Acute Hepatitis Associated With Autochthonous Hepatitis E Virus Infection--San Antonio, Texas, 2009

Abstract

Locally acquired hepatitis E infection is increasingly being observed in industrialized countries. We report 2 cases of autochthonous acute hepatitis E in the United States. Hepatitis E virus genotype 3a related to US-2 and swine hepatitis E virus strains was isolated from one of the patients, indicating potential food-borne or zoonotic transmission.

Laboratory-based Surveillance for Hepatitis E Virus Infection, United States, 2005–2012

“…These strains clustered with HEV previously found in case-patients with nonimported acute hepatitis E ( 9 – 12 , 14 ) in the United States (Figure), suggesting that the nontravelers were infected by autochthonously circulating HEV. The similarity between HEV genotype 3 strains identified in nontravelers with those in swine ( 4 ) (Figure) suggests, but does not prove, HEV transmission linkage between humans and pigs ( 2 ).…”

“…‡Within 2 mo before illness or visit to physician. §Fulminant hepatic failure developed but resolved ( 14 ). ¶Fulminant hepatic failure developed; patient died at time of liver transplantation ( 14 ).…”

“…This unexpectedly high prevalence rate would not be ascribable to imported HEV infection alone. Indeed, cases of hepatitis E unassociated with travel abroad have been observed in the United States, implying infection by indigenous HEV strains ( 9 – 14 ). Moreover, the increasing number of reports from Europe of hepatitis E among SOTRs ( 3 , 15 ) suggests that SOTRS in the United States might be similarly susceptible to the disease.…”

Acute liver failure caused by hepatitis E virus genotype 3 and 4: A systematic review and pooled analysis

“…Thirty‐five studies from 9 countries published between 1992 and 2017 met the selection criteria . We identified 12 studies through the librarian search, 12 studies through the Google Scholar database, and 11 studies through manual search of reference . The publication language was Spanish in 1 study, French in 1 study, Japanese in 4 studies, and English in the remaining studies.…”

“…HEV‐RNA was tested in 64 patients: in blood (55 patients), in stool (2 patients), in both blood and stool (4 patients), in blood and liver (1 patient) and the method was not reported in 2 patients . Anti‐HEV IgM was positive in the 9 patients who had negative polymerase chain reaction (PCR) which was performed in blood in 7 patients, and in both blood and stool in 2 patients . Wantai assay for anti‐HEV IgM was applied in 6 of the 9 patients with negative HEV‐RNA.…”