HEV-3 subtypes and strains detected in cases of HEV infection in central Italy from 2015 to 2023.

PURPOSE: HEV is an emerging pathogen in Europe and was previously shown to be hyperendemic in areas of Abruzzo and Lazio, Central Italy. No systematic analysis of the HEV strains responsible for human infections over several years in Central Italy has previously been reported. Aim of the study was the molecular characterization of HEV from autochthonous hepatitis E cases occurred in Abruzzo and Lazio between 2015 and 2023. METHODS: Samples from 118 cases collected as part of virological surveillance in Abruzzo and Lazio from 2015 to 2023 were subjected to HEV sequencing and phylogenetic analysis. RESULTS: The main observed subtype was 3f, followed by 3c and 3e. The annual subtype distribution was quite stable over the observation period, but 3f cases tended to concentrate in winter/early spring whereas 3e cases in summer. Phylogenetic clusters of highly related sequences (a) highlighted unrecognized "point source outbreaks", (b) provided molecular support to temporally and/or geographically linked cases and (c) provided evidence for transmission of identical/highly related strains up to months/years following their first detection. CONCLUSIONS: The data provide an overview of the HEV strains responsible for human infections over eight years in Central Italy. The observed subtype distribution appears to agree better with the subtype distribution reported in Italy in pigs rather than in geographically matched wild boars, suggesting pig and its derivate food was a more frequent source of infection than wild boar in Abruzzo and Lazio. Molecular characterization is essential to recognize "point source outbreaks" and to monitor HEV circulation.

Tracking the phylogenetic profile of HEV in swine and wild boar in Europe.

Hepatitis E virus (HEV) infection is prevalent among domestic pigs and wild boar in Europe. This study focused on the genetic diversity of HEV subtypes 3c, 3e and 3f among swine and wild boar in Europe as well as their circulation. Phylogenetic analysis and Bayesian phylogenetic inference were applied on the selected ORF2 capsid HEV sequences to co-estimate the viral circulation, the mean evolutionary rates and the dated trees. The estimated mean values of the HEV ORF2 capsid gene evolutionary rate were 8.29 x 10-3, 5.96 x 10-3, and 1.107 x 10-2 substitutions/site/year, respectively for 3c, 3e and 3f. The majority of the HEV 3c and 3e supported clusters did not show intermixing between swine and wild boar. Thus, although the intermixing observed in a minority of HEV 3c and 3e supported clusters suggests that transmission/circulation of these subtypes between swine and wild boar can potentially occur, 3c and 3e European wild boar HEV populations remained mainly segregated. In contrast, one half of the HEV 3f supported clusters showed intermixing between swine and wild boar, providing evidence for transfer/circulation to swine. The data suggest that continued virologic surveillance in swine and wild boar is necessary, together with targeted measures to reduce the chance of HEV transmission to humans.

A cross-sectional study of online learning during the COVID-19 pandemic: Student perceptions.

Background: Severe acute respiratory syndrome coronavirus 2 caused an unprecedented pandemic for more than 2 years, affecting the lifestyle health, and education systems at the global level. During this long pandemic period, online learning was considered the only secure learning alternative. Multiple studies have demonstrated positive or negative perceptions related to online teaching. Aim: Through this study, we identified the perceptions and different challenges that online learning brought to the education of the students of Alexander Xhuvani University, Elbasan, focusing on their achievements. Method: This cross-sectional study was conducted by Alexander Xhuvani University from March to May 2021. A questionnaire that assessed students' perceptions related to the effectiveness of distance learning was used for this study. This questionnaire had a Cronbach α value of 0.760. Students from two faculties were welcomed to be part of this survey and to fill out the questionnaire on the Google platform. The data of the online questionnaire was made in Excel format and then analyzed using the statistical program SPSS version 20.0. Results: Overall, 350 students were included in the study about 268 (76.6%) belong to the female gender, and most students 239 (68.3%) belong to the age group of 18-20 years. It is worth mentioning that 271 (77.4%) had a negative perception related to e-learning. Approximately, 201 (57.4%) of students encountered difficulties with the internet, 49 (14%) of cases reported a lack of technological equipment, and 111 (31.7%) encountered distraction while using the phone to listen to the online lesson. Problems with visual images and audio were also reported. As advantages, we mention freer time and greater flexibility in the learning process. Changes in health and management of online learning were observed in 123 (35.1%) of students, where loss of time and lack of concentration to learn, sleep problems, stress, anxiety, and fear were encountered the most. Conclusions: This is the first study in university education to assess students' perceptions and results achieved by online learning during our country's pandemic. Our study's findings show that 271 (77.4%) of participants have a negative perception of online learning. The most common challenges among students were Internet speed, a lack of technological equipment, and Internet disconnection. In terms of expectation fulfillment during online learning and assessment results, 245 (70%) of students' expectations were unsatisfied and unmet. These findings will address the gaps in the literature and may influence future online learning design in our country.