Hepatitis E is endemic in many developing countries where it causes substantial morbidity. In industrialised countries, it is considered rare, and largely confined to travellers returning from endemic areas. However, there is now a growing body of evidence that challenges this notion. Autochthonous hepatitis E in developed countries is far more common than previously recognised, and might be more common than hepatitis A. Hepatitis E has a predilection for older men in whom it causes substantial morbidity and mortality. The disease has a poor prognosis in the context of pre-existing chronic liver disease, and is frequently misdiagnosed as drug-induced liver injury. The source and route of infection remain uncertain, but it might be a porcine zoonosis. Patients with unexplained hepatitis should be tested for hepatitis E, whatever their age or travel history.

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(08)70255-X.pdf

Hepatitis E: an emerging infection in developed countries

Among ten patients who contracted sporadic acute or fulminant hepatitis E between 2001 and 2002 in Hokkaido, Japan, nine (90 %) had a history of consuming grilled or undercooked pig liver 2-8 weeks before the disease onset. We tested packages of raw pig liver sold in grocery stores as food in Hokkaido for the presence of hepatitis E virus (HEV) RNA by RT-PCR. Pig liver specimens from seven (1.9 %) of 363 packages had detectable HEV RNA. Partial sequence analyses revealed that the seven swine HEV isolates belonged to genotype III or IV. One swine HEV isolate (swJL145) from a packaged pig liver had 100 % identity with the HE-JA18 isolate recovered from an 86-year-old patient in Hokkaido. Two swine HEV isolates (swJL234 and swJL325) had 98.5-100 % identity with the HE-JA4 isolate obtained from a 44-year-old patient in Hokkaido. These results indicate that inadequately cooked pig liver may transmit HEV to humans.

Short Communication Sporadic acute or fulminant hepatitis E in Hokkaido, Japan, may be food-borne, as suggested by the presence of hepatitis E virus in pig liver as food

Genetic variability and evolution of hepatitis E virus.

In total, 335 serum samples were collected from rabbits from two farms in Gansu province, China, and tested for anti-hepatitis E virus (HEV) antibody using EIA and for HEV RNA using nested RT- PCR with ORF2 primers. The overall prevalence of anti-HEV antibody and HEV RNA was 57.0% (191/335) and 7.5% (25/335), respectively. The positivity rate of HEV RNA in the anti-HEV antibody negative group (7.6% (11/144)) did not differ significantly from that in the positive group (7.3% (14/191)). The concordance between HEV RNA and anti-HEV antibody was 43.3% with no significant correlation (P < 0.05). All 25 amplicons from the ORF2 region were cloned and sequenced. On the basis of nucleotide sequence comparison, they had 84-99% identity to each other and 73-77%, 70-76%, 75-82%, 71-77%, and 53-65% with the corresponding regions of genotypes 1, 2, 3, 4, and avian HEV, respectively. Samples that were positive with the ORF2 primers were amplified using ORF1 region primers; 17 were positive and shared 71-78%, 73-76%, 74-82%, 72-78%, and 39-58% identity with the corresponding regions of genotypes 1, 2, 3, 4, and avian HEV, respectively, at the nucleotide level. Two representative full-length sequences were determined. These two sequences shared 85% identity with each other and had 74%, 73%, 78-79%, 74-75%, and 46-47% identity to full-length genotypes 1, 2, 3, 4, and avian HEV, respectively. Thus, the sequences isolated from the rabbits represent a novel genotype of HEV. This study provides novel information about HEV genotypes infecting rabbits as well as evidence of a new mammalian genotype of HEV.

A novel genotype of hepatitis E virus prevalent among farmed rabbits in China.

AimsTo report the natural history of autochthonous hepatitis E and hepatitis E virus (HEV) IgG seroprevalence in Southwest England.MethodsPatients with unexplained hepatitis were tested for hepatitis E and cases followed until recovery or death. Five hundred blood donors, 336 individuals over the ag

Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease.

Evidence that hepatitis E is zoonotic is accumulating. Serum samples were collected from pigs, cattle, and goats from various regions of China to determine whether they had been infected with hepatitis E virus (HEV). An in-house enzyme immunoassay (EIA) and reverse transcriptase-polymerase chain reaction (RT-PCR) with primers from open reading frame (ORF) 2 were used to detect anti-HEV antibodies and HEV RNA. The mean positivity rates of anti-HEV antibody for pigs and cattle were 78.8% and 6.3% but none of the goat sera were positive. Pigs may be more susceptible to infection with HEV than cattle or goats. Five of 263 pig sera were positive for HEV RNA and four of these five were also positive for anti-HEV. The PCR products (nt 6007-6354) were cloned and sequenced and compared to other HEV sequences in the nucleotide databases. The five sequences shared 83-93% identity to each other at the nucleotide level and 74-79%, 73-74%, 73-78%, and 83-99% identity to HEV genotypes 1, 2, 3, and 4, respectively. They were closely related to human isolates of HEV genotype 4. Phylogenetic analyses also place these swine sequences in HEV genotype 4, resembling most closely viruses isolated from Chinese patients with acute hepatitis. These data support the hypothesis that sporadic hepatitis E in China is zoonotic.

Prevalence, isolation, and partial sequence analysis of hepatitis E virus from domestic animals in China

The first nucleotide sequences of hepatitis E virus (HEV) acquired in the United Kingdom are described. The sequences are novel and are related most closely to HEV isolated from Greece (Greece 2 strain), consistent with their having been derived from an indigenous European virus. HEV was assumed until recently to be rare in the United Kingdom and other industrialised countries and, consequently, hepatitis E may be under-diagnosed in industrialised countries.

Partial sequence analysis of indigenous hepatitis E virus isolated in the United Kingdom.

BACKGROUND To investigate the prevalence of anti-HEV among swine, sheep and chickens. METHODS Totally 498 sera of swine, sheep and chickens collected from Xingjiang, Guangxi, Guangdong, Beijing and Hebei were detected for the anti-HEV by an enzyme linked immunoassay. RESULTS The anti-HEV positive rate of swine was 67.53%(104/154), in pigs between 4-5 months of age the rate was 100.00%(9/9) from Xingjiang. The rate in pigs under 3 months of age from Guangxi was 36.00%(9/25) and in pigs older than six months of age was 71.67% (86/120), respectively. The 108 sera of sheep collected from Xingjiang were all negative. The positive rate of chickens was only 1.27% (3/236). The anti-HEV prevalence rates of chickens from Luoding, Shenzhen, Liuzhou, Beijing and Hebei were 4.00%, 1.49%, 1.49%, 0, 0 respectively. CONCLUSION HEV infection does exist among swine and chickens. The anti-HEV prevalence of swine was the highest among domestic animals. The role of swine and chickens in transmission of HEV needs to be further studied.

[Prevalence of anti-HEV among swine, sheep and chickens].

OBJECTIVE 64 sera with serologically negative nonA-E were tested for HEV RNA and their serological characteristics were studied. METHODS HEV RNA was tested by a reverse transcriptase PCR(RT-PCR) and the positive PCR products were cloned and sequenced. Of 15 patients positive for HEV RNA, 6 were followed up and tested for anti-HEV. RESULTS 15 of them(23.4%) were HEV RNA positive. 9 of the 15 HEV sequences have 95% homology and the remaining 6 have only 80% homology as compared with the Chinese HEV strain at the nucleotide level. Of 15 patients positive for HEV RNA, 6 were followed up. 3 of 4 patients infected with typical HEV had anti-HEV seroconversion 1 month after infection and 2 patients infected with HEV mutants were persistently negative for anti-HEV 1 or 3 months after infection. CONCLUSION The Commercial anti-HEV EIA Kit can not detect HEV mutants.

Serological character of hepatitis E virus mutants

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Prevalence, isolation, and partial sequence analysis of hepatitis E virus from domestic animals in China

Partial sequence analysis of indigenous hepatitis E virus isolated in the United Kingdom.

[Prevalence of anti-HEV among swine, sheep and chickens].

Serological character of hepatitis E virus mutants