where it can represent the main cause of acute hepatitis (Arankalle et al. 1995 reported in these areas (Shakhgildyan et al. 1986, CDC 1987, Belyakov et al. 1990, Zuang 1992. On the other hand, epidemiological investigations in non-endemic areas show a low, but constant presence of anti-HEV antibodies (about 1.2%) in normal human populations (Balayan et al. 1996, Psichogiou et al. 1996, Irshad 1999.In 1986, the occurrence of outbreaks of HEV infection in the Americas was recognized in Mexico (Velazquez et al. 1990). More recently, two acute cases of hepatitis E were described in Argentina (Schlauder et al. 2000). In Brazil, outbreaks of hepatitis E have never been reported, although some authors found antibodies in some population groups (Focaccia et al. 1995, Parana et al. 1997, Souto & Fontes 1998, Trinta et al. 2001.Nowadays, hepatitis A can be prevented by active immunoprophylaxis and, for a better control of infection, it is necessary to investigate its current prevalence in different areas. On the other hand, further data are needed in order to evaluate the importance of HEV infection in our country. The aim of the present study was to evaluate the prevalence of HAV and HEV infections in an area where sanitary conditions were improved over the last few years. MATERIALS AND METHODSCalculation of sample size -The minimum sample size was estimated using the formula: n = Z² P Q / d², considering as n = estimated sample size; Z = reduced variable, which value is 1,96 when alpha = 0,05; P (estimated prevalence) = probability to achieve the studied phenomenon; Q (1-P) = complement of the estimated prevalence; d (desired precision) = margin of error.

BackgroundHepatitis E virus (HEV) has been described as an emerging pathogen in Brazil and seems to be widely disseminated among swine herds. An autochthonous human case of acute hepatitis E was recently reported. To obtain a better understanding of the phenotypic profiles of both human and swine HEV strains, a experimental study was conducted using the animal model, Macaca fascicularis.MethodsSix cynomolgus monkeys (Macaca fascicularis) were inoculated intravenously with swine HEV genotype 3 that was isolated from naturally and experimentally infected pigs in Brazil and the Netherlands. Two other monkeys were inoculated with HEV genotype 3 that was recovered from Brazilian and Argentinean patients with locally acquired acute and fulminant hepatitis E. The haematological, biochemical, and virological parameters of all animals were monitored for 67 days.ResultsSubclinical hepatitis was observed in all monkeys after inoculation with HEV genotype 3 that was recovered from the infected swine and human patients. HEV RNA was detected in the serum and/or faeces of 6 out of the 8 cynomolgus monkeys between 5 and 53 days after inoculation. The mild inflammation of liver tissues and elevations of discrete liver enzymes were observed. Seroconversions to anti-HEV IgM and/or IgG were detected in 7 animals. Reactivities to anti-HEV IgA were also detected in the salivary samples of 3 animals. Interestingly, all of the infected monkeys showed severe lymphopenia and a trend toward monocytosis, which coincided with elevations in alanine aminotransferase and antibody titres.ConclusionsThe ability of HEV to cross the species barrier was confirmed for both the swine (Brazilian and Dutch) and human (Argentinean) strains, thus reinforcing the zoonotic risk of hepatitis E in South America. Cynomolgus monkeys that were infected with HEV genotype 3 developed subclinical hepatitis that was associated with haematological changes. Haematological approaches should be considered in future studies of HEV infection.

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