Zoonotic Hepatitis E Virus: An Ignored Risk for Public Health

Abstract

Hepatitis E virus (HEV) is a quasi-enveloped, single-stranded positive-sense RNA virus. HEV belongs to the family Hepeviridae, a family comprised of highly diverse viruses originating from various species. Since confirmation of HEV’s zoonosis, HEV-induced hepatitis has been a public health concern both for developing and developed countries. Meanwhile, the demonstration of a broad host range for zoonotic HEV suggests the existence of a variety of transmission routes that could lead to human infection. Moreover, anti-HEV antibody serosurveillance worldwide demonstrates a higher than expected HEV prevalence rate that conflicts with the rarity and sporadic nature of reported acute hepatitis E cases. In recent years, chronic HEV infection, HEV-related acute hepatic failure, and extrahepatic manifestations caused by HEV infection have been frequently reported. These observations suggest a significant underestimation of the number and complexity of transmission routes previously predicted to cause HEV-related disease, with special emphasis on zoonotic HEV as a public health concern. Significant research has revealed details regarding the virology and infectivity of zoonotic HEV in both humans and animals. In this review, the discovery of HEV zoonosis, recent progress in our understanding of the zoonotic HEV host range, and classification of diverse HEV or HEV-like isolates from various hosts are reviewed in a historic context. Ultimately, this review focuses on current understanding of viral pathogenesis and cross-species transmission of zoonotic HEV. Moreover, host factors and viral determinants influencing HEV host tropism are discussed to provide new insights into HEV transmission and prevalence mechanisms.

Detection and quantification of hepatitis E virus in the absence of IgG and IgM anti-HEV in HIV-positive patients

“…; Nan et al . ). In these situations, the infection is caused by genotype 3, the same genotype found in this study and reported in Brazil.…”

“…Thus, the HIV group presents a higher risk of developing a HEV chronic infection because of the changes in CD4 + T cell levels even during the treatment, once the immunocompromised patients are more susceptible to the occurrence of HEV infections in comparison to the immunocompetent population (Debes et al 2016). In addition, studies show that HEV infection in HIV-positive patients probably occurs by ingestion of contaminated food, mainly swine (Park et al 2016;Nan et al 2017). In these situations, the infection is caused by genotype 3, the same genotype found in this study and reported in Brazil.…”

Hepatitis E Virus Seroprevalence in Patients with Hepatitis Delta Virus Infection

“…HEV infection presents a significant public health problem in Asia and Africa where environmental conditions are detoriated and lack of infrastructure is evident. 8 Most of the cases with acute viral hepatitis is caused by HEV (HEV genotype 1 or 2) in developing countries, with fulminant liver failure in pregnant women, but co-infection with HEV genotype 3 or 4 may lead to chronic HEV infection in immunocompromised or immunosuppressed patients which is characterized by elevated liver transaminases.A substantial number of persons with incident hepatitis E were identified in subjects who reside in rural areas of Asia, particularly in India. Currently there are no specific treatment regimens for HEV infected patients.…”

High seroprevalence of hepatitis E virus in rabbit slaughterhouse workers

“…The genotypes (HEV-1, 2, 3, 4 and 7) recognized to infect humans belong to the genus Orthohepevirus, species Orthohepevirus A, which comprises eight genotypes to date (Lhomme et al, 2016;Purdy et al, 2017). Among them, HEV-3, 4 and 7 are known to infect both humans and animal species and have been found to be zoonotic, transmitted to humans by direct contact with infected animals or consumption of food products (Nan, Wu, Zhao, & Zhou, 2017). Correspondingly, occupational exposure to animals was also recognized to play a significant role in zoonotic transmission of HEV (Carpentier et al, 2012;Chaussade et al, 2013).…”