Changing Epidemiology of Hepatitis A and Hepatitis E Viruses in China, 1990–2014

Ren, Xiang; Wu, Peng; Wang, Liping; Geng, Mengjie; Zeng, Lingjia; Zhang, Jun; Xia, Ningshao; Lai, Shengjie; Dalton, Harry R.; Cowling, Benjamin J.; Yu, Hongjie

doi:10.3201/2302.161095

Cited by 31 publications

(21 citation statements)

References 14 publications

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“…According to public health improvement, the incidence of HAV infections has been steadily decreasing as observed in China (30-fold decline of infections between 1990 and 2014). 31 The same has been earlier observed in France with a decrease of seroprevalence from 50% to 10% in 20-year-old adults between 1978 and 2000. 32 Currently, HAV endemic areas are associated with an anti-HAV IgG prevalence above 50% which corresponds to a large part of Africa as well as some areas of Asia and South America 33 ( Figure 2).…”

Section: Epidemiology and Distribution Of Genotypessupporting

confidence: 70%

“…During Chinese public health improvements characterized by HAV decrease, HEV infections have increased 8-fold and the mortality rates have surpassed those of HAV between 2004 and 2014. 31 We can assume here that water-transmitted HEV gt1 and gt2 have progressively been replaced by other genotypes more specific to industrialized countries and associated with zoonotic transmission. Among them, HEV gt3 circulates among humans and many animals (eg, swine, rabbit, and deer) and has a worldwide distribution while gt4 circulating between humans and swine is mostly present in Southeastern Asia.…”

Section: Epidemiology and Distribution Of Genotypesmentioning

confidence: 99%

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Emerging hepatitis E virus compared with hepatitis A virus: A new sanitary challenge

Hartard

Gantzer

Bronowicki

et al. 2019

Reviews in Medical Virology

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Summary Hepatitis A (HAV) and E (HEV) viruses are able to cause liver disease in humans. Among the five classical hepatotropic viruses, they are mainly transmitted via the fecal‐oral route. Historically, many similarities have thus been described between them according to their incidence and their pathogenicity, especially in countries with poor sanitary conditions. However, recent advances have provided new insights, and the gap is widening between them. Indeed, while HAV infection incidence tends to decrease in developed countries along with public health improvement, HEV is currently considered as an underdiagnosed emerging pathogen. HEV autochthonous infections are increasingly observed and are mainly associated with zoonotic transmissions. Extra hepatic signs resulting in neurological or renal impairments have also been reported for HEV, as well as a chronic carrier state in immunocompromised patients, arguing in favor of differential pathogenesis between those two viruses. Recent molecular tools have allowed studies of viral genome variability and investigation of links between viral plasticity and clinical evolution. The identification of key functional mutations in viral genomes may improve the knowledge of their clinical impact and is analyzed in depth in the present review.

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Section: Epidemiology and Distribution Of Genotypessupporting

confidence: 70%

Section: Epidemiology and Distribution Of Genotypesmentioning

confidence: 99%

Emerging hepatitis E virus compared with hepatitis A virus: A new sanitary challenge

Hartard

Gantzer

Bronowicki

et al. 2019

Reviews in Medical Virology

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“…Owing to rapid industrialization and socioeconomic development, incidence and mortality of hepatitis A in China have undergone sharp declines, leaving hepatitis E as the most common cause of acute viral hepatitis. 3 Such an epidemiological shift is likely driven by ongoing zoonotic foodborne transmission of HEV, which has been demonstrated in swine populations across the country. In this systematic investigation of human hepatitis E infections in Shenzhen, we noted several novel features of hepatitis E in a key population center of the highly industrialized Pearl River Delta region of southern China with a large migrant population.…”

Section: Discussionmentioning

confidence: 99%

“… 2 In China, hepatitis E has overtaken hepatitis A in terms of both incidence and mortality rates over the past decade. 3 This trend is driven by a combination of factors: increasing vaccination coverage against hepatitis A, improving sanitation, and an epidemiological shift in the transmission patterns of hepatitis E.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and molecular epidemiology of hepatitis E in Shenzhen, China: a shift toward foodborne transmission of hepatitis E virus infection

Sridhar

Xing

et al. 2017

Emerging Microbes & Infections

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Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in China. Recently, a shift in molecular epidemiology from hepatitis E genotype 1 (HEV-1) to hepatitis E genotype 4 (HEV-4) has been observed in Northern China, marking a switch from human-to-human transmission to zoonosis. However, similar data from cities in Southern China are lacking. This observational study of human hepatitis E cases in Shenzhen, a metropolitan city in the Pearl River Delta region, aimed to describe the clinical features and molecular epidemiology of hepatitis E in Southern China. Over a 55-month period, we identified 20 patients with acute hepatitis E. Most were middle-aged men, and 50% of patients had concomitant liver disease, of whom 70% were identified to have non-alcoholic fatty liver disease; such patients had a trend toward higher liver enzymes. Quantitative real-time RT-PCR using archived serum samples showed that 12 patients had hepatitis E viremia at presentation. Sequencing of the RNA-dependent RNA polymerase gene was performed for five of these patients, and phylogenetic analysis revealed that these five HEV isolates belonged to subgenotype 4b and were clustered with swine HEV isolates from Southern China. Combined with other studies showing similar findings, this suggests that the molecular epidemiology of hepatitis E in China is evolving toward low-level endemicity driven by foodborne transmission from seafood or pork products. The importance of concomitant liver disease, in particular non-alcoholic fatty liver disease, as a risk factor for severe hepatitis E requires further study.

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“…Up to now, 1.5 million cases of hepatitis A virus (HAV) infections are reported worldwide [2], which indicated that hepatitis A remains a primary problem in hygiene and public health. Hepatitis A has a very similar clinical symptom compared to hepatitis E. Except for the severer pathological injuries of hepatitis E than that of hepatitis A, both of two are self-limiting diseases, do not lead to liver cirrhosis and liver cancer, and transmit via orofecal route and personto-person contact [4]. Consequently, HAV-contaminated water, vegetables, fruits, blood products, and other foodstuffs, especially undercooked shellfish including clams, oysters, and mussels (Figure 1) [5,6], are the major pathways of infections with hepatitis A [7,8].…”

Section: Introductionmentioning

confidence: 99%

Applications of Animal Models in Researching Hepatitis A

Lin¹,

Min²,

Li³

et al. 2020

Hepatitis a and Other Associated Hepatobiliary Diseases

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Hepatitis diseases are remaining in the list of significant threats to human health. Human hepatitis viruses are basically classified into six major hepatotropic pathogens-hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), hepatitis E virus (HEV), and hepatitis G virus (HGV). Among these different forms of hepatotropic viruses, HAV as the leading cause of acute viral hepatitis is characterized as a kind of tiny ribonucleic acid virus that is linked to atopic disease. As we know, animal models have been instrumental in promoting understanding of complex host-virus interactions and boosting the advancement of immune therapies. So far, animal models such as nonhuman primates (NHPs) have enabled scientists to mimic and study the pathogenicities and host immune responses for hepatitis A infection. With the exception of chimpanzees and marmosets, animals like mice, pigs, guinea pigs, and tree shrews can also be selected as alternative animal models infected with HAV under laboratory conditions. In order to gain a better insight into hepatitis A pathogenesis and relevant contents, this chapter is mainly focused on the research progress in animal models of hepatitis A, and discusses the merits and demerits of these alternative models.

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Changing Epidemiology of Hepatitis A and Hepatitis E Viruses in China, 1990–2014

Cited by 31 publications

References 14 publications

Emerging hepatitis E virus compared with hepatitis A virus: A new sanitary challenge

Emerging hepatitis E virus compared with hepatitis A virus: A new sanitary challenge

Clinical characteristics and molecular epidemiology of hepatitis E in Shenzhen, China: a shift toward foodborne transmission of hepatitis E virus infection

Applications of Animal Models in Researching Hepatitis A

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