Hepatitis E Virus Infection among Animals and Humans in Xinjiang, China: Possibility of Swine to Human Transmission of Sporadic Hepatitis E in an Endemic Area

Fu, Hongqiao; Li, Lingjun; Zhu, Yu-Xian; Wang, Ling; Geng, Jie; Chang, Yibin; Xue, Chunyan; Du, Gang; Li, Yaning; Zhang, Hui

doi:10.4269/ajtmh.2010.09-0689

Cited by 44 publications

(42 citation statements)

References 31 publications

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“…Several studies had been reported from Japan of autochthonous HEV infections acquired from the consumption of undercooked pig liver or intestine [49,50], wild hog [68] or deer [51,69]. Antibodies to HEV were detected in several animal species in western China but HEV RNA has only been detected in pigs and human cases [70]. Genotype 4 HEV strains have been isolated from swine and a human hepatitis case in western China with 99% identity over the entire genome [70].…”

Section: Hev Infections In Industrialized Countries In Asiamentioning

confidence: 97%

“…Antibodies to HEV were detected in several animal species in western China but HEV RNA has only been detected in pigs and human cases [70]. Genotype 4 HEV strains have been isolated from swine and a human hepatitis case in western China with 99% identity over the entire genome [70]. Both genotype 3 and 4 HEV strains have been isolated from human cases of HE in Japan [59][60][61]71,72].…”

Section: Hev Infections In Industrialized Countries In Asiamentioning

confidence: 97%

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The epidemiology of hepatitis E virus infections in developed countries and among immunocompromised patients

Nelson

Kmush

Labrique

2011

Expert Review of Anti-infective Therapy

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Hepatitis E virus (HEV) is an important cause of acute hepatitis in humans worldwide, both as epidemic and sporadic disease. Since the virus was identified in 1983, epidemics have occurred regularly in many countries across South and Southeast Asia when seasonal floods have contaminated drinking water supplies and in Africa during humanitarian crises among refugee populations without access to clean water. In addition, sporadic cases and small clusters of HEV infections have been recognized throughout the world in developed countries over the past couple of decades. This review will focus on emerging evidence of HEV infection as an under-recognized pathogen in Europe, the USA and other industrialized countries. We will discuss some of the issues associated with the recognition, diagnosis and treatment of these sporadic cases. We will also summarize the recent literature on autochthonous HEV infection among populations in developed countries in industrialized Europe, the USA, Japan and other industrialized Asian countries. We will review recent reports of acute and chronic HEV infections among transplant recipients and other immunocompromised individuals including HIV/AIDS patients.

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Section: Hev Infections In Industrialized Countries In Asiamentioning

confidence: 97%

Section: Hev Infections In Industrialized Countries In Asiamentioning

confidence: 97%

The epidemiology of hepatitis E virus infections in developed countries and among immunocompromised patients

Nelson

Kmush

Labrique

2011

Expert Review of Anti-infective Therapy

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“…First, it incorporates antigens representing all four HEV genotypes, so allowing for the detection of antibodies generated in the host regardless of the genotype of the infecting HEV. Other DASAs developed for anti-HEV detection (14,22,55,63) mostly utilize antigenic preparations derived from one genotype only. Second, the highly immunodominant p166 antigens (37) are used to capture antibody, as well as to report its solid-phase capture, thereby conferring both sensitivity and specificity to anti-HEV detection.…”

Section: Discussionmentioning

confidence: 99%

“…Except for farmed Rex rabbits (Oryctolagus cuniculus) in China (15,16,36), the evidence for HEV as being enzootic in species other than pigs, boars, deer, and chickens is weak, for several reasons. First, HEV RNA or antigen is infrequently, if ever, detected in their blood, bile or feces (1,14,16,25,35,51,63,69). Although HEV RNA sequences have occasionally been amplified from single animals (71,72), such detection would not necessarily implicate HEV enzooticity in the species to which those animals belong; rather, they could be accidental hosts or their samples (especially if of fecal origin) might have been contaminated with HEV shed from true maintenance hosts sharing the same habitats (58).…”

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confidence: 99%

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Restricted Enzooticity of Hepatitis E Virus Genotypes 1 to 4 in the United States

et al. 2011

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Hepatitis E is recognized as a zoonosis, and swine are known reservoirs, but how broadly enzootic its causative agent, hepatitis E virus (HEV), is remains controversial. To determine the prevalence of HEV infection in animals, a serological assay with capability to detect anti-HEV-antibody across a wide variety of animal species was devised. Recombinant antigens comprising truncated capsid proteins generated from HEV-subgenomic constructs that represent all four viral genotypes were used to capture anti-HEV in the test sample and as an analyte reporter. To facilitate development and validation of the assay, serum samples were assembled from blood donors (n ‫؍‬ 372), acute hepatitis E patients (n ‫؍‬ 94), five laboratory animals (rhesus monkey, pig, New Zealand rabbit, Wistar rat, and BALB/c mouse) immunized with HEV antigens, and four pigs experimentally infected with HEV. The assay was then applied to 4,936 sera collected from 35 genera of animals that were wild, feral, domesticated, or otherwise held captive in the United States. Test positivity was determined in 457 samples (9.3%). These originated from: bison (3/65, 4.6%), cattle (174/1,156, 15%), dogs (2/212, 0.9%), Norway rats (2/318, 0.6%), farmed swine (267/648, 41.2%), and feral swine (9/306, 2.9%). Only the porcine samples yielded the highest reactivities. HEV RNA was amplified from one farmed pig and two feral pigs and characterized by nucleotide sequencing to belong to genotype 3. HEV infected farmed swine primarily, and the role of other animals as reservoirs of its zoonotic spread appears to be limited.Hepatitis E virus (HEV), the causative agent of hepatitis E, is a nonenveloped, single-stranded, positive-sense RNA virus that belongs to the Hepeviridae family (11). Among the mammalian HEV, at least four genotypes have been recognized (47). In addition, two putative genotypes of HEV, one genotype from the Norway rat (Rattus norvegicus) (25) and the other from a wild boar (56), were recently reported. In addition to mammalian HEV strains, avian HEV (38) and the newly described cutthroat trout virus represent new genera (3). Among mammalian HEV, genotypes 1 and 2 are primarily associated with fecal-oral transmission among humans which in developing countries can lead to waterborne epidemics of jaundice. Genotypes 3 and 4 circulate in humans and several animal species, and are associated with sporadic infection among humans in industrialized countries (57). Hepatitis E is mostly self-limiting but can progress to fulminant liver failure especially in pregnant women, and chronic HEV infection resulting in cirrhosis has been observed among solid-organ-transplant recipients and other immunosuppressed people (32).HEV infection and hepatitis E in industrialized countries, including the United States, are more common than previously recognized (33,58). A study conducted in a large civilian, noninstitutionalized U.S. population found an average anti-HEV-IgG seroprevalence rate of 21%, with a strongly positive

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Excretion of infectious hepatitis E virus into milk in cows imposes high risks of zoonosis

et al. 2016

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Hepatitis E virus (HEV) represents the main cause of acute hepatitis worldwide. HEV infection in immunocompromised patients involves a high risk for the development of chronic hepatitis. Because HEV is recognized as a zoonotic pathogen, it is currently believed that swine is the primary reservoir. However, this is not sufficient to justify the strikingly high seroprevalence of HEV in both developing and Western countries. Thus, this study aimed to identify new zoonotic sources that bear a high risk of transmission to humans. We collected fecal, blood, and milk samples of cows in a typical rural region of Yunnan Province in southwest China, where mixed farming of domestic animals is a common practice. HEV RNA was quantified by quantitative real-time polymerase chain reaction, and the whole genome was sequenced. HEV infectivity was assessed in rhesus macaques. We found a high prevalence of active HEV infection in cows as determined by viral RNA positivity in fecal samples. Surprisingly, we discovered that HEV is excreted into milk that is produced by infected cows. Phylogenetic analysis revealed that all HEV isolates from cow/ milk belong to genotype 4 and subtype 4h. Gavage with HEV-contaminated raw and even pasteurized milk resulted in active infection in rhesus macaques. Importantly, a short period of boiling, but not pasteurization, could completely inactivate HEV. Conclusion: Infectious HEV-contaminated cow milk is recognized as a new zoonotic source that bears a high risk of transmission to humans; these results call attention to understanding and establishing proper measurement and control of HEV zoonotic transmission, particularly in the setting of mixed farming of domestic animals. (HEPATOLOGY 2016;64:350-359) H epatitis E virus (HEV) is a positive singlestranded RNA virus with four defined genotypes and other newly discovered strains that have not been assigned to these known genotypes. (1) It is the most common cause of acute hepatitis globally. (2) In the Western world, chronic hepatitis has been frequently described in immunocompromised patients. (3) Thus, HEV infection has emerged as a global public health issue with a particularly high mortality rate in pregnant women. (4) Seroprevalence is rather high in the developing world, ranging 30%-80%. Strikingly, it is also very high in Western countries. In the United States, population-based surveys have indicated a seroprevalence of 21% from 1988 to 1994 and 6% from 2009 to 2010. (5) An overall seroprevalence of 22.4% and 27% was found in French (6) and Dutch (7) blood donors, respectively.In the developing world, epidemics of hepatitis E occur periodically and are mainly attributed to genotypes 1 and 2. They account for annually 20 million infections, over 3 million cases with symptomatic diseases, and 70,000 deaths. (8) Fecal contamination of drinking water is a major route of transmission of these two genotypes. (8) In contrast, in developed countries, HEV genotype 3 is predominant and spread by zoonotic transmission.

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Hepatitis E Virus Infection among Animals and Humans in Xinjiang, China: Possibility of Swine to Human Transmission of Sporadic Hepatitis E in an Endemic Area

Cited by 44 publications

References 31 publications

The epidemiology of hepatitis E virus infections in developed countries and among immunocompromised patients

The epidemiology of hepatitis E virus infections in developed countries and among immunocompromised patients

Restricted Enzooticity of Hepatitis E Virus Genotypes 1 to 4 in the United States

Excretion of infectious hepatitis E virus into milk in cows imposes high risks of zoonosis

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