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Introduction:In general, the hepatitis E virus (HEV) causes acute, self-limiting hepatitis. Prolonged and chronic infections caused by HEV genotype 3 have been found in some immunosuppressed patients in developed countries.Case Presentation:Here we report a Chinese boy with acute lymphoblastic leukemia, who developed hepatitis E during a period of intensive chemotherapy. Twenty months after the initial infection, HEV viremia was reappeared in the patient, with detectable anti-HEV IgM and IgG and modestly elevated serum transaminases. Sequence analysis of the viral RNAs revealed the reactivation of the HEV genotype 4d strain, indicating viral persistence in the patient.Conclusions:To our knowledge, this is the first chronic case confirmed by the prolonged presence of HEV RNA in china. It is also the first reported persistent hepatitis E infection caused by HEV genotype 4.

Hepatitis E virus (HEV) was first detected in rabbits in the year 2009. Rabbit HEV is now known to be widely prevalent in rabbits and tentatively assigned into genotype 3 (HEV‐3) as subgenotype‐3ra (HEV‐3ra). However, its role in human infection remains undetermined. This study was conducted to investigate the prevalence of HEV infection among rabbit slaughterhouse workers and to identify whether the workers exposed to rabbits are at a higher risk of HEV infection. Seventy‐five workers at rabbit slaughterhouses and a control group of 421 general adults in the same area in Hebei province, China, were serologically examined for anti‐HEV antibodies. HEV seroprevalences between the slaughterhouse workers and the general adults were compared. Age‐adjusted prevalence of anti‐HEV immunoglobulin G (IgG) in the rabbit slaughterhouse workers and control group was 46.1% and 10.8% respectively. The slaughterhouse workers had significantly higher seroprevalence and an approximately 6.9‐fold increased risk for being seropositive for anti‐HEV IgG as compared to the general population (odds ratio, 6.9; 95% CI: 4.3, 10.9). In slaughterhouse workers, anti‐HEV IgG positive rate was positively associated with working years; in general adults, this rate was positively associated with age. The prevalence of anti‐HEV immunoglobulin M (IgM) among exposed workers (6.7%) was significantly higher than that of control groups (1.2%). In conclusion, the seroprevalence of HEV is significantly higher in slaughterhouse workers than in general adults indicating that occupational exposure to rabbits is a potential risk factor for HEV infection.

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