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High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India
Pischke, Sven; Schulze-zur-Wiesch, Julian; Lütgehetmann, Marc; Kreuels, Benno; Lueth, Stefan; Kapaun, Petra; Benten, Daniel; Schmiedel, Stefan; Sterneck, Martina; Lohse, Ansgar W; Polywka, Susanne.
  • Pischke, Sven; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Schulze-zur-Wiesch, Julian; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Lütgehetmann, Marc; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Kreuels, Benno; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Lueth, Stefan; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Kapaun, Petra; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Benten, Daniel; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Schmiedel, Stefan; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Sterneck, Martina; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Lohse, Ansgar W; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
  • Polywka, Susanne; University Medical Center Hamburg-Eppendorf. Department of Internal Medicine. Hamburg. DE
Ann. hepatol ; 16(1): 57-62, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838086
ABSTRACT
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.
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Full text: Available Index: LILACS (Americas) Main subject: Travel / Disease Outbreaks / Hepatitis E virus / Hepatitis E Type of study: Diagnostic study / Etiology study / Prognostic study / Risk factors Limits: Adolescent / Adult / Aged / Humans Country/Region as subject: Asia / Europa Language: English Journal: Ann. hepatol Journal subject: Gastroenterology Year: 2017 Type: Article Affiliation country: Germany Institution/Affiliation country: University Medical Center Hamburg-Eppendorf/DE

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Full text: Available Index: LILACS (Americas) Main subject: Travel / Disease Outbreaks / Hepatitis E virus / Hepatitis E Type of study: Diagnostic study / Etiology study / Prognostic study / Risk factors Limits: Adolescent / Adult / Aged / Humans Country/Region as subject: Asia / Europa Language: English Journal: Ann. hepatol Journal subject: Gastroenterology Year: 2017 Type: Article Affiliation country: Germany Institution/Affiliation country: University Medical Center Hamburg-Eppendorf/DE