Antibodies against hepatitis E virus (anti-HEV) were found in 248 Swedish and Danish patients between 1993 and 2007. Most patients were symptomatic and tested for anti-HEV due to travel abroad. Among patients with known country of infection, most were infected in Asia, mainly on the Indian subcontinent. However, 29 patients were infected in Europe, nine of these had HEV IgM and/or HEV RNA in serum. In sera from 65 of 141 tested patients HEV RNA could be detected, and 63 strains could be typed by limited sequencing within ORF2. HEV RNA was found in sera from 71% of the patients with HEV IgM and IgG and in 18% of the patients with only detectable HEV IgG. It was also found up to three weeks after the onset of disease in 67% of the patients with known date of onset. Patients infected in Europe were infected by genotype 3, and were older than those infected by genotype 1 (mean age 55.3 vs 30 years, p<0.001). Since it is known that genotype 3 can infect domestic pigs, HEV strains from 18 piglets in 17 herds in Sweden and Denmark were sequenced. Phylogenetic analyses of the genotype 3 strains showed geographical clades and high similarity between strains from patients and pigs from the same area. There are thus autochthonous hepatitis E cases in Scandinavia, and there are probably many undiagnosed ones. Patients with hepatitis of unknown etiology should therefore be investigated for anti-HEV even if they have not been outside Europe, since infections acquired from pigs or other animals should be taken into consideration.
Background and Aims: Naturally occuring hepatitis B virus (HBV) with surface mutations in a variety of chronic hepatitis B (CHB) patients who have received no vaccine or HBIG bearing substitutions in surface protein, have been reported. Current knowledge concerning the prevalence of these naturally occurring surface antigen mutations among Iranian carriers is limited. Materials and Methods: In a retrospective cross-sectional study, 119 HBV inactive chronic carriers were enrolled. The surface gene was amplified, sequenced and subsequently aligned using international and national sequence database. Results: All strains belonged to genotype D, subgenotype D1 and subtype ayw2. In 74 (62.18%) of patients, 146 (68.8%) out of 212 amino acid mutations occurred in different immune epitopes within surface protein, of which 28 (19.17%) in B cell, 37 (25.34%) in T helper and 81 (55.47%) inside CTL epitopes. 13 (8.9%) and 15 (10.27%) of amino acid substitutions occurred outside and within the "a" determinant in Major Hydrophilic Region (MHR). While 11 (9.24%) and 77 (64.7%) patients who harbored amino acid mutations, were HBeAg and anti-HBe positive, respectively (p=0.004). 9 and 63 amino acid mutations occurred in different HBsAg epitopes in HBeAg and anti-HBe positive patients, respectively (P=0.04). Conclusion: HBV mutants within the immune epitopes of surface Ag seem to be extremely common among chronic carriers from Tehran, especially those who are anti-HBe positive, indicating that after HBeAg seroconversion, due to the selection pressure of Ag e antibody, the occurrence of mutation is an inevitable effect of the evolutionary process.
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