Hepatitis E Virus in Cambodia: Prevalence among the General Population and Complete Genome Sequence of Genotype 4

Abstract

Hepatitis E virus (HEV) is a growing public health problem in many countries. In this study, we investigated HEV seroprevalence among the general population in the Siem Reap province, Cambodia, and performed HEV genetic analysis with the aim to develop an HEV prevention strategy. This seroepidemiological cross-sectional study conducted from 2010 to 2014 included 868 participants from four different locations in Siem Reap province, Cambodia. They answered questionnaires and provided blood samples for the analysis of hepatitis virus infections. Among the participants (360 men and 508 women; age range, 7–90 years), the prevalence of anti-HEV IgG was 18.4% (95% confidence interval: 15.9–21.0); HEV RNA was detected in two participants (0.23%) and was classified as genotype 3 and 4. Full-length genome of the genotype 4 isolate, CVS-Sie10, was sequenced; it contained 7,222 nucleotides and three ORFs and demonstrated high sequence identity with the swine China isolates swGX40 (95.57%), SS19 (94.37%), and swDQ (91.94%). Multivariate logistic regression analysis revealed that men, elderly people, and house workers were risk groups significantly associated with the positivity for anti-HEV IgG. This is the first report on the detection of HEV genotype 4 in humans in Cambodia and on the complete genome sequence of HEV genotype 4 from this country. Our study demonstrates that new HEV infection cases occur frequently among the general population in Cambodia, and effective preventive measures are required.

Evidence of increased Hepatitis E virus exposure in Lao villagers with contact to ruminants

“…With an IgG seroprevalence of 51.8%, HEV is hyperendemic in the rural population at least in Vientiane Capital. In South‐East Asia, seroprevalence rates between 8.9% and 77.7% have been reported (Gonwong et al, ; Holt et al, ; Sa‐nguanmoo et al, ; Yamada et al, ). This wide range certainly reflects regional differences and differing cohort selection criteria, but also disparities in sensitivity and specificity between commercial antibody detection kits (Avellon, Morago, Garcia‐Galera del Carmen, Munoz, & Echevarria, ; Vollmer, Diekmann, Eberhardt, Knabbe, & Dreier, ; Wenzel, Preiss, Schemmerer, Huber, & Jilg, ).…”

Hepatitis E virus antibody prevalence, RNA frequency, and genotype among blood donors in Cambodia (Southeast Asia)

“…In Cambodia, two recent studies revealed high HEV prevalence rates among general populations, including cases of early HEV infection and the presence of Genotypes 3 and 4 . Here, we investigated the HEV antibody prevalence and HEV RNA frequency in Cambodian blood donors.…”

Hepatitis E in Southeast Asia

“…[25][26][27][28] And in humans, genotype 3 have also been found. [19][20][21][22][23][24] The seroprevalence of HEV, defined in this paper as the presence of anti-HEV immunoglobin G, was found to be 14% nationally in 2007-2008, but the seroprevalence was not homogenous, varying greatly within the country. 29 The study found lower HEV seroprevalence in Muslim dominated regions where pork consumption is relatively scarce.…”

“…17,18 However, recent evidence found conflicting results suggesting that those previous studies may be outdated. [19][20][21][22][23][24] The prevalent genotype of HEV is largely unclear and varies greatly by countries.…”

“…In humans, genotypes 3 and 4 have been found. 22,32 And swine have been found to carry HEV genotype 1, 3, and 4. 32,33 Genotype 3 has also been found in the river water.…”