Hepatitis E virus (HEV) is currently one of the most common causes of acute viral hepatitis. The Czech Republic is a region with a natural occurrence of genotype 3 HEV (HEV-3). The disease caused by this genotype has specific characteristics. The predominant route of transmission is zoonotic, through undercooked meat or offal from reservoir animals. Most infections are asymptomatic. Symptomatic hepatitis E may present as acute hepatitis with non-specific symptoms of viral infection and elevated serum aminotransferase activity, or it may lead to liver failure and death. Additionally, numerous extrahepatic manifestations and the potential for chronic hepatitis development in immunocompromised patients have been described. The article provides a comprehensive summary of current recommendations for the diagnosis and treatment of hepatitis E virus infections in the context of the Czech Republic.
- MeSH
- Hepatitis E * diagnosis therapy transmission drug therapy MeSH
- Humans MeSH
- Hepatitis E virus genetics MeSH
- Check Tag
- Humans MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
- Practice Guideline MeSH
- Geographicals
- Czech Republic MeSH
AIM: To analyse clinical, laboratory, and epidemiological data of a cohort of patients with acute hepatitis E treated at the Clinic of Infectology and Travel Medicine (CITM) in Košice. MATERIAL AND METHODS: Retrospective analysis of hospital information system data on patients diagnosed with acute hepatitis E who were examined or hospitalized at CITM in 2015-2023. Statistical evaluation of the available data with a focus on epidemiology, course, and complications. RESULTS: The cohort consisted of 62 patients. Fifty-eight percent were male. The mean age was 56 years. Seventy-four percent of patients were hospitalized, with a mean length of hospital stay of 10 days. The most common clinical manifestation was jaundice (in 40% of patients). Six patients had stool HEV RNA testing and all were confirmed to have genotype 3. In 5% of patients, the infection was classified as imported (they did not have HEV RNA tested), and 95% of cases were autochthonous. A history of contact with an HEV infected person was reported by 26% of patients. A history of preexisting liver disease was noted in 13% of patients who were confirmed with higher bilirubin, GMT, and ammonia levels. No statistically significant differences were found for patients with a history of immune deficiency. One patient with preexisting liver disease developed fulminant infection resulting in death. Four hepatitis E patients with neurological symptoms had lower bilirubin levels. CONCLUSIONS: The study cohort included predominantly older men. Genotype 3 was confirmed in all patients who underwent HEV RNA testing. Higher bilirubin, ammonia, and GMT levels were confirmed in patients with preexisting liver disease. Patients with neurological complications had lower bilirubin levels. One patient with preexisting liver disease died.
- Keywords
- hepatitis E, acute hepatitis E, autochthonous hepatitis E, hepatitis E,
- MeSH
- Acute Disease MeSH
- Travel Medicine MeSH
- Adult MeSH
- Hepatitis E * epidemiology diagnosis MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Hepatitis E virus genetics MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Italy epidemiology MeSH
In high-income countries, the hepatitis E virus (HEV) is considered an emerging threat causing autochthonous acute hepatitis in humans, with an increased number of reported cases over the last 10 years and related increased burden of chronic hepatitis in immunocompromised and transplant patients. Pigs are the main reservoir of the HEV-3 genotype, which is the most common in Europe, and can be transmitted to humans through the consumption of raw and undercooked pork products. Extensive sequencing revealed the existence of several HEV-3 subtypes in both humans and pigs, confirming a broad heterogeneity of the virus, with some subtypes, such as 3e, 3f, and 3c, which are predominant in Europe. In this study, 291 HEV sequences were obtained from pig feces sampled in more than 74 farms located in Austria, Bulgaria, Czech Republic, Germany, Italy, Poland, the United Kingdom, as well as an unknown number of farms in Netherlands. Of the 99 nonidentical sequences (99/291), 90 were assigned to seven established HEV-3 subtypes: 3a, 3c, 3e, 3f, 3g (here named 3g-like), 3i, and 3l (named 3l-like), already described in Europe, while nine sequences of HEV-3 could not be assigned to any existing subtype (here named 3 ∗ ). The 3e subtype was the most common, detected in six out of eight countries, followed by 3f and 3c, which were also present in several countries; 3g-like, 3i, and 3l-like subtypes showed only a limited circulation. The distribution of frequently (3e, 3f, and 3c) and rarely (3g-like, 3i, and 3l-like) detected HEV-3 subtypes in pigs was correlated with their detection rates in human patients in Europe. The results from this study confirm the wide circulation of several HEV-3 strains in European pigs and confirm that sequencing is needed to monitor the different strains and to identify possible zoonotic transmission paths.
- MeSH
- Feces virology MeSH
- Phylogeny MeSH
- Genotype MeSH
- Hepatitis E * veterinary virology epidemiology MeSH
- Swine Diseases * virology epidemiology MeSH
- Swine MeSH
- Hepatitis E virus * genetics isolation & purification classification MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe epidemiology MeSH
OBJECTIVES: Hepatitis E virus (HEV) has recently become endemic in Europe, however, it is often a remnant neglected by clinicians as the causative agent of acute and chronic hepatitis and is often misdiagnosed as a drug-induced liver injury. The infection rate in European pig farms is estimated to be around 15-20%, therefore, the primary source of HEV infections might be poorly prepared pork meat. As HEV infections may occur more often in clinical practice than previously thought, the present paper aims to analyse the seroprevalence of HEV in patients with acute hepatitis over a period of 14 years in Csongrád County, Hungary. METHODS: The sera of 4,270 hepatitis patients collected between 2004-2018 were tested for cumulative anti-HEV IgG/IgM. Furthermore, 170 IgM positive sera were tested for the presence of viral RNA by RT-qPCR. RESULTS: Between 2012-2018, the cumulative seroprevalence has increased 9.18 times, and between 2013-2018, IgM prevalence has increased 12.49 times. Viral RNA was detectable in 12.35% of IgM positive sera. CONCLUSION: The present paper presents data showing that the seroprevalence of hepatitis E virus has increased markedly over the course of the last decade in Hungary and in other European countries as well. The exact reason behind this phenomenon is yet to be determined. To assess the dynamics and the reason for this increase in prevalence, pan-European, multicentre studies should be conducted.
- Keywords
- hepatitis E virus, molecular detection, serology, seroprevalence,
- MeSH
- Hepatitis E * MeSH
- Immunoglobulin M MeSH
- Humans MeSH
- Swine MeSH
- RNA, Viral MeSH
- Seroepidemiologic Studies MeSH
- Hepatitis E virus * MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Hungary MeSH
- Names of Substances
- Immunoglobulin M MeSH
- RNA, Viral MeSH
Hepatitis E virus (HEV) is the etiological agent behind hepatitis E infection. Domestic pigs and wild boars are the main animal reservoirs of HEV. Very few papers describe HEV infection in goats and sheep. As the data pertaining to the presence of HEV virus in the milk of small ruminants in Europe are lacking, the aim of this paper was to examine a representative number of milk samples from these animals. The detection of HEV genome (HEV RNA) was performed using reverse transcriptase real-time polymerase chain reaction (RT-qPCR). HEV RNA was found in 2.8% of the examined samples. Positivity ranged from 101 to 103 genome equivalents/mL (GE/mL) with a median of 9.99 × 102 GE/mL. On the basis of these results, the milk of small ruminants could represent a source of HEV infection to consumers.
- Keywords
- HEV, RT-qPCR, milk, small ruminant,
- MeSH
- Hepatitis E veterinary MeSH
- Goats virology MeSH
- Milk virology MeSH
- Animal Diseases diagnosis virology MeSH
- Sheep virology MeSH
- RNA, Viral MeSH
- Hepatitis E virus genetics isolation & purification MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
- Names of Substances
- RNA, Viral MeSH
OBJECTIVE: Hepatitis E infection is one of the most frequent acute hepatitis in the world. Currently five human genotypes with different geographical distributions and distinct epidemiologic patterns are identified. In Slovakia, only rare cases of hepatitis E have been reported in recent years. Therefore, the aim of the study was to evaluate the prevalence of anti-HEV total antibodies and the main risk factors for HEV in the general population in Eastern Slovakia. METHODS: Detection of anti-HEV total antibodies samples was done by a commercial enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: Of 175 hospitalized patients included in the study, 76 (43.5%) showed positivity for anti-HEV total antibodies. No statistically significant differences were found in anti-HEV positivity between men and women or in the groups of different living areas (town/village - urban/rural). CONCLUSION: Prevalence of anti-HEV total antibodies of hospitalised patients was high. The risk factor significantly associated with antibody positivity was eating raw meat. Other factors, such as sex, age, living area and contact with animals were not associated with antibody positivity.
- Keywords
- Slovakia, hepatitis E, hospitalized patients, seroprevalence,
- MeSH
- Enzyme-Linked Immunosorbent Assay MeSH
- Hepatitis Antibodies isolation & purification MeSH
- Hepatitis E epidemiology MeSH
- Hospitalization statistics & numerical data MeSH
- Humans MeSH
- Risk Factors MeSH
- Seroepidemiologic Studies MeSH
- Hepatitis E virus immunology MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Slovakia epidemiology MeSH
- Names of Substances
- Hepatitis Antibodies MeSH
BACKGROUND: Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses. OBJECTIVE AND STUDY DESIGN: WHO's European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC's HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods. RESULTS: The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission. DISCUSSION: Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.
- Keywords
- EU/EEA, Hepatitis E virus, Surveillance, Testing,
- MeSH
- Disease Outbreaks MeSH
- Epidemiological Monitoring MeSH
- European Union MeSH
- Hepatitis E diagnosis epidemiology MeSH
- Incidence MeSH
- Humans MeSH
- RNA, Viral analysis MeSH
- Population Surveillance MeSH
- World Health Organization MeSH
- Hepatitis E virus genetics MeSH
- Government Programs standards MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
- Names of Substances
- RNA, Viral MeSH
Hepatitis E virus (HEV) infection is one of the most common causes of acute hepatitis worldwide. The Czech Republic is also a region with a natural occurrence of HEV genotype 3. Diseases caused by different genotypes have distinct clinical and epidemiological characteristics. In industrialized countries, numerous local animal reservoirs have been described and infection is considered to be zoonotic disease in these areas. The most significant route of transmission is through ingestion of insufficiently cooked meat of reservoir animals. In addition, numerous extrahepatic manifestations, even without dominant liver disease, and the possibility of chronic hepatitis in immunocompromised patients have been described. The review summarizes the current knowledge of HEV related disease and current approaches to the treatment of acute and chronic hepatitis E.
- Keywords
- hepatitis E, management HEV in The Czech Republic, treatment of acute/chronic HEV, virus hepatitis E (HEV),
- MeSH
- Genotype MeSH
- Hepatitis E * diagnosis drug therapy MeSH
- Humans MeSH
- Hepatitis E virus * genetics pathogenicity MeSH
- Zoonoses MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
Hepatitis E is a major concern to public health, it is estimated that 44,000 people die annually due to hepatitis E. Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. HEV has been found with 7 genotypes, only 4 can infect humans. Genotypes 1 and 2 are major causes of the epidemic and endemic acute hepatitis in developing countries. In the poor hygienic conditions, these genotypes are obligate human pathogens transmitted between humans by the fecal-oral route and via contaminated water. On the contrary, in developed countries, genotypes 3 and 4 are of zoonotic origin and they are transmitted by alimentary route and via direct contact with the infected animal. Transmission by blood, blood products and tissues from infected persons or animals and even mother-to-infant transmission is also possible. Hepatitis E clinical course varies from self-limiting disease to fulminant hepatic failure, and extrahepatic manifestations have occurred. Management to control and prevent this infection is mainly hygienic measures. The provision of clean drinking water and ameliorating the sanitation of human wastes are the most effective preventive approaches as in any infection outbreak transmitted through the fecal-oral route. Nevertheless, dietary habits, distribution of different zoonotic reservoirs and the hygienic level play a crucial role in limiting and preventing the spread of hepatitis E in the developed countries. Although HEV vaccine was developed, it is still available only in China. It protects against genotype 4 with no clear evidence of protection against other genotypes.
- Keywords
- HEV, epidemiology, hepatitis E, prevention, risk factors,
- MeSH
- Genotype MeSH
- Hepatitis E * epidemiology transmission MeSH
- Humans MeSH
- Hepatitis E virus * genetics MeSH
- Zoonoses epidemiology MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- China epidemiology MeSH
To determine whether hepatitis E virus (HEV) was distributed in the population of wild boars in South Moravia between 1990 and 2008, a total of 366 samples of archived sera from wild boars were investigated using serological (commercial ELISA) and molecular (RT-qPCR) methods. A total of 31 (8.5%) wild boars were seropositive, and from two of them, RNA sequences were recovered by nested RT-PCR. The presented results, with one of the oldest animal's HEV-positive serum (collected in 1990), suggest that wild boars may be a reservoir of HEV in the Czech Republic and that this virus has been circulating in studied areas for more than 20 years.
- Keywords
- ELISA, Europe, RT-qPCR, emerging zoonoses, hepatitis E virus, wildlife,
- MeSH
- Enzyme-Linked Immunosorbent Assay MeSH
- Hepatitis E blood epidemiology veterinary MeSH
- Swine Diseases epidemiology virology MeSH
- Reverse Transcriptase Polymerase Chain Reaction MeSH
- Swine MeSH
- Sus scrofa virology MeSH
- Hepatitis E virus genetics isolation & purification MeSH
- Disease Reservoirs MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic epidemiology MeSH
