Lack of evidence of acute HEV infections as a sexually transmitted disease: Data from a German cohort of PrEP users

Abstract Background While the sexual transmissibility of HAV in MSM has been extensively described, the potential for sexual transmission of HEV has not been definitively established. Although HEV has been detected in the ejaculate of chronically infected men, studies among MSM PrEP users in France did not observe an elevated anti-HEV seroprevalence as an indicator of increased exposure risk by sexual intercourse. Patients and methods A total of 111 unselected PrEP users and 111 age- and sex-matched blood donors were tested for anti-HEV IgG, IgM and HEV (PCR). Of the participants 79/111 (71 %) responded to a questionnaire covering topics as sexual preferences, previous sexually transmitted diseases, profession, food consumption, and pet ownership. Results The anti-HEV IgG seroprevalence in PrEP users (22 %) did not differ significantly from the rate in controls (17 %). While one PrEP user and three controls tested positive for anti-HEV IgM, all PrEP users and controls tested PCR negative. Conclusion In immunocompetent individuals with frequent changes of sexual partners, the epidemiology of Hepatitis E Virus does not significantly involve the sexual transmission route.

Laboratory diagnosis of hepatitis type E / 中华肝脏病杂志

Hepatitis type E virus (HEV) infection is a common cause of acute viral hepatitis in China, and its etiological diagnosis relies on laboratory detection. Therefore, this article introduces the HEV RNA, HEV antigen, anti-HEV IgM, and IgG detection methods and their diagnostic application value. In addition, it also discusses the current international diagnostic standard and HEV infection presentation.

Research progress in the etiology of hepatitis type E virus / 中华肝脏病杂志

Hepatitis type E virus (HEV) is a significant infectious zoonotic disease that causes hepatitis E. The disease is primarily transmitted via the fecal-oral route through contaminated water or food and is transmissible between species and genera. The causative agent for the disease is the hepatitis type E virus, which is a member of the Hepadnaviridae family and a single-stranded RNA virus. Its 7.2 kb genome mainly contains three open reading frames (ORFs): ORF1 encodes a non-structural polyprotein that mediates viral replication and transcription; ORF2 encodes a capsid protein and free antigen that induce neutralizing antibodies; ORF3 partially overlaps with ORF2 and encodes a small multifunctional protein involved in virion formation and release. HEV has a unique dual life cycle: it is excreted into feces in the form of naked virions but circulates in the blood in the form of "quasi-enveloped" particles. The two kinds of virus particles adsorb and penetrate the host cell in distinct ways, then internalize and decapsulate to replicate the genome, thereby producing more virion and releasing it outside the cell to mediate the virus's spread. This paper reviews the morphological characteristics, genome structure, encoded proteins, and function of HEV virus-like particles in order to provide a theoretical basis for basic research and comprehensive disease prevention and control.

Advances in hepatitis E epidemiology / 中华肝脏病杂志

Hepatitis E is a viral hepatitis that the hepatitis E virus (HEV) causes. In the early 1980s, the hepatitis E virus was first discovered and identified, and it is one of the important pathogens that cause acute viral hepatitis globally. HEV infection is usually self-limiting, but in some groups of populations, such as pregnant women, patients with chronic liver disease, and the elderly, the prognosis is poor and may result in acute or subacute liver failure or even death. In addition, HEV infection can occur in chronically immunocompromised populations. At present, some regions and countries are not paying enough attention to hepatitis E prevention, diagnosis, and treatment, which suggests that we should study the epidemiology of HEV infection.

Strengthening the study of chronic hepatitis E / 中华肝脏病杂志

This paper summarizes the incidence, modes of transmission, diagnosis, treatment and prevention of chronic hepatitis E.

Prevalence of HEV infection markers in Chinese blood donors: a meta-analysis / 中国输血杂志

【Objective】 To analyze the serological markers and RNA prevalence of HEV infection in Chinese voluntary blood donors in different regions of China, so as to provide basis for the necessity of HEV screening and the formulation of screening strategies for voluntary blood donors. 【Methods】 Databases such as CNKI, Wanfang medicine and PubMed were searched for eligible literature, and the literature data meeting the inclusion criteria were extracted for meta-analysis using R4.1.3 software. 【Results】 A total of 26 studies were included, involving 97 928, 117 831 and 82 673 cases, respectively, for anti-HEV IgG, anti-HEV IgM and HEV RNA. The pooled estimated prevalence of anti-HEV IgG, anti-HEV IgM and HEV RNA among Chinese voluntary blood donors was 23.0% [95% CI (18%, 29%)] vs 1.13% [95% CI (0.94%, 1.36%)] vs 0.028%[95%CI(0.006%, 0.059%)], and there were significant differences among different cities and regions. 【Conclusion】 The past infection rate of HEV among voluntary blood donors in China was somewhat high and with significant regional differences. The current infection rate was relatively low and had decreased compared with that in the past decade, but there was still residual risk of blood transfusion. It is necessary to pay more attention to blood HEV screening of voluntary blood donors.

HPV B19, HAV and HEV infection among voluntary blood donors in Nantong / 中国输血杂志

【Objective】 To evaluate the viability of nucleic acid test(NAT) of human parvovirus B19 (HPV B19), hepatitis A virus (HAV) and hepatitis E virus (HEV) along with routine NAT for voluntary blood donors, and to analyze HPV B19, HAV and HEV prevalence in Nantong, so as to provide reference for rational blood screening programs. 【Methods】 HPV B19 DNA, HAV RNA and HEV RNA of blood donors in Nantong from November 2021 to May 2022 were detected using NAT, and serological antibody testing was performed on NAT reactive samples. 【Results】 Three HPV B19 DNA was yielded out of 3 440 blood donors, with a positive rate of 0.09%, among which 2 were negative for HPV B19-IgM and 1 was undetermined due to insufficient sample size. HAV RNA and HEV RNA were not detected in 3 440 blood donors. HPV B19, HAV, and HEV NAT were conducted simultaneously with routine HBV, HCV and HIV screening, prolonging the test reports by 20 minutes. 【Conclusion】 Although the HPV B19 DNA, HAV RNA and HEV RNA prevalence among voluntary blood donors in Nantong is low, the risk of transfusion transmitted infection still exsits and can be reduced by NAT.

Haematological diseases associated with Hepatitis E virus infection / 临床肝胆病杂志

‍Hepatitis E virus （HEV） infection can cause acute， fulminant， and chronic hepatitis and is thus a worldwide health problem. The general population has no obvious symptoms or only mild symptoms after HEV infection， and most symptoms are self-limited and are easily ignored in clinical diagnosis. Previous reports have shown that HEV infection can cause dysfunction in multiple systems， especially the blood system， in which it often leads to a series of adverse outcomes. Comprehensive evaluation， early diagnosis， and early intervention of these HEV-related diseases will greatly reduce the medical burden of individuals and society. With reference to the previous reports， this article reviews the blood system diseases associated with HEV infection.

Research advances in the interspecies transmission of hepatitis E virus / 临床肝胆病杂志

‍Hepatitis E virus （HEV） is a pathogen for viral hepatitis and can be transmitted across species via animals. The incidence rate of hepatitis E caused by HEV infection ranks first among acute viral hepatitis worldwide， and now it has become a major public health issue that threatens human health. In recent years， more and more species have been identified as the natural hosts of HEV， and there are more routes for the interspecies transmission of HEV， which greatly inhibits the prevention and control of this virus. Therefore， this article reviews and discusses the advances in the interspecies transmission of HEV， so as to provide a reference for the prevention and control of HEV.

The mechanism of the severe exacerbation and chronicity of hepatitis E virus infection / 临床肝胆病杂志

‍Hepatitis E virus （HEV） infection is the most common cause of acute viral hepatitis worldwide， and over the past ten years， studies have shown that HEV can not only cause acute self-limiting hepatitis， but also lead to severe and chronic infection. Pregnant women or patients with underlying liver disease may progress to liver failure after HEV infection， resulting in a relatively high mortality rate， and patients receiving solid organ transplantation may progress to chronic hepatitis after HFV infection. This article introduces the diagnosis， clinical features， transmission， prevention， and treatment of severe and chronic HEV infection， discusses the features of immune response， inflammatory response， and the virus itself during the severe exacerbation and chronicity of HEV infection， and summarizes the mechanism in promoting the progression of HEV. Nevertheless， there are still large gaps between current studies and clinical application， and there is still a lack of effective diagnosis and treatment regimens for severe and chronic HEV infection. It is necessary for clinical researchers to conduct research on the pathogenesis of hepatitis E and systematic cohort studies and improve the level of clinical nursing， thereby achieving the goal of preventing hepatitis E and improving the prognosis of patients with hepatitis E.

Research advances in hepatitis E virus infection in pregnancy / 临床肝胆病杂志

Previous studies have shown that hepatitis E virus （HEV） infection in pregnancy can cause liver failure and adverse pregnancy outcomes such as miscarriage， stillbirth， and vertical transmission， especially in countries where HEV genotypes 1 and 2 are prevalent. In recent years， HEV infection in China is sporadic and is mainly caused by HEV genotype 4， and although studies have shown that most pregnant women with HEV infection in China have no signfinicant clinical symptoms， there is still a high incidence rate of adverse pregnancy outcomes. This article reviews the recent studies on HEV infection in pregnancy， including the advances in pathogenesis， epidemiology， prognosis， mechanism of severe exacerbation， treatment， and prognosis， and puts forward recommendations for the screening and evaluation of HEV infection in pregnancy.

Virus de la hepatitis E

Resumen El virus de la hepatitis E (VHE) es uno de los principales agentes etiológicos de hepatitis entérica en el mundo. En países en vía de desarrollo, la seroprevalencia oscila entre 20 y 50% y en países desarrollados entre 4,4 y 21%. Clínicamente los casos de infección por VHE en individuos inmunocompetentes cursan como una hepatitis viral aguda auto limitada; por el contrario, en mujeres embarazadas, individuos receptores de trasplantes de órganos e individuos que conviven con el virus de la inmunodeficiencia humana (VIH), la infección puede manifestarse como una hepatitis crónica y grave. En América Latina, sólo Brasil y Argentina reportan cifras en individuos que conviven con el VIH. Se requieren más estudios en nuestra región que permitan determinar la prevalencia del VHE en individuos inmunosuprimidos, donantes de sangre y población general para adoptar medidas que garanticen un diagnóstico oportuno, acceso a la atención y el control de la transmisión.

Abstract The hepatitis E virus (HEV) is one of the main etiological agents of enteric hepatitis in the world. In developing countries its sero-prevalence ranges from 20 to 50% and in developed countries from 4.4% to 21%. Clinically, cases of HEV infection in immunocompetent individuals present as self-limited acute viral hepatitis; conversely, in pregnant women, transplanted individuals, and individuals living with the human immunodeficiency virus (HIV), the infection can manifest as chronic and severe hepatitis. In Latin America, only Brazil and Argentina report figures for individuals living with HIV. More studies are required in our region to determine the prevalence of HEV in immunosuppressed individuals, blood donors, and the general population to adopt measures that guarantee timely diagnosis, access to care, and control of transmission.

Assessment of hepatitis E seropositivity among HIV-infected patients in Bulgaria

Abstract It is debatable whether HIV-infected patients are at greater risk for hepatitis E virus (HEV) infection compared with healthy subjects. The reported anti-HEV seroprevalence among different groups in Bulgaria varied from 9.04% to 25.9%, but the information regarding the HIV population is still missing. The aim of the present study was to evaluate hepatitis E seroprevalence among HIV-infected patients in Bulgaria and to analyze demographic and immunological factors associated with HEV infection. Serum samples of 312 HIV-infected patients were analyzed retrospectively. Age, sex, residence and laboratory markers for HEV, HBV, HCV and HIV infection, and lymphocytes subpopulations were collected for all patients. None of the tested samples were positive for HEV RNA. HEV seroprevalence among HIV-infected patients was 10.9%. Males were more affected with the highest prevalence of positivity in the age group > 30 to ≤ 40 years. The documented HIV transmission routes in HIV/HEV co-infected group were heterosexual, homosexual, intravenous drug use (IDU), and vertical with predominace of the heterosexual route (z = 0.2; p = 0.804). There was a statistically significant trend of HIV mixed infection with routes of HIV transmission other than homosexual - heterosexual in HIV/HEV group and injection drug use in HIV/HBV/HCV co-infected group. The route of HIV transmission, in contexts of patients' behavior, was associated with HEV prevalence among HIV-infected patients.

Seroprevalence of hepatitis E virus infection among volunteer blood donors in Central Brazil

Abstract A cross-sectional study was carried out in the Hematology and Hemotherapy Institute of the state of Mato Grosso do Sul (Hemosul) to evaluate the seroprevalence and risk factors of Hepatitis E Virus (HEV) exposure among volunteer blood donors in Central Brazil. Two-hundred fifty samples from the biorepository were tested for anti-HEV IgG and IgM using the Wantai HEV ELISA test. The seroprevalence of HEV exposure was 6.4% (95% CI: 3.9-10.2). Being born in another state of Brazil, mainly in the Southeast and South regions, was associated with a higher risk of HEV exposure (p < 0.001).

Investigation on current Hepatitis E virus infection among voluntary blood donors / 中国输血杂志

【Objective】 To investigate the situation of hepatitis E virus(HEV) infection among voluntary blood donors in Wuhan area and provide evidences for enhancing blood screening strategies. 【Methods】 HEV nucleic acid detection(NAT) was performed on blood samples from eligible blood donors in Wuhan from November to December 2020. The testing results were analyzed, and the blood donors with repeated reactive results were followed up to clarify the status of infection. 【Results】 Routine screening was performed on 17 409 blood samples from November to December 2020. A total of 17 322 blood samples of eligible blood donors were tested for HEV NAT, and one case of HEV RNA reactivity was detected. The results from the follow-ups showed that the blood donor should be in the window period of HEV seroconversion. The current HEV infection rate of voluntary blood donors in Wuhan arewas 0.058‰(1/17 322), which was lower than other domestic areas. 【Conclusion】 The current HEV infection rate of voluntary blood donors was at a relatively low prevalence level in Wuhan area. Selective blood screening strategies can be taken to further reduce potential risk of blood transfusion infection with hepatitis E virus.

Hepatitis E virus infection and gene polymorphism in murine-shaped animals of plague foci in Yunnan Province / 中华地方病学杂志

Objective:To learn about the infection and gene polymorphisms of hepatitis E virus (HEV) in murine-shaped animals of plague foci in Yunnan Province.Methods:From July to August 2019, around 16 natural villages (4 in Mile City, 6 in Mangshi and 6 in Lianghe County), which were the foci of domestic plague in Yunnan Province, the murine-shaped animals were captured by the night-time method. The liver RNA was extracted, and the target gene of rat HEV was detected by one-step real-time fluorescence quantitative PCR, and the positive rate of rat HEV was calculated. The rat HEV positive samples were amplified by PCR for further clone sequencing, and the resulting sequences were compared with the HEV sequences registered in the GenBank and a phylogenetic tree was constructed by using MegAlign and MEGA 7.0.Results:A total of 491 murine-shaped animals were captured from 3 orders, 5 families, 8 genera, 15 species, and the positive rate of rat HEV was 4.89% (24/491). Among them, the positive rate of Rattus tanezumi and Niviventer fulvescens was 9.39% (23/245) and 1/3, respectively; and other species were negative. There was a statistically significant difference in the positive rate of rat HEV between different habitats ( P = 0.014), and the positive rate of rat HEV in the habitats near the dwellings was higher than that in other habitats ( P < 0.05). The sequence comparison analysis showed that the gene sequence of P018 from Lianghe County was 100.0% homologous to the MG813927.1 sequence of the first patient with rat HEV in Hongkong, and it was clustered into the same branch with the sequences of MG813927.1 and LC549185.1 from rat, was the type HEV C. G024 from Mangshi shared a low homology (20.7% - 31.5%) with other virus strains, and it was clustered into the same branch with a HEV sequence from an avian (AY535004.1). Conclusions:Rat HEV is prevalent in murine-shaped animals of plague foci of Yunnan Province, and there may be gene polymorphisms of rat HEV. In addition, the difference infection rate may be related to the habitats.

High genetic diversity of hepatitis E virus in swine in São Paulo State, Brazil / Diversidade genética do vírus da hepatite E em suínos no estado de São Paulo, Brasil

A hepatite E é uma zoonose emergente que afeta diversas espécies de mamíferos, inclusive o ser humano. É ocasionada por um vírus da espécie Orthohepevirus A que possui diversos genótipos e subgenótipos. No Brasil é descrito o genótipo HEV-3, cujo principal reservatório é o porco doméstico. Testes moleculares e sorológicos demonstram o HEV-3 em diferentes estados, tanto em animais quanto em humanos. No estado de São Paulo, existem diversos estudos sobre a epidemiologia da hepatite E em humanos, mas faltam informações sobre o HEV-3 em suínos. Assim, o objetivo deste trabalho foi verificar a ocorrência de HEV por meio da técnica de RT-PCR e posterior sequenciamento em um banco de amostras de fezes de suínos colhidas entre 2008 e 2009, na região metropolitana de Campinas. Das 89 amostras analisadas, foi possível detectar o HEV-3 em sete e, pela reconstrução filogenética, foram encontrados os subgenótipos HEV-3b, HEV-3h, e HEV-3j. Uma amostra disponível no GenBank, proveniente de São Paulo, que ainda não havia sido subgenotipada, foi agrupada ao HEV-3i. Os subgenótipos HEV-3j e HEV-3i ainda não tinham sido relatados no país. O estudo demonstra uma grande diversidade genética do HEV no estado de São Paulo e reforça o caráter zoonótico da HEV-3.(AU)

Detección de anticuerpos anti virus hepatitis E IgG e IgM utilizando un método automatizado: experiencia de un hospital universitario / Detection of anti-virus hepatitis e IgG and IgM antibodies using an automated method: experience of a university hospital

Resumen La determinación de anticuerpos anti virus hepatitis E (anti-VHE) tiene gran variabilidad dependiendo del ensayo utilizado. En 2015, con un método ELISA manual, publicamos una seroprevalencia de anti-VHE IgG de 32,6% en pacientes con estudio de hepatitis. Existen escasas publicaciones de anti-VHE IgM. Recientemente, se desarrolló el primer método automatizado y en el presente estudio comunicamos la experiencia obtenida. Se analizaron los resultados de 272 pacientes con estudio de anti-VHE IgG y/o IgM mediante técnica automatizada ELFA (VIDAS®), entre mayo de 2018 y agosto de 2020. Se encontró 25,8% (68/264) de positividad para anti-VHE IgG y 3,5% (9/259) para anti-VHE IgM. Cuatro muestras tuvieron ambos anticuerpos positivos. La seropositividad de anti-VHE IgG aumentó con la edad. En conclusión, la seroprevalencia de anti-VHE IgG obtenida fue similar a la publicada previamente. Considerando las ventajas de los ensayos IgM e IgG anti-VHE en el sistema VIDAS®, parecen ser nuevas herramientas valiosas en el estudio serológico de VHE.

Abstract The determination of anti-hepatitis E virus antibodies (anti-HEV) has a high variability depending on the assay used. In 2015, with a manual ELISA method, we reported anti-HEV IgG seroprevalence of 32.6% in patients under hepatitis study. There are few reports of anti-HEV IgM. Recently, it was developed the first automated method and in the present study, we report the experience using this new method. Between May 2018 and August 2020, the results of 272 patients with an anti-HEV IgG and/or IgM study were analyzed using the automated ELFA technique (VIDAS®). Seroprevalence was 25.8% (68/264) for anti-HEV IgG and 3.5% (9/259) for anti-HEV IgM. Four samples were positive for both antibodies. Anti-HEV IgG seropositivity increased with age. In conclusion, the seroprevalence of anti-HEV IgG obtained was similar to previously reported. Taking into account the advantages of these assays, anti-HEV IgM and IgG assays on VIDAS® system, seem to be valuable new tools in serological study of HEV.

Acute Viral Hepatitis E Infection With Conjugated Hyperbilirubinemia In 9-Year Boy

Hepatitis E virus (HEV) infection is most common among acute viral hepatitis (AVH) infections in developed countries. It is an enteric virus which usually causes a self-resolving hepatitis. We report the case of a 9-year old boy who presented with anorexia, fever, pain in abdomen and jaundice. Ultrasound revealed no signs of cholestasis. Laboratory findings revealed conjugated hyperbilirubinemia, transaminitis, and bilirubinuria. There was no evidence of any autoimmune or metabolic disease, and routine viral serology was normal except for immunoglobulin M to HEV suggestive of acute origin of disease. The jaundice resolved slowly after a period of 2 months. Hepatitis E virus RNA was not detectable in the convalescent serum. This case is an example of conjugated hyperbilirubinemia seen in acute phase of viral hepatitis caused by HEV.

Prevalencia de anticuerpos anti-hepatitis E de tipo IgG evaluados a través de tres ensayos comerciales / Prevalence of anti-Hepatitis E IgG analyzed in sera through three commercial kits

Resumen Introducción: El virus de la Hepatitis E (HVE) es de ácido ribonucleico desnudo, los genotipos 3 y 4 pueden presentarse como una zoonosis transmitida por agua o alimentos contaminados. En la zona del eje cafetero-Colombia, no se ha descrito la presencia de anticuerpos para este virus en la comunidad. Objetivo: Determinar la prevalencia de anticuerpos anti-HVE de tipo Inmuniglobulinas G (IgG) en muestras de suero de un laboratorio clínico del Eje Cafetero. Materiales y métodos: En un periodo de dos meses se analizaron 90 sueros de pacientes atendidos en un laboratorio clínico de la ciudad de Armenia, se utilizaron tres técnicas diferentes para la caracterización de los anticuerpos y se compararon sus resultados. Resultados: De los 90 sueros evaluados, la técnica de ELISA de anticuerpos totales ELISA IgG anti HVE Recom Well marca Mikrogen identificó 2 sueros positivos (2,2%), la Prueba ELISA IgG HVE versión ULTRA® marca Diapro evidenció una muestra equivoca (1,1%). La prueba western blot Recom line HVE marca Mikrogen detectó 4 muestras positivas (4,4%). Conclusiones: Se encontró una prevalencia de anticuerpos HVE IgG que oscila entre 0 y 4,4% dependiendo de la prueba comercial utilizada, evidenciando circulación del virus y un posible ciclo infecciosos en la región.

Abstract Introduction: Hepatitis E virus (HEV) is a nonenveloped, RNA virus. HEV genotypes 3 and 4 are considered zoonosis transmitted by contaminated water and/or food. The presence of antibodies against this virus have not been described in communities inhabiting the "Coffee Axis" region of Colombia. Objective: To determine the prevalence of anti-Hepatitis E IgG in serum samples analyzed in a clinical laboratory from the Colombian Coffee Axis. Materials and methods: 90 serum samples from patients treated at a clinical laboratory in the city of Armenia (Quindio) were analyzed and compared through three different methods that characterize antibodies. Results: The Mikrogen recomWell ELISA kit (IgG anti-HEV) identified two positive sera (2.2%). The Diapro HEV IgG ELISA (version ULTRA®) test registered a false positive sample (1.1%). The Mikrogen recom Line HVE western blot assay detected 4 positive samples (4.4%). Conclusions: Depending on the commercial kit used, the prevalence of anti-HEV IgG antibodies fluctuated between 0% to 4.4%, which demonstrates that the virus is circulating and that a possible infectious cycle in this region exists.