Using a validated sensitive assay, we found hepatitis E virus (HEV) IgG in 52.5% of voluntary blood donors in southwestern France. This fi nding suggests HEV is highly endemic to this region. The high HEV prevalence may refl ect local dietary practices, such as eating uncooked pork and game products. It is now recognized that hepatitis E virus infection is not confi ned to developing countries. HEV infection is a growing public health concern in industrialized countries where the disease is mainly autochthonous, caused by HEV genotypes 3 (Europe) and 4 (People's Republic of China and Japan), and is thought to be zoonotic (1).In a previous study, we estimated that 16.6% of blood donors in the Midi-Pyrénées region of southwestern France have HEV antibodies (2). This rate was much higher than that measured in northern France (3), which suggests differences between these 2 populations and their exposure to HEV that we wished to explore further. However, it is diffi cult to make wider comparisons with seroprevalence studies from other areas because the various assays used differed in sensitivity and specifi city (4). Because a recent study suggested that the HEV IgG assay we used in our original study lacks sensitivity (5), we repeated and extended the study using a more sensitive assay that has been validated by using serum from PCR-proven HEV genotype 3 infections (5). The StudyDuring September 2003 through May 2004, serum samples were collected from 512 adult blood donors 18-64 years old (median 42 years) and 188 children 2-4 years old. The blood donors were unpaid voluntary donors; the children were hospitalized in Toulouse for surgery or trauma. All were residents of the Midi-Pyrénées region. The prevalence of HEV IgG was determined by using the Wantai HEV IgG enzyme immunoassay (Wantai Biologic Pharmacy Enterprise, Beijing, People's Republic of China), according to the manufacturer's instructions. Details of baseline demographic data and putative risk factors were collected from blood donors by using a structured questionnaire. In addition, to assess the risk for foodborne infection, we tested 18 local pig-liver sausages for HEV RNA using a quantitative real-time PCR based on the open reading frame 2 region of the HEV genome (6).HEV IgG was detected in 268 (52.5%) of 512 (95% confi dence interval [CI] 48.2%-56.8%) of the blood donors. Seroprevalence increased with age ( Figure 1). The ranges of optical density/cutoff ratios for positive and negative samples showed a clear bimodal distribution (Figure 2). Of 244 rural donors, 63.1% (95% CI 57%-69.2%) were anti-HEV positive compared with 42.9% (95% CI 37-48.8) of 268 urban donors (p<0.01). For children, seroprevalence was 3.7% (95% CI 1.0%-6.5%). The mean ± SD optical density/cutoff ratio of the positive samples was 5.43 ± 3.93 for children and 5.99 ± 3.52 for adults. Although several factors were associated with the presence of HEV IgG after univariate analysis, multivariate analysis identifi ed only age, rural residence, hunting, and contact with cats as factor...

A total of 431 consecutive patients from the Midi Pyrenees area with acute hepatitis with unknown etiology in 2001-2002 were tested for the presence of immunoglobulin G-class (IgG) anti-hepatitis E virus (HEV) antibodies. Forty-six (10.7%) had anti-HEV IgG, and the results were questionable for a further 17 (3.9%). Real time PCR based on TaqMan detection was used to identify HEV genome fragments in the serum of patients with positive or questionable anti-HEV serology. HEV RNA was found in 25.4% of cases. All amplification products were sequenced and analyzed. Phylogenetic analysis revealed that all the strains were genotype 3. In conclusion, virological and epidemiological data indicate that genotype 3 viruses are circulating in the south west part of France (Midi-Pyrenees) in patients with acute hepatitis and who have not visited recently areas in which HEV is endemic.

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Background Patients with chronic kidney disease, dialysis patients and kidney-transplant patients are at high risk of developing severe coronavirus disease-19 (COVID-19). Data regarding the immunogenicity of anti-Severe Acute Respiratory Syndrome coronavirus-2 messenger RNA (anti-SARS-CoV-2 mRNA) vaccines in dialysis patients were published recently. We assessed the immunogenicity of anti-SARS-CoV-2 mRNA vaccine in dialysis patients. Patients and Methods One hundred-nine patients on hemodialysis (n = 85) or peritoneal dialysis (n = 24) have received two injections of 30-μg doses of BNT162b2 mRNA COVID-19 Vaccine (Pfizer-BioNTech), that were administered intramuscularly 28 days apart. Those who were still seronegative after the second dose were given a third dose one month later. Anti-SARS-CoV-2 antibodies were tested before and after vaccination. Results Ninety-one out of the 102 patients who had at least a one-month follow-up after the second (n = 97) or the third (n = 5) vaccine doses had anti-SARS-CoV-2 antibodies. The seroconversion rate was 88.7% (86 out of 97 patients) among SARS-CoV-2 seronegative patients at the initiation of vaccination. Receiving immunosuppressive therapy was an independent predictive factor for non-response to vaccination. Conclusion Due to high immunogenicity and safety of mRNA vaccines, we strongly recommend prioritizing a two-doses vaccination of dialysis patients. A third dose can be required in non-responders to two doses. When possible, patients waiting for a kidney transplantation, should be offered the vaccine before transplantation.