Hepatitis E indigenous to economically developed countries: to what extent a zoonosis?

Teo, Chong Gee

doi:10.1097/01.qco.0000244052.61629.49

Cited by 54 publications

(69 citation statements)

References 108 publications

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“…However, an increasing number of sporadic hepatitis E cases not associated with travel have been reported from industrialized countries, including England and Wales (1).…”

mentioning

confidence: 99%

Hepatitis E in England and Wales

Lewis¹,

Boisson²,

Ijaz³

et al. 2008

Emerg. Infect. Dis.

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In 2005, 329 cases of hepatitis E virus infection were confi rmed in England and Wales; 33 were confi rmed indigenous infections, and a further 67 were estimated to be indigenous infections. Hepatitis E should be considered in the investigation of patients with hepatitis even if they have no history of travel.A cute hepatitis caused by hepatitis E virus (HEV) has historically been considered an imported disease associated with travel to a disease-endemic area. However, an increasing number of sporadic hepatitis E cases not associated with travel have been reported from industrialized countries, including England and Wales (1).Four HEV genotypes have been identifi ed that correlate with the geographic origin of the virus (2). Genotype 1 is regularly identifi ed with disease-hyperendemic areas such as Africa and southern Asia; genotype 2, with Mexico and West Africa; genotype 3, with industrialized countries such as North America, Europe, and Japan; and genotype 4, with eastern Asia and India.The epidemiology of non-travel-associated hepatitis E is largely unknown. Although the main route of transmission in disease-hyperendemic areas is the consumption of fecally contaminated water, risk factors for HEV infection in nondisease-hyperendemic countries have included occupational exposure to pigs (3) and consumption of raw or undercooked pork products (4), shellfi sh (5), and venison (6).HEV is endemic in pig populations worldwide (7), including England and Wales, where HEV genotype 3 is widespread in pigs, and subgenomic sequencing studies have shown a close relationship between pig and human HEV strains (8). Although zoonotic transmission from swine to humans appears plausible, the possibility of a reservoir common to both swine and humans cannot be excluded. The StudyThe reference laboratory for hepatitis E at the Health Protection Agency's Centre for Infections reported 17 cases of non-travel-associated hepatitis E in England and Wales from 1996 through 2003 (5). During 2004, that laboratory and the other hepatitis E reference laboratory in Birmingham received an increased number of samples for HEV testing with a corresponding increase in numbers of hepatitis E cases diagnosed by testing for HEV immunoglobulin (Ig) M and IgG by using ELISAs (Genelabs Technologies Inc, Redwood City, CA, USA). These observations led to this study, the aims of which were to describe the epidemiology of hepatitis E in England and Wales, estimate the number of non-travel-associated cases, and identify risk factors for HEV infection in indigenous cases.During 2005 The number of indigenous HEV infections was estimated for those with an unknown travel history by fi tting a logistical regression model that used Caucasian name and age as predictor variables. An estimated 67 (95% confidence interval 58-75) of the 176 patients (when the date of birth was known) in this group acquired their infection in England and Wales.Twenty-eight indigenous case-patients were available for telephone interview in which a detailed structured questionnaire w...

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“…However, an increasing number of sporadic hepatitis E cases not associated with travel have been reported from industrialized countries, including England and Wales (1).…”

mentioning

confidence: 99%

Hepatitis E in England and Wales

Lewis¹,

Boisson²,

Ijaz³

et al. 2008

Emerg. Infect. Dis.

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“…The discovery of novel HEVs from wild and farmed animals has broadened the known host range of HEV. HEV can be transmitted zoonotically to humans [Meng, 2000;Teo, 2006].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis E virus isolated from rabbits is genetically heterogeneous but with very similar antigenicity to human HEV

Wang

Dong

Xing

et al. 2013

Journal of Medical Virology

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Rabbit hepatitis E virus (HEV) in China may represent a novel HEV genotype, although no consensus has been reached. It is unclear whether the ORF2 capsid protein containing the immunodominant epitopes from rabbit HEV differs from those of human HEV. In this study, 661 bile samples collected from domestic rabbits in Jiangsu province, eastern China were amplified by RT-nPCR using a set of HEV universal ORF2 primers. All 42 (6.4%) positive PCR products were sequenced. Phylogenetic analysis using the ORF2 sequences of 557 bp in length showed the Jiangsu isolates were separate from HEV genotypes 1, 2, 3, 4, avian HEV and rat HEV, and clustered together with rabbit HEV sequences. These 42 isolates were divided into five branches including two newly identified in the present study. Comparison with rabbit HEV sequences from China available in GenBank, using a 298 bp ORF2 segment, showed these sequences clustered together into a unique rabbit HEV clade, and were divided into eight sub-branches with high genetic heterogeneity. In addition, 267 serum samples collected from domestic rabbits, serial serum samples from two rhesus monkeys experimentally infected with HEV genotype 1 or 4, and serial serum samples from two New-Zealand rabbits infected experimentally with rabbit HEV were tested simultaneously by EIA using recombinant truncated ORF2 capsid proteins derived from rabbit and human HEV. The virtually identical results obtained suggest that rabbit and human HEV ORF2 antigens contain very similar immunodominant epitopes. All these data are helpful to identify the biological characteristics of the newly identified rabbit HEV.

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“…The only apparent exception is hepatitis E, which is carried by a variety of wild, domestic, and feral mammals (Goens and Perdue, 2004;Smith, 2001). The primary exposure to humans in industrialized countries is through direct contact with infected animals, primarily swine, or eating undercooked meat and organs from infected animals (Teo, 2006). Seropositive (Smith, 2001).…”

Section: Viral Pathogensmentioning

confidence: 99%