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1.
Virologie (Montrouge) ; 25(4): 197-212, 2021 08 01.
Artigo em Francês | MEDLINE | ID: mdl-34338645

RESUMO

Hepatitis E virus is the main cause of acute hepatitis worldwide. The dichotomy between waterborne human-restricted genotypes 1 and 2 circulating in developing countries and zoonotic genotypes 3 and 4 infecting human through consumption of contaminated meat in industrialized countries is currently discussed, with the detection of HEV in waters of industrialized nations. Chronic infections are described in immunocomprommised patients, as well as extra hepatic syndromes. In vivo and in vitro data have shown that HEV genetic variability can impact the bioclinical relevance of the infection, by highlighting mutations associated with severity. Genetic variability has also to be considered when exploring transmission ways, with the description of new animal reservoirs and new strains able to infect humans. HEV genetic variability is one of the keys to better control its transmission and to adapt diagnostic tools and strategies, with the aim to protect vulnerable populations.


Assuntos
Vírus da Hepatite E , Hepatite E , Animais , Países Desenvolvidos , Hepatite E/epidemiologia , Vírus da Hepatite E/genética , Humanos , Carne , Zoonoses
2.
Ugeskr Laeger ; 183(29)2021 07 19.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34356017

RESUMO

Hepatitis E virus (HEV) is a common cause of acute hepatitis worldwide and is endemic in Europe, including Denmark. Several non-liver manifestations have been apparent, the most important of which is neurological, including neuralgic amyotrophy and Guillain-Barré syndrome as summarised in this review. Certain neurological presentations and patients with unexplained mild to moderate increase in liver enzymes, should lead to the consideration of a HEV-related condition. Many research questions regarding HEV-related neurological injury remain unanswered and need further investigation.


Assuntos
Neurite do Plexo Braquial , Síndrome de Guillain-Barré , Vírus da Hepatite E , Hepatite E , Doenças do Sistema Nervoso , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Hepatite E/complicações , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Humanos , Doenças do Sistema Nervoso/etiologia
3.
World J Gastroenterol ; 27(28): 4603-4638, 2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34366625

RESUMO

In this review the current overall knowledge on hepatitis A, B, C, D, and E will be discussed. These diseases are all characterized by liver inflammation but have significant differences in distribution, transmission routes, and outcomes. Hepatitis B virus and hepatitis C virus are transmitted by exposure to infected blood, and in addition to acute infection, they can cause chronic hepatitis, which in turn can evolve into cirrhosis. It is estimated that more than 300 million people suffer from chronic hepatitis B or C worldwide. Hepatitis D virus, which is also transmitted by blood, only affects hepatitis B virus infected people, and this dual infection results in worse liver-related outcomes. Hepatitis A and E spread via the fecal-oral route, which corresponds mainly to the ingestion of food or water contaminated with infected stools. However, in developed countries hepatitis E is predominantly a zoonosis. Although hepatitis A virus and hepatitis E virus are usually responsible for a self-limiting hepatitis, a serious, rarely fatal illness is also possible, and in immunosuppressed patients, such as organ transplant recipients, hepatitis E virus infection can become chronic. The description of goals achieved, unresolved issues, and the latest research on this topic may make it possible to speculate on future scenarios in the world of viral hepatitis.


Assuntos
Hepatite B Crônica , Vírus da Hepatite E , Hepatite E , Animais , Objetivos , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Humanos , Zoonoses
4.
Int J Artif Organs ; 44(10): 658-663, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34308705

RESUMO

OBJECTIVE: Hepatitis E virus (HEV) is one of the prevalent nosocomially transmitted agents among patients on maintenance hemodialysis due to parenteral transmission of HEV and immunocompromised condition of chronic hemodialysis patients. Therefore, this study aimed to investigate prevalence, risk factors, and genotypic pattern of HEV infection among hemodialysis patients in South of Iran. METHODS: All patients on maintenance hemodialysis attending the hemodialysis centers of Bushehr, Borazjan, and Genaveh cities for regular hemodialysis were enrolled in this study. Serum samples were tested for the presence of anti-HEV antibodies using ELISA kit. The serum samples were further tested for detection of HEV RNA using nested RT-PCR. RESULTS: Of 226 hemodialysis patients, 155 patients (68.6%, 95% CI: 62.3%-74.3%) were positive for anti-HEV IgG antibody, of which 33 patients (14.6%, 95% CI: 10.6%-19.8%) had anti-HEV IgM antibody. The prevalence of anti-HEV IgG and anti-IgM antibodies in non-hemodialysis controls were 65.1% and 9.6%, respectively. Although the hemodialysis patients had higher prevalence of HEV than the controls, the difference was not significant. All samples were negative for HEV RNA. HEV seroprevalence among hemodialysis patients was not significantly associated with place of residency, ethnicity, level of education, gender distribution, hemodialysis duration, and levels of liver enzymes. HEV seropositive patients had significantly higher mean age compared to seronegative patients. CONCLUSION: This study reports the highest seroprevalence of HEV among hemodialysis patients in Iran. Inapparent HEV infection in the dialysis setting calls for regular screening of hemodialysis patients regardless of the hemodialysis duration, clinical symptoms, and liver function parameters.


Assuntos
Hepatite E , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Prevalência , Diálise Renal/efeitos adversos , Estudos Soroepidemiológicos
5.
Viruses ; 13(5)2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34067873

RESUMO

People who use crack-cocaine (PWUCC) have numerous vulnerabilities and pose a challenge to health and social assistance services. The exposure to pathogens and risk situations occur differently according to each individual, region and social group. This study identified the presence, genotypes and factors associated with hepatitis E virus (HEV) exposure among a community-recruited cohort of 437 PWUCC in northern Brazil. Epidemiological information was collected through community-based assessments and interviews. Thereafter, blood and fecal samples were collected and tested for HEV using an immunoenzymatic assay, and the genotype was identified by PCR. Logistic regressions were used to identify the risk factors independently associated with exposure to HEV. In total, 79 (18.1%) PWUCC were exposed to HEV: 73 (16.7%) for IgG and six for IgG + IgM. HEV RNA was detected in six fecal samples and in two blood samples from PWUCC with IgM + IgG. Subtype 3c was identified in all of the samples. The factors associated with exposure to HEV were low monthly income, unstable housing (e.g., homelessness), crack-cocaine use ≥40 months, and the shared use of crack-cocaine equipment. The current study provides unique initial insights into HEV status and risk factors among PWUCC in a remote area in Brazil, with diverse implications for urgently improved diagnosis, prevention, and treatment intervention needs.


Assuntos
Cocaína Crack , Usuários de Drogas , Vírus da Hepatite E , Hepatite E/epidemiologia , Hepatite E/transmissão , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Genótipo , Geografia Médica , Hepatite E/virologia , Vírus da Hepatite E/classificação , Vírus da Hepatite E/genética , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Vigilância em Saúde Pública , Adulto Jovem
6.
BMC Gastroenterol ; 21(1): 266, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130641

RESUMO

BACKGROUND: The rapid growth of Qatar in the last two decades has attracted a large influx of immigrant workers who mostly come from HEV-hyperendemic countries. Thus, we aim to investigate the prevalence of HEV among acute non-A-C hepatitis patients in Qatar; and to evaluate the performance of four dominant commercial serological assays for HEV diagnosis. METHODS: 259 patients with non-A-C hepatitis were tested using the Wantai HEV-IgM, HEV-IgG, HEV-Ag ELISA kits, and the MP Biomedical HEV-Total Ab ELISA kit. ALT levels were tested and HEV RNA (viral loads) was performed using Taqman AmpliCube HEV RT-PCR kit (Mikrogen, Neuried, Germany). The performance of each kit was assessed according to the RT-PCR results. RESULTS: HEV-RNA was detected in 23.1% of the samples. Most of these HEV-RNA-positive cases belonged to non-Qatari residents from the Indian subcontinent; India, Pakistan, etc. HEV-Ag, HEV-IgM, HEV-IgG, HEV-Total Ab were detected in 5.56%, 8.65%, 32.1%, and 34.2% of all tested samples, respectively. Elevated ALT levels were highly correlated with the HEV-Ag, HEV-IgM, HEV-RNA but not with the HEV-IgG and HEV-Total Ab. Although HEV-Ag was very specific (100%), yet its sensitivity was poor (36.7%). HEV-IgM demonstrated the best second marker for diagnosis of acute HEV after RT-PCR as jugged by the overall performance parameters: specificity (96.2%), sensitivity (71.4%), PPV (83.3%), NPP (92.7%), agreement with RT-PCR (91.0%), and Kappa-value (0.71). CONCLUSION: Our study demonstrated a high prevalence of HEV virus in Qatar, mostly among immigrants from the Indian subcontinent. The HEV-IgM represents the best marker for detecting the acute HEV infection, where RT-PCR cannot be performed.


Assuntos
Vírus da Hepatite E , Hepatite E , Alemanha , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Vírus da Hepatite E/genética , Humanos , Imunoglobulina G , Imunoglobulina M , Índia , Paquistão , Prevalência , Catar/epidemiologia , RNA Viral , Sensibilidade e Especificidade
7.
Infect Dis Poverty ; 10(1): 91, 2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187566

RESUMO

BACKGROUND: Hepatitis E, an acute zoonotic disease caused by the hepatitis E virus (HEV), has a relatively high burden in developing countries. The current research model on hepatitis E mainly uses experimental animal models (such as pigs, chickens, and rabbits) to explain the transmission of HEV. Few studies have developed a multi-host and multi-route transmission dynamic model (MHMRTDM) to explore the transmission feature of HEV. Hence, this study aimed to explore its transmission and evaluate the effectiveness of intervention using the dataset of Jiangsu Province. METHODS: We developed a dataset comprising all reported HEV cases in Jiangsu Province from 2005 to 2018. The MHMRTDM was developed according to the natural history of HEV cases among humans and pigs and the multi-transmission routes such as person-to-person, pig-to-person, and environment-to-person. We estimated the key parameter of the transmission using the principle of least root mean square to fit the curve of the MHMRTDM to the reported data. We developed models with single or combined countermeasures to assess the effectiveness of interventions, which include vaccination, shortening the infectious period, and cutting transmission routes. The indicator, total attack rate (TAR), was adopted to assess the effectiveness. RESULTS: From 2005 to 2018, 44 923 hepatitis E cases were reported in Jiangsu Province. The model fits the data well (R2 = 0.655, P < 0.001). The incidence of the disease in Jiangsu Province and its cities peaks are around March; however, transmissibility of the disease peaks in December and January. The model showed that the most effective intervention was interrupting the pig-to-person route during the incidence trough of September, thereby reducing the TAR by 98.11%, followed by vaccination (reducing the TAR by 76.25% when the vaccination coefficient is 100%) and shortening the infectious period (reducing the TAR by 50.05% when the infectious period is shortened to 15 days). CONCLUSIONS: HEV could be controlled by interrupting the pig-to-person route, shortening the infectious period, and vaccination. Among these interventions, the most effective was interrupting the pig-to-person route.


Assuntos
Hepatite E/prevenção & controle , Zoonoses/prevenção & controle , Animais , China/epidemiologia , Modelos Animais de Doenças , Estudos de Viabilidade , Hepatite E/epidemiologia , Hepatite E/transmissão , Humanos , Modelos Teóricos , Suínos , Vacinação
8.
J Vet Diagn Invest ; 33(4): 655-663, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34075814

RESUMO

The use of oral fluid (OF) to detect zoonotic pathogens in pigs has been only scarcely assessed. We evaluated OF as a potential specimen for detection by culture of methicillin-resistant Staphylococcus aureus (MRSA) and Yersinia enterocolitica, and the detection of antibodies against Salmonella spp. and hepatitis E virus (HEV) using commercial ELISAs. Samples from 33 pig farms were collected at the beginning and end of the fattening period. Results of the OF samples were compared with the results of serum samples and nasal swabs from individual pigs and pen floor fecal samples, using the Cohen kappa (κ) and the McNemar test. For Salmonella spp. antibodies, OF samples were negative, although the corresponding serum samples were positive. The detection of HEV antibodies in sera and OF had agreement at the first sampling, and poor and significant agreement at the second sampling (κ = 0.185, McNemar p = 0.238; κ = 0.088, McNemar p < 0.001). At both sampling times, the detection of MRSA in nasal swabs and OF showed agreement (κ = 0.466, McNemar p = 0.077; κ = 0.603, McNemar p = 1); agreement was seen for the detection of Y. enterocolitica in fecal and OF samples (κ = 0.012, McNemar p = 0.868; κ = 0.082, McNemar p = 0.061, respectively). According to the McNemar test, the use of pen-based OFs is more feasible for the detection of MRSA and Y. enterocolitica by culture than is detection of antibodies by commercial ELISA.


Assuntos
Hepatite E/veterinária , Saliva/microbiologia , Salmonelose Animal/epidemiologia , Infecções Estafilocócicas/veterinária , Doenças dos Suínos/epidemiologia , Yersiniose/veterinária , Animais , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Hepatite E/microbiologia , Vírus da Hepatite E/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Prevalência , Salmonella/isolamento & purificação , Salmonelose Animal/diagnóstico , Salmonelose Animal/microbiologia , Estudos Soroepidemiológicos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Sus scrofa , Suínos , Doenças dos Suínos/diagnóstico , Doenças dos Suínos/microbiologia , Suíça/epidemiologia , Yersiniose/diagnóstico , Yersiniose/epidemiologia , Yersiniose/microbiologia , Yersinia enterocolitica/isolamento & purificação
9.
J Clin Virol ; 139: 104738, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33933822

RESUMO

Hepatitis E Virus (HEV) is emerging as a public health concern across Europe and tools for complete genome data to aid epidemiological and virulence analysis are needed. The high sequence heterogeneity observed amongst HEV genotypes has restricted most analyses to subgenomic regions using PCR-based methods, which can be unreliable due to poor primer homology. We designed a panel of custom-designed RNA probes complementary to all published HEV full genome NCBI sequences. A target enrichment protocol was performed according to the NimbleGen® standard protocol for Illumina® library preparation. Optimisation of this protocol was performed using 40 HEV RNA-positive serum samples and the World Health Organization International Reference Panel for Hepatitis E Virus RNA Genotypes for Nucleic Acid Amplification Technique (NAT)-Based Assays and related reference materials. Deep sequencing using this target enrichment protocol resulted in whole genome consensus sequences from samples with a viral load range of 1.25 × 104-1.17 × 107 IU/mL. Phylogenetic analysis of these sequences recapitulated and extended the partial genome results obtained from genotyping by Sanger sequencing (genotype 1, ten samples and genotype 3, 30 samples). The protocol is highly adaptable to automation and could be used to sequence full genomes of large sample numbers. A more comprehensive understanding of hepatitis E virus transmission, epidemiology and viral phenotype prediction supported by an efficient method of sequencing the whole viral genome will facilitate public health initiatives to reduce the prevalence and mitigate the harm of HEV infection in Europe.


Assuntos
Vírus da Hepatite E , Hepatite E , Genoma Viral , Genótipo , Hepatite E/epidemiologia , Vírus da Hepatite E/genética , Humanos , Fenótipo , Filogenia , RNA Viral/genética , Sequenciamento Completo do Genoma
10.
Zoonoses Public Health ; 68(5): 474-482, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33934531

RESUMO

In humans, hepatitis E virus (HEV) is responsible for an acute enterically transmitted hepatitis, which can become chronic in immune-compromised patients. Genotypes 3 and 4 (HEV-3 and HEV-4) are zoonotic, and domestic pigs and wild boar are the main reservoirs. The occurrence of autochthonous cases in Europe, which have been increasing over the last 10 years, has been associated with food-borne zoonotic transmission of HEV-3, mainly linked to consumption of undercooked or raw pork products (sausages containing liver) and wild boar meat. Zoonotic HEV-3 strains are widespread on pig farms, but little information is available on the dynamic of HEV-3 infection within farms, among pigs. The aims of this study were to evaluate the prevalence of the infection among pigs of different ages along the production chain by the zoonotic HEVs, and to evaluate how long the virus may persist in the farm environment. The presence of HEV-RNA was investigated by real-time reverse transcription PCR (RT-PCR) in 281 test faecal pools over 19 months (2017-2019) on a two-site farrow-to-finish farm (about 1,000 sows), in Northern Italy. A total of 67/281 test faecal pools (23.8%) resulted positive for the presence of HEV-RNA (site 1: 59/221, 26.7%; site 2: 8/60, 13.3%). Nucleotide sequencing revealed a unique HEV-3 viral variant circulating during 19 months of surveillance. The same HEV-3 strain was detected in the same farm on 2012, indicating the persistence of the same virus over 7 years, and highlighting the role of the environment as a continuous source of infection on pig farms. The results confirmed the circulation of the zoonotic genotype HEV-3 in pigs before slaughtering.


Assuntos
Vírus da Hepatite E/isolamento & purificação , Hepatite E/veterinária , Doenças dos Suínos/virologia , Animais , Fazendas , Fezes/virologia , Hepatite E/epidemiologia , Hepatite E/virologia , Vírus da Hepatite E/genética , Itália/epidemiologia , Filogenia , Vigilância da População , Suínos , Doenças dos Suínos/epidemiologia , Fatores de Tempo , Zoonoses Virais/epidemiologia , Zoonoses Virais/virologia
11.
World J Gastroenterol ; 27(18): 2090-2104, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34025066

RESUMO

Hepatitis E virus (HEV) is an important cause of repeated waterborne outbreaks of acute hepatitis. Recently, several extrahepatic manifestations (EHMs) have been described in patients with HEV infection. Of these, neurological disorders are the most common EHM associated with HEV. The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation. Patients can present with normal liver function tests, which can often be misleading for physicians. There is a paucity of data on HEV-related neurological manifestations; and these data are mostly described as case reports and case series. In this review, we analyzed data of 163 reported cases of HEV-related neurological disorders. The mechanisms of pathogenesis, clinico-demographic profile, and outcomes of the HEV-related neurological disorders are described in this article. Nerve root and plexus disorder were found to be the most commonly reported disease, followed by meningoencephalitis.


Assuntos
Neurite do Plexo Braquial , Vírus da Hepatite E , Hepatite E , Doenças do Sistema Nervoso , Sistema Nervoso Central , Hepatite E/complicações , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Humanos , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia
12.
Liver Int ; 41(7): 1462-1473, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33960603

RESUMO

The hepatitis E virus (HEV) is one of the main causes of acute hepatitis and the de facto global burden is underestimated. HEV-related clinical complications are often undetected and are not considered in the differential diagnosis. Convincing findings from studies suggest that HEV is clinically relevant not only in developing countries but also in industrialized countries. Eight HEV genotypes (HEV-1 to HEV-8) with different human and animal hosts and other HEV-related viruses are in circulation. Transmission routes vary by genotype and location, with large waterborne outbreaks in developing countries and zoonotic food-borne infections in developed countries. An acute infection can be aggravated in pregnant women, organ transplant recipients, patients with pre-existing liver disease and immunosuppressed patients. HEV during pregnancy affects the fetus and newborn with an increased risk of vertical transmission, preterm and stillbirth, neonatal jaundice and miscarriage. Hepatitis E is associated with extrahepatic manifestations that include neurological disorders such as neuralgic amyotrophy, Guillain-Barré syndrome and encephalitis, renal injury and haematological disorders. The risk of transfusion-transmitted HEV is increasingly recognized in Western countries where the risk may be because of a zoonosis. RNA testing of blood components is essential to determine the risk of transfusion-transmitted HEV. There are currently no approved drugs or vaccines for HEV infections. This review focuses on updating the latest developments in zoonoses, screening and diagnostics, drugs in use and under development, and vaccines.


Assuntos
Medicina Clínica , Vírus da Hepatite E , Hepatite E , Saúde Única , Animais , Feminino , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Vírus da Hepatite E/genética , Humanos , Recém-Nascido , Gravidez , Zoonoses/epidemiologia
13.
Liver Int ; 41 Suppl 1: 68-72, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33975382

RESUMO

Hepatitis E virus (HEV) infection is a worldwide disease and the primary cause of acute viral hepatitis with an estimated 3.3 million symptomatic cases every year and 44,000 related deaths. It is a waterborne infection in the developing countries. In these countries, HEV genotypes 1 and 2 cause large outbreaks and affect young subjects resulting in significant mortality in pregnant women and patients with cirrhosis. In developed countries, HEV genotypes 3 and 4 are responsible for autochthonous, sporadic hepatitis and transmission is zoonotic. Parenteral transmission by the transfusion of blood products has been identified as a potential new mode of transmission. HEV can also cause neurological disorders and chronic infections in immunocompromised patients. The progression of acute hepatitis E is usually asymptomatic and resolves spontaneously. Diagnosis is based on both anti-HEV IgM antibodies in serum and viral RNA detection in blood or stools by PCR in immunocompetent patients, while only PCR is validated in immunocompromised individuals. Ribavirin is the only validated treatment in chronic infection. A vaccine has been developed in China.


Assuntos
Vírus da Hepatite E , Hepatite E , China , Feminino , Anticorpos Anti-Hepatite , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Vírus da Hepatite E/genética , Humanos , Gravidez , Ribavirina
14.
Res Vet Sci ; 137: 40-43, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33932821

RESUMO

Hepatitis E virus (HEV) typically causes self-limiting acute viral hepatitis, however chronic infection and extrahepatic manifestations have increasingly become a significant health problem. Domestic pigs and wild boars are the main reservoirs of HEV genotype 3 and genotype 4 for human infections in industrialized countries, although molecular and serological evidence suggest that several additional animal species may act as HEV hosts. In this study, by assessing serologically and molecularly the sera of 324 household cats from Apulia region (Italy), HEV antibodies were detected with an overall prevalence of 3.1%. Viral RNA was not detected in the sera of the animals using both HEV-specific assays and a pan-hepevirus broadly reactive set of primers for Hepeviridae. These findings document a low seroprevalence to HEV in cats in the investigated geographical setting. The exact nature of the HEV-like strains circulating in feline population remains to be established.


Assuntos
Doenças do Gato/epidemiologia , Anticorpos Anti-Hepatite/sangue , Hepatite E/veterinária , Animais , Doenças do Gato/sangue , Doenças do Gato/virologia , Gatos , Genótipo , Anticorpos Anti-Hepatite/genética , Hepatite E/epidemiologia , Hepatite E/genética , Vírus da Hepatite E/imunologia , Itália/epidemiologia , Prevalência , Estudos Soroepidemiológicos
15.
PLoS One ; 16(4): e0250505, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33914782

RESUMO

In the summer of 2017, an estimated 745,000 Rohingya fled to Bangladesh in what has been described as one of the largest and fastest growing refugee crises in the world. Among numerous health concerns, an outbreak of acute jaundice syndrome (AJS) was detected by the disease surveillance system in early 2018 among the refugee population. This paper describes the investigation into the increase in AJS cases, the process and results of the investigation, which were strongly suggestive of a large outbreak due to hepatitis A virus (HAV). An enhanced serological investigation was conducted between 28 February to 26 March 2018 to determine the etiologies and risk factors associated with the outbreak. A total of 275 samples were collected from 18 health facilities reporting AJS cases. Blood samples were collected from all patients fulfilling the study specific case definition and inclusion criteria, and tested for antibody responses using enzyme-linked immunosorbent assay (ELISA). Out of the 275 samples, 206 were positive for one of the agents tested. The laboratory results confirmed multiple etiologies including 154 (56%) samples tested positive for hepatitis A, 1 (0.4%) positive for hepatitis E, 36 (13%) positive for hepatitis B, 25 (9%) positive for hepatitis C, and 14 (5%) positive for leptospirosis. Among all specimens tested 24 (9%) showed evidence of co-infections with multiple etiologies. Hepatitis A and E are commonly found in refugee camps and have similar clinical presentations. In the absence of robust testing capacity when the epidemic was identified through syndromic reporting, a particular concern was that of a hepatitis E outbreak, for which immunity tends to be limited, and which may be particularly severe among pregnant women. This report highlights the challenges of identifying causative agents in such settings and the resources required to do so. Results from the month-long enhanced investigation did not point out widespread hepatitis E virus (HEV) transmission, but instead strongly suggested a large-scale hepatitis A outbreak of milder consequences, and highlighted a number of other concomitant causes of AJS (acute hepatitis B, hepatitis C, Leptospirosis), albeit most likely at sporadic level. Results strengthen the need for further water and sanitation interventions and are a stark reminder of the risk of other epidemics transmitted through similar routes in such settings, particularly dysentery and cholera. It also highlights the need to ensure clinical management capacity for potentially chronic conditions in this vulnerable population.


Assuntos
Surtos de Doenças , Vírus da Hepatite A/isolamento & purificação , Hepatite A/epidemiologia , Icterícia/epidemiologia , Adolescente , Bangladesh/epidemiologia , Criança , Pré-Escolar , Feminino , Hepacivirus/genética , Hepacivirus/patogenicidade , Hepatite A/sangue , Hepatite A/virologia , Vírus da Hepatite A/patogenicidade , Hepatite B/sangue , Hepatite B/epidemiologia , Hepatite B/virologia , Vírus da Hepatite B/genética , Vírus da Hepatite B/patogenicidade , Hepatite C/sangue , Hepatite C/epidemiologia , Hepatite C/virologia , Hepatite E/sangue , Hepatite E/epidemiologia , Hepatite E/virologia , Vírus da Hepatite E/genética , Vírus da Hepatite E/patogenicidade , Humanos , Lactente , Recém-Nascido , Icterícia/sangue , Icterícia/patologia , Icterícia/virologia , Leptospirose/sangue , Leptospirose/epidemiologia , Leptospirose/parasitologia , Leptospirose/patologia , Masculino , Gravidez , Campos de Refugiados , Refugiados , Fatores de Risco , Populações Vulneráveis
16.
J Viral Hepat ; 28(7): 1078-1090, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33877740

RESUMO

Hepatitis E virus (HEV) usually causes self-limited liver diseases but can also result in severe cases. Genotypes 1 (G1) and 2 circulate in developing countries are human-restricted and waterborne, while zoonotic G3 and G4 circulating in industrialized countries preferentially infect human through consumption of contaminated meat. Our aims were to identify amino acid patterns in HEV variants that could be involved in pathogenicity or in transmission modes, related to their impact on antigenicity and viral surface hydrophobicity. HEV sequences from human (n = 37) and environmental origins (wild boar [n = 3], pig slaughterhouse effluent [n = 6] and urban wastewater [n = 2]) were collected for the characterization of quasispecies using ultra-deep sequencing (ORF2/ORF3 overlap). Predictive and functional assays were carried out to investigate viral particle antigenicity and hydrophobicity. Most quasispecies showed a major variant while a mixture was observed in urban wastewater and in one chronically infected patient. Amino acid signatures were identified, as a rabbit-linked HEV pattern in two infected patients, or the S68L (ORF2) / H81C (ORF3) residue mostly identified in wild boars. By comparison with environmental strains, molecular patterns less likely represented in humans were identified. Patterns impacting viral hydrophobicity and/or antigenicity were also observed, and the higher hydrophobicity of HEV naked particles compared with the enveloped forms was demonstrated. HEV variants isolated from human and environment present molecular patterns that could impact their surface properties as well as their transmission. These molecular patterns may concern only one minor variant of a quasispecies and could emerge under selective pressure.


Assuntos
Vírus da Hepatite E , Hepatite E , Animais , Países Desenvolvidos , Hepatite E/epidemiologia , Vírus da Hepatite E/genética , Humanos , Quase-Espécies , Coelhos , Propriedades de Superfície , Suínos
17.
J Viral Hepat ; 28(7): 1091-1097, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33894038

RESUMO

Some studies have exposed an increase in liver cirrhosis in hepatitis E seropositive individuals living with human immunodeficiency virus. The interrelation between HEV seroprevalence and risk of liver disease in immune-competent individuals remains under- investigated. Using the National Health and Nutrition Examination Survey (NHANES) data containing >30,000 subjects, we addressed if HEV exposure leads to subclinical effects that can influence liver health. We determined the association between HEV IgM and ALT and that of HEV IgG and Fib-4-a composite score reflecting potential liver fibrosis. These analyses were repeated in populations at risk for liver disease as well as among different races and ethnicities. The prevalence of HEV IgG was significantly associated with age as IgG positive individuals were, on average, 20 years older than IgG negative patients. We found a statistically significant increase in the likelihood of having a Fib-4 score >1.45 (significant fibrosis) in those positive for HEV IgG (RR: 1.03; 95% CI: 1.01-1.05). However, due to the small effect, it is unlikely that this association has clinical significance. Moreover, the effect was not present in those with pre-existing liver disease. We found no association between ALT levels and the presence of HEV IgM or IgG. This is the first study examining subclinical effects of HEV infection in the United States. Our study found that in the general US population, predominantly asymptomatic HEV infections do not contribute to the overall burden of liver disease.


Assuntos
Vírus da Hepatite E , Hepatite E , Adulto , Anticorpos Anti-Hepatite , Hepatite E/complicações , Hepatite E/epidemiologia , Humanos , Imunoglobulina G , Imunoglobulina M , Inquéritos Nutricionais , Estudos Soroepidemiológicos , Estados Unidos/epidemiologia , Adulto Jovem
18.
AIDS Res Hum Retroviruses ; 37(7): 534-541, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33794657

RESUMO

Hepatitis E virus (HEV) is thought to be common in the United States with increased prevalence in those with concomitant hepatitis C virus (HCV) or HCV/HIV coinfection. Little is known regarding true prevalence, incidence, and antibody seroreversion in these populations. We sought to define these rates among HCV and HCV/HIV coinfected persons in the Washington, DC area. Two longitudinal cohorts of HCV and HCV/HIV coinfected subjects from the Washington, DC area were evaluated. Multiple HEV test modalities were deployed including immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody testing, evaluation of antibody avidity, HEV RNA testing, and HEV enzyme-linked immune absorbent spot (ELISPOT) analysis. A total of 379 individuals were evaluated including 196 who were HCV monoinfected and 183 HCV/HIV coinfected. Anti-HEV IgG was detected and confirmed in 18.7% of the cohort at baseline. None demonstrated anti-HEV IgM positive or HEV RNA positive results. Proportions of HEV antibody prevalence did not significantly differ between groups. Longitudinal follow-up samples were available for 226 individuals with a mean follow-up time of 24 months. Seroreversion was noted in 1.8%. One HCV/HIV infected person seroconverted to HEV IgG positivity in the followed cohort. About 40% of the positive population demonstrated high avidity suggestive of more remote exposure. Interferon gamma ELISPOT was performed in 70 subjects and false negative and false positive HEV enzyme-linked immunosorbent assay antibodies were identified. In HIV-infected persons in the United States HEV exposure and seroconversion is frequent enough that HEV should be considered in the differential diagnosis of acute hepatitis. Seroreversion may lead to underestimation of true infection risk.


Assuntos
Coinfecção , Infecções por HIV , Hepatite C , Hepatite E , Coinfecção/epidemiologia , Infecções por HIV/complicações , Hepacivirus , Hepatite C/complicações , Hepatite C/epidemiologia , Hepatite E/complicações , Hepatite E/epidemiologia , Humanos , RNA Viral
19.
Viruses ; 13(3)2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33809748

RESUMO

Hepatitis E virus (HEV) infection is widespread among domestic pigs, industrial swine, and wild boars in Bulgaria. The aim of the current research was to present the HEV seroprevalence among blood donors in Bulgaria. In the present study, 555 blood donors (479 males and 76 females) were enrolled from five districts in the country (Shumen, Pleven, Stara Zagora, Plovdiv, and Sofia districts). All blood samples were tested for anti-HEV IgG using the recomWell HEV IgG ELISA test (Mikrogen GmbH, Neuried, Germany). Each participating donor completed a short, structured, and specific questionnaire to document data on the current study. Anti-HEV IgG positive results were detected in 144 (25.9%) blood donors, including 129 (26.9%) males and 15 (19.7%) females. The established HEV seropositivity was 28.8% (23/80) in Shumen district, 23.2% (22/95) in Pleven district, 27.1% (38/140) in Stara Zagora district, 27.5% (44/160) in Plovdiv district, and 21.3% (17/80) in Sofia district. A high HEV seroprevalence was found for persons who declared that they were general hunters (48.7%; 19/39; p = 0.001) and hunters of wild boars (51.6%; 16/31; p = 0.001). We present the first seroprevalence rates of HEV infection in blood donors from Bulgaria. The results of our research showed high HEV seropositivity among blood donors.


Assuntos
Anticorpos Antivirais/sangue , Doadores de Sangue , Anticorpos Anti-Hepatite/sangue , Hepatite E/epidemiologia , Imunoglobulina G/sangue , Adulto , Bulgária/epidemiologia , Feminino , Vírus da Hepatite E , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos
20.
World J Gastroenterol ; 27(12): 1240-1254, 2021 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-33828397

RESUMO

BACKGROUND: Hepatitis E virus (HEV) infection is underdiagnosed due to the use of serological assays with low sensitivity. Although most patients with HEV recover completely, HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death. AIM: To demonstrate the prevalence of HEV infection in solid organ transplant (SOT) recipients. METHODS: We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through October 2020. The inclusion criteria consisted of adult patients with history of SOT. HEV infection is confirmed by either HEV-immunoglobulin G, HEV-immunoglobulin M, or HEV RNA assay. RESULTS: Of 563 citations, a total of 22 studies (n = 4557) were included in this meta-analysis. The pooled estimated prevalence of HEV infection in SOT patients was 20.2% [95% confidence interval (CI): 14.9-26.8]. The pooled estimated prevalence of HEV infection for each organ transplant was as follows: liver (27.2%; 95%CI: 20.0-35.8), kidney (12.8%; 95%CI: 9.3-17.3), heart (12.8%; 95%CI: 9.3-17.3), and lung (5.6%; 95%CI: 1.6-17.9). Comparison across organ transplants demonstrated statistical significance (Q = 16.721, P = 0.002). The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries. The pooled estimated prevalence of de novo HEV infection was 5.1% (95%CI: 2.6-9.6) and the pooled estimated prevalence of acute HEV infection was 4.3% (95%CI: 1.9-9.4). CONCLUSION: HEV infection is common in SOT recipients, particularly in middle-income countries. The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants. More studies examining the clinical impacts of HEV infection in SOT recipients, such as graft failure, rejection, and mortality are warranted.


Assuntos
Vírus da Hepatite E , Hepatite E , Transplante de Órgãos , Adulto , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Vírus da Hepatite E/genética , Humanos , Transplante de Órgãos/efeitos adversos , RNA Viral , Transplantados
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