High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India

Abstract: Background. There are only few reports about travel-associated, imported tropical hepatitis E virus (HEV) genotype 1 infections within Western travellers. We describe the clinical course of a single outbreak of hepatitis E in a German travellers group returning from India and compare the results of two commercial HEV-seroassays. Material and methods. After identifying hepatitis E in an index patient returning from a journey to India all 24 members of this journey were tested for anti-HEV-IgG and IgM using two commercial seroassays (Wantai and Mikrogen), for HEV-RNA by PCR and HEV-Ag by an antigen-assay (Wantai). Results. 5/24 (21%) individuals were viraemic with viral loads between 580-4,800,000 IU/mL. Bilirubin and ALT levels in these patients ranged from 1.3-14.9 mg/dL (mean 7.3 mg/dL, SD 5.6 mg/dL) and 151-4,820 U/L (mean 1,832U/L, SD 1842U/L), respectively and showed significant correlations with viral loads (r = 0.863, p < 0.001; r = 0.890, p < 0.001). No risk factor for food-borne HEV-transmission was identified. All viraemic patients (5/5) tested positive for anti-HEV-IgG and IgM in the Wantai-assay but only 4/5 in the Mikrogen-assay. Wantai-HEV-antigen-assay was negative in all patients. Six months later all previously viraemic patients tested positive for anti-HEV-IgG and negative for IgM in both assays. However, two non-viremic individuals who initially tested Wantai-IgM-positive stayed positive indicating false positive results. Conclusions. Despite the exact number of exposed individuals could not be determined HEV genotype 1 infections have a high manifestation rate of more than 20%.The Wantai-antigen-test failed, the Wantai-IgMrapid-test and the Mikrogen-IgM-recomblot showed a better performance but still they cannot replace real-time PCR for diagnosing ongoing HEV-infections.

Contribution of hepatitis E virus in acute sporadic hepatitis in north western India.

Background & objectives: Hepatitis E virus (HEV) causes acute viral hepatitis. Majority of the documented studies on hepatitis E have been focused on the incidence of this disease in northern and south central India. Limited data are available on HEV infection among acute sporadic hepatitis cases in north western India. The present study was undertaken to investigate the contribution of hepatitis E virus infection in sporadic hepatitis cases in Rajasthan and neighbouring States. Methods: Seven hundred and thirty six patients suspected to have viral hepatitis were screened for the hepatotropic viral markers, hepatitis A, B, C and E by using commercial enzyme immunoassay kits with a high sensitivity and specificity. The acute nature of HEV infection was also confirmed by the detection of HEV RNA by nested RT-PCR. Results: Hepatitis E was found to be the major cause of acute sporadic viral hepatitis (49.7%) in this region of India. Mixed infections of HEV-HAV (1.2%), HEV-HBV (6.1%), and HEV-HCV (1.7%) were also detected. No viral marker was detected in 32 per cent cases. Interpretation & conclusion: HEV was found as the major aetiological agent of acute sporadic viral hepatitis in Rajasthan (north western India). It is important to screen primarily for all the common enterically and parenterally transmitted hepatotropic viral markers in acute sporadic viral hepatitis. There is a need to do additional serological and molecular tests to identify the aetiological agent in the cases of acute hepatitis.

Nuevos virus de hepatitis / New hepatitis viruses

Desde 1990 se han descrito nuevos virus responsables de hepatitis que hasta ese momento eran catalogadas como No A- No B. El virus de la hepatitis E fue descrito como virus transmisión entérica responsable de brotes epidémicos en Asia y México, documentados retrospectivamente. Es un virus RNA, de la familia Caliciviridae, que produce un cuadro similar al virus de la hepatitis A y no produce infección ni partación crónica. Posterior a 1995 se han identificado por técnicas de genéticas molecular nuevos virus, teóricamente responsables de hepatitis post-transfuncional como el virus de la hepatitis G y el virus TT, pero aún no existe certeza de su verdadero rol patogénico

Hepatitis virales / Viral hepatitis

En esta revisión se describen los virus hepatotropos actualmente conocidos, su epidemiología con referencia especial a los datos nacionales relativos a los virus A, B, C y E; su historia natural y sus aspectos clínicos más relevantes. Se enfatizan, además los diferentes marcadores virales serológicos, para el diagnóstico de infección aguda o crónica. Se incluyen también los diferentes tratamientos y las medidas de prevención (pasivas o activas) recomendadas actualmente

Epidemiologie de l'hepatite E en Tunisie

The enterically-transmitted hepatitis E virus [HEV] causes large outbreaks and also sporadic cases in various areas of the world. In order to assess the HEV seroprevalence in Tunisia, serum samples from 234 asymptomatic patients have been tested. 3 groups were investigated: group 1 included 100 blood donors, group 2 was made up of 100 individuals aged more than 60 years and the group 3 was composed of 34 children attending paediatric consultation for chronic haematological diseases. The commercial kit ABBOTT HEV EIA was used in this study. The prevalence of HEV infection was respectively 22% in group 1, 46% in group 2 and 29,5% in group 3. This study substantiates the existence of hepatitis E in Tunisia and confirms the increase of its seroprevalence with age. It would be useful to know the means of contamination, which can be achieved by seeking for the virus in water supplies. Besides, more studies are needed to assess the contribution of HEV to acute non A-C hepatitis in Tunisia

role of hepatitis E virus infection among patients with acute viral hepatitis in southern Saudi Arabia

We investigated etiology of acute sporadic viral hepatitis in southern in Saudi Arabia in a series of 132 patients admitted with acute viral hepatitis. Of these cases, 108 [51.8%] were due to acute hepatitis A virus infection, of which 11 [8.3%] patients had been previously exposed to hepatitis E virus, and another 10 [7.6%] were chronic carriers of hepatitis B virus. These cases [2.3%] were acute hepatitis B virus infection. The overall prevalence of hepatitis E I[g]G antibodies was found to be 9.1%. The remaining 21 [15.9%] patients were tested for hepatitis E I[g]M, EBV-VCA I[g]G antibodies by sensitive enzyme immunoassays. In none of them could hepatitis E I[g]M, EBV-VCA I[g]M or hepatitis C I[g]G antibodies be demonstrated, and these patients were thus considered as acute non-A, non-B hepatitis. Acute hepatitis C virus infection, however, could not be ruled out from this group. We therefore concluded that the majority of clinically apparent viral hepatitis cases were due to HAV, while HBV accounted for a small proportion of the cases. Clinically apparent HEV infection dose not appear to be common in the population studied, since even those with serologic evidence of previous exposure to HEV did no recall a history suggestive of acute viral hepatitis

Prevalence and severity of viral hepatitis in Pakistani pregnant women: a five year hospital based study

A hospital based observational study was carried out on pregnant women presenting with either acute hepatitis or fulminant hepatic failure [FHF], during the past years. Of 53 patients, 20 [38%] developed FHF.Non-A, Non-B was the commonest cause [62%] followed by hepatitis B in 17% and hepatitis A in 4% cases. Eight women expired [case fatality rate 15%] with a high maternal mortality [62%] caused by NANB hepatitis. Perinatal mortality was 30%. Poor prognostic factors identified were lack of antenatal care, severity of jaundice, history of somnolence, gastrointestinal bleeding and a high grade of encephalopathy

Infección con el virus de la hepatitis E en Chile: comunicación preliminar / Hepatitis E virus infection in Chile: preliminary report

Using and Elisa technique, IgG antibodies against hepatitis E virus were measured in 40 alcoholics, 40 hemophilics, 174 blood donors, 36 subjects with acute non A non B non C hepatitis and 66 subjects with acute hepatitis A. Antibodies were detected in 1 alcoholic (2,5 percent), 3 hemophilics (7,5 percent), 7 blood donors (4 percent), 3 patients with non-A-non-B-non-C hepatitis (8,3 percent) and 3 patients with acute hepatitis A (4,5 percent). A low frequency of hepatitis E infection was detected in the studied subjects

El espectro creciente de las hepatitis virales / The growing spectrum of viral hepatitis

El conocimiento de las hepatitis se remonta por lo menos al siglo VIII, pero éste ha avanzado vertiginosamente en los últimos 30 años gracias a factores como la aplicación de técnicas de inmunoquímica, microscopía electrónica, estudios epidemiológicos tanto clínicos como experimentales, técnicas de ingeniería genética, etc. Este trabajo revisa aspectos históricos de estas afecciones, las lateraciones histológicas hepáticas y manifestaciones clínicas que desencadenan. También describe las características principales de los virus A, B, C y E, la respuesta inmune que produce cada uno de ellos, su forma de infectar y la evolución, complicaciones y posibilidades de prevención de la enfermedad que desencadenan. Se comentan los resultados de los tratamientos con antivirales e interferón para las infecciones crónicas por virus B y C

Prevalence of hepatitis E among patients with acute hepatitis

This study included 361 patients who were admitted with clinical manifestations and laboratory results of acute virus hepatitis. It was carried out in King Faisal Hospital, Makkah, the only center for infectious disease there. The results revealed that the hepatitis A is the most common cause of acute hepatitis [74.5%], and the male were affected more than females [56.5%, 43.5%]. Both acute hepatitis and hepatitis E have high prevalence rate below the age of 12 years. Hepatitis E virus plays a minor role [11.3%] as a cause of acute hepatitis in Makkah and most of the cases were coming from low standard area where poor sanitary disposal of excreta. So, improvement in water supplies, sewage disposal and hygiene should be effective in lowering HEV incidence