Hepatitis E Virus Genotype 3 in Sewage and Genotype 1 in Sporadic Acute Hepatitis Cases in Israel

ABSTRACT Currently, diagnosis of acute hepatitis E virus (HEV) in patients is primarily based on anti-HEV immunoglobulin M (IgM) detection. However, several investigations suggest the use of HEV-specific IgA for diagnosing acute HEV infections. We evaluated two commercially available assays, an IgA enzyme-linked immunosorbent assay (ELISA) (Diacheck) and an adapted immunoblot protocol (Mikrogen) for IgA detection and compared the performance in genotype 1- and 3-infected patients. The specificity of the IgA assays was high, with no positive reactions in a control group of 18 acute hepatitis patients who were negative for HEV. The sensitivity calculated in nine PCR-positive type 1-infected patients was 100% in both assays but was clearly lower in genotype 3-infected patients (n = 14), with sensitivities of only 67% and 57% for the ELISA and immunoblot assay, respectively. The lower IgA responses detected in genotype 3-infected patients could be caused by the use of only the genotype 1 and 2 antigens in the serological assays. Interestingly in two patients with possible infection through blood transfusion no response or intermediate IgA responses were detected, and this might confirm the parenteral route of transmission. In both the type 1- and type 3-infected patients both the IgA and IgM responses disappeared simultaneously. We conclude that IgA detection is of limited value for the serodiagnosis of acute HEV cases, particularly with genotype 3.

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Acute hepatitis caused by a novel strain of hepatitis E virus most closely related to United States strains

Journal of General Virology ◽

10.1099/0022-1317-82-7-1687 ◽

2001 ◽

Vol 82 (7) ◽

pp. 1687-1693 ◽

Cited By ~ 27

Author(s):

Yamina Kabrane-Lazizi ◽

Mingdong Zhang ◽

Robert H. Purcell ◽

Kirk D. Miller ◽

Richard T. Davey ◽

...

Keyword(s):

United States ◽

Phylogenetic Analysis ◽

Acute Hepatitis ◽

Sequence Comparison ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Aetiological Agent ◽

Genotype 1 ◽

Genotype 3 ◽

The Us

A unique hepatitis E virus (HEV) strain was identified as the aetiological agent of acute hepatitis in a United States (US) patient who had recently returned from vacation in Thailand, a country in which HEV is endemic. Sequence comparison showed that this HEV strain was most similar, but not identical, to the swine and human HEV strains recovered in the US. Phylogenetic analysis revealed that this new HEV isolate was closer to genotype 3 strains than to the genotype 1 strains common in Asia. The fact that this HEV was closely related to strains recovered in countries where HEV is not endemic and was highly divergent from Asian HEV strains raises the questions of where the patient’s infection was acquired and of whether strains are geographically as localized as once thought.

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Four cases of sporadic acute hepatitis E in Mie, Japan who were infected with European type genotype 3 hepatitis E virus

Kanzo ◽

10.2957/kanzo.52.295 ◽

2011 ◽

Vol 52 (5) ◽

pp. 295-302 ◽

Cited By ~ 5

Author(s):

Hiroshi Okano ◽

Tatsunori Nakano ◽

Shimpei Matsusaki ◽

Tomohiro Sase ◽

Tomonori Saitou ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Genotype 3 ◽

Sporadic Acute Hepatitis ◽

Acute Hepatitis E

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Use of Serological Assays for Diagnosis of Hepatitis E Virus Genotype 1 and 3 Infections in a Setting of Low Endemicity

Clinical and Vaccine Immunology ◽

10.1128/cvi.00231-06 ◽

2007 ◽

Vol 14 (5) ◽

pp. 562-568 ◽

Cited By ~ 87

Author(s):

M. Herremans ◽

J. Bakker ◽

E. Duizer ◽

H. Vennema ◽

M. P. G. Koopmans

Keyword(s):

Hepatitis E Virus ◽

Specific Antigen ◽

Hepatitis E ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Genotype 1 ◽

Genotype 3 ◽

Virus Genotype ◽

Immunoblot Assay ◽

Specificity And Sensitivity

ABSTRACT Because of the occurrence of genotype 3 hepatitis E virus (HEV) in regions of low endemicity, it is important to validate the currently used serological assays for diagnosing infections with viruses belonging to this lineage, since these assays only use antigens derived from genotype 1 and 2 viruses. We evaluated the Genelabs enzyme-linked immunosorbent assay (ELISA) and the RecomBlot from Mikrogen for the detection of HEV-specific immunoglobulin M (IgM) and IgG under conditions of low endemicity. We compared test results of 16 patients with locally acquired genotype 3 HEV, 8 genotype 1 patients, 167 healthy controls from the general population, and 101 cases with hepatitis due to other viral causes. The measured specificities of the ELISA (98%) and the RecomBlot (97%) were comparable to those given by the manufacturer for IgM but were significantly lower for IgG (93% by ELISA and 66% by immunoblotting, versus reported values of 98% for ELISA and 95% for blotting). Antibody levels detected following infections with genotype 3 were lower than those following genotype 1 infections except for those measured in the IgM ELISA. Reactivity to the four antigens used in the immunoblot assay were analyzed and showed differences in the IgM immunoblot reactions between genotype 1 patients and genotype 3 patients. The ORF3 antigen was the most specific antigen. The specificity could be improved by a combined testing regimen with confirmation by immunoblotting of all positive ELISA results and by raising the cutoff of the IgG immunoblot assay without loss of sensitivity. We conclude that a combination of ELISA and immunoblotting is needed for acceptable specificity and sensitivity of HEV assays under conditions of low endemicity.

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Severe Acute Hepatitis E in a Woman with an Autoimmune Background

Acta Médica Portuguesa ◽

10.20344/amp.10429 ◽

2020 ◽

Vol 33 (6) ◽

pp. 425

Author(s):

Maria S.J. Nascimento ◽

Madalena Almeida-Santos ◽

Maria Fernandes ◽

Fernando Maltez ◽

Sara Lino ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Hepatic Necrosis ◽

Coagulation Disorder ◽

Genotype 3 ◽

Virus Genotype ◽

Younger Men ◽

Acute Hepatitis E ◽

Severe Acute Hepatitis

Hepatitis E virus genotype 3 infections are normally asymptomatic in immunocompetent individuals. Symptomatic cases of acute icteric hepatitis E are seldom observed among women, younger men and children but are particularly seen in middle-aged/elderly men. We report a case of severe acute hepatitis E caused by genotype 3 in an immunocompetent 40-year-old woman that required prolonged hospitalization. Her medical history included an autoimmune background, namely atrophic gastritis and Graves’ disease. She presented an extensive hepatic necrosis as revealed by the high levels of aminotransferases (ALT 4893 U/L; AST 3138 U/L). She showed also a coagulation disorder (prothrombin time; INR = 1.33). Serological markers for hepatitis viruses A, B and C were negative but serum was positive for hepatitis E virus RNA. Sequencing and phylogenetic analysis revealed that the hepatitis E virus strain belonged to subgenotype 3a. This is suggestive of an association between the severe acute hepatitis E virus genotype 3 infection and the autoimmune background.

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Acute Hepatitis due to Hepatitis E Virus Genotype 1 As an Imported Infectious Disease in Japan

Internal Medicine ◽

10.2169/internalmedicine.49.4221 ◽

2010 ◽

Vol 49 (23) ◽

pp. 2613-2616 ◽

Cited By ~ 1

Author(s):

Koji Miyahara ◽

Yasuhiro Miyake ◽

Tetsuya Yasunaka ◽

Fusao Ikeda ◽

Akinobu Takaki ◽

...

Keyword(s):

Infectious Disease ◽

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Genotype 1 ◽

Virus Genotype

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Performance of an antigen assay for diagnosing acute hepatitis E virus genotype 3 infection

Journal of Clinical Virology ◽

10.1016/j.jcv.2016.03.019 ◽

2016 ◽

Vol 79 ◽

pp. 1-5 ◽

Cited By ~ 25

Author(s):

Pauline Trémeaux ◽

Sébastien Lhomme ◽

Sabine Chapuy-Regaud ◽

Jean-Marie Peron ◽

Laurent Alric ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Genotype 3 ◽

Virus Genotype ◽

Antigen Assay ◽

Acute Hepatitis E

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Hepatitis E virus genotype 3 and sporadically also genotype 1 circulate in the population of Catalonia, Spain

Journal of Water and Health ◽

10.2166/wh.2009.120 ◽

2009 ◽

Vol 7 (4) ◽

pp. 664-673 ◽

Cited By ~ 30

Author(s):

Pilar Clemente-Casares ◽

Jesus Rodriguez-Manzano ◽

Rosina Girones

Keyword(s):

Hepatitis E Virus ◽

Western Europe ◽

Wastewater Treatment Plants ◽

Significant Risk ◽

Hepatitis E ◽

Human Populations ◽

Genotype 1 ◽

Genotype 3 ◽

Virus Genotype ◽

Urban Sewage

Autochthonous hepatitis E virus (HEV) strains have been described infecting populations of industrialized countries, previously considered as non-endemic areas. The HEV strains circulating in one of those areas in south-western Europe (Barcelona, Spain) have been studied by analysing amplicons obtained from HEV genomes identified in wastewater, biosolids and sludge. Six sewage and two biosolid HEV positive samples from urban wastewater treatment plants and two positive HEV sludge samples with animal contamination were analysed by cloning and sequencing of 10–12 clones per sample. The results proved the presence of HEV strains belonging to genotype 3 and also sporadically to genotype 1 in urban sewage and biosolids, showing the simultaneous circulation of diverse HEV strains in the human population of the studied area. Only HEV genotype 3 was identified in slaughterhouse sludge samples. The circulation of genotype 1 in industrialized areas may have further health implications since this genotype has been associated with important epidemics in developing areas. Contamination of food and water through their contact with sewage not properly treated and biosolids presenting HEV may represent a significant risk for human populations in relation to HEV even in industrialized areas.

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