Current epidemiology of hepatitis E virus infection in the United States: Low seroprevalence in the National Health and Nutrition Evaluation Survey

Ditah, Ivo; Ditah, Fausta; Devaki, Pardha; Ditah, Calistus; Kamath, Patrick S.; Charlton, Michael

doi:10.1002/hep.27219

Cited by 98 publications

(117 citation statements)

References 49 publications

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“…Last, the proportion of patients with detectable anti‐HEV IgG declined over time during the study period from 1998 to 2011 (http://onlinelibrary.wiley.com/doi/10.1002/hep.28649/suppinfo). Other studies have also noted a decline in the prevalence of anti‐HEV IgG‐positive blood donors and individuals in the general population using the same assay . The reason for the declining seroprevalance in Western patients over time is unknown, but a consistent finding.…”

Section: Discussionmentioning

confidence: 78%

The role of hepatitis E virus infection in adult Americans with acute liver failure

Fontana

Engle

Scaglione³

et al. 2016

Hepatology

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Acute hepatitis E virus (HEV) infection is a leading cause of acute liver failure (ALF) in many developing countries yet rarely identified in Western countries. Since antibody testing for HEV infection is not routinely obtained, we hypothesized that HEV-related ALF might be present and unrecognized in North American ALF patients. Serum samples of 681 adults enrolled in the US ALF Study Group were tested for anti-HEV IgM and anti-HEV IgG levels. Subjects with a detectable anti-HEV IgM also underwent testing for HEV-RNA. Mean patient age was 41.8 years, 32.9% male, and ALF etiologies included acetaminophen hepatotoxicity (29%), indeterminate ALF (23%), idiosyncratic DILI (22%), acute HBV infection (12%), autoimmune hepatitis (12%) and pregnancy related ALF (2%). Three men ages 36, 39, and 70 demonstrated repeatedly detectable anti-HEV IgM but all were HEV RNA negative and had other putative diagnoses. The latter two subjects died within 3 and 11 days of enrollment while the 36 year old underwent emergency liver transplantation on study day 2. At admission, 294 (43.4%) of the ALF patients were anti-HEV IgG positive with the seroprevalence being highest in those from the Midwest (50%) and lowest in those from the Southeast (28%). Anti-HEV IgG + subjects were significantly older, less likely to have APAP overdose, and had a lower overall 3 week survival compared to anti-HEV IgG − subjects (63% vs 70%, p= 0.018). CONCLUSIONS Acute HEV infection is very rare in adult Americans with ALF (i.e., 0.4%) and could not be implicated in any indeterminate, autoimmune, or pregnancy-related ALF cases. Prior exposure to HEV with detectable anti-HEV IgG was significantly more common in the ALF patients compared to the general US population.

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Section: Discussionmentioning

confidence: 78%

The role of hepatitis E virus infection in adult Americans with acute liver failure

Fontana

Engle

Scaglione³

et al. 2016

Hepatology

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“…The lower prevalence of anti-HEV in the animal handlers and blood donor population also may be due to the implementation of stringent universal precautions in the workplace and a declining prevalence of anti-HEV in the general population. Indeed, a recent analysis of the general U.S. population sampled in the NHANES study conducted between 2009 and 2010 reported an estimated anti-HEV prevalence of 6% (35). Although different assays with different performance characteristics were used for anti-HEV testing between studies (36), a recent comparison of the prevalence of anti-HEV in both NHANES panels with the same anti-HEV assay found a prevalence of 16.8% in the 1988-1994 panel and only 6.4% in the 2009-2010 panel, suggesting that the prevalence of anti-HEV in the United States has diminished (37).…”

Section: Discussionmentioning

confidence: 99%

An Epidemiologic Investigation of a Case of Acute Hepatitis E

et al. 2015

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Hepatitis E virus (HEV) is considered a zoonotic infection in developed nations. A case of acute hepatitis E in a researcher following a scalpel injury while working on a pig prompted a seroepidemiologic study to identify potential modes of transmission and determine the seroprevalence of HEV among animal handlers at the institute. Sera from personnel (n ‫؍‬ 64) in two animal facilities and age/sex-matched blood donors (n ‫؍‬ 63) as controls were tested for IgG anti-HEV and, if positive, for IgM anti-HEV and HEV RNA. Sera and stool from pigs aged 6 to 12 weeks from the breeding farm and older pigs from animal facilities were tested similarly. The median age of personnel was 36 years, 74% were white, 56% were male, and 74% had direct exposure to pigs. The prevalence of anti-HEV was 3.1% among personnel compared to 3.2% among blood donors; none were positive for IgM anti-HEV or HEV RNA. IgG anti-HEV was detected in sera from 10% of pigs aged 6 to 8 weeks, 80% aged 10 weeks, 100% aged 12 weeks, and 76% aged >12 weeks. HEV RNA was detected in stool but not sera from three 12-week-old pigs. Sequencing revealed HEV genotype 3 with ϳ10% difference between the patient and pig sequences. Parenteral transmission is a potential mode of acute HEV infection. The low and similar seroprevalence of anti-HEV between the at-risk group and age-matched blood donors suggests low transmission risk with universal precautions among animal handlers.H epatitis E virus (HEV) is a small, single-stranded RNA virus that is transmitted principally by the fecal-oral route in developing nations and presumptively via zoonotic transmission or food exposure in developed nations (1, 2). Four genotypes have been identified. Genotypes 1 and 2 are known to infect only humans and are responsible for large waterborne outbreaks. Genotypes 3 and 4, on the other hand, primarily infect other animals, including swine, rats, and rabbits, among others, and have been associated with sporadic cases of acute and chronic infections in humans (2, 3). Most cases of HEV genotype 3, and probably also genotype 4, are anicteric and asymptomatic and resolve spontaneously without long-term sequelae. However, severe cases with jaundice can occur in the elderly, in persons with immunodeficiency, and in persons with preexisting liver disease. In addition, HEV genotype 1 has been associated with high case fatality rates in pregnant women. Recently, cases of chronic HEV infection due to genotype 3 have been reported in immunosuppressed individuals, such as solid-organ transplant recipients, patients on cancer chemotherapy, and those with human immunodeficiency virus infection and AIDS (4-7).A surprisingly high prevalence of HEV infection, 21%, was reported in the U.S. population from an analysis of samples collected during the Third National Health and Nutrition Examination Survey (NHANES III) (8). Testing positive for anti-HEV was related to older age, and minor associations were found with having a pet in the home and consuming liver or other organ meats more than once per m...

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“…The estimated prevalence is 18.6% among those exposed to porcine livestock (4) and 10.4% in HIV-infected individuals (12). In the United States the reported prevalence is 6% (13), while in England the prevalence is only 0.04% among donors (7). The true number of infections is difficult to establish, since subclinical infections are common and probably outnumber clinical infections.…”

Section: Introductionmentioning

confidence: 99%

Autochthonous acute hepatitis E: an increasingly frequent diagnosis. Clinical-epidemiological analysis of our experience

Ron¹,

Palacios²,

Torres³

et al. 2017

Rev Esp Enferm Dig

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Background: In Europe, acute hepatitis caused by the hepatitis E virus (HEV) traditionally was an infection found in people who had travelled to endemic zones, mainly Asia and Africa. However, a growing number of sporadic autochthonous cases are now being diagnosed in the Western world.Objective: To analyze the cases of acute HEV hepatitis diagnosed in our setting, with the identification of the clinicalepidemiological characteristics. Material and methods:We included the cases of acute HEV hepatitis diagnosed (positive anti-HEV IgM and/or HEV RNA present in serum) between January 2008 and December 2014. Different clinical, epidemiological and evolutive parameters were analyzed.Results: A total of 23 patients were identified, all originating from Spain. Fourteen cases (60.87%) presented jaundice and marked cytolysis at the time of diagnosis (aspartate aminotransferase [AST] 1,106.91 U/l and alanine aminotransferase [ALT] 1,407.04 U/l). Twenty-two cases were regarded as autochthonous, and one patient had travelled to China three months before. The mean time to resolution was 11.2 weeks. Some autoimmune markers were positive in 43.5% of the patients. Two subjects were diagnosed with previous chronic liver disease and were classified as "acuteon-chronic liver failure" (ACLF), one died and the other underwent liver transplantation.Conclusion: Acute HEV hepatitis in our setting is an autochthonous condition that is probably underdiagnosed, manifesting with jaundice and cytolysis. Autoimmune marker positivity is an epiphenomenon, which in some cases complicates the diagnosis.

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Current epidemiology of hepatitis E virus infection in the United States: Low seroprevalence in the National Health and Nutrition Evaluation Survey

Cited by 98 publications

References 49 publications

The role of hepatitis E virus infection in adult Americans with acute liver failure

The role of hepatitis E virus infection in adult Americans with acute liver failure

An Epidemiologic Investigation of a Case of Acute Hepatitis E

Autochthonous acute hepatitis E: an increasingly frequent diagnosis. Clinical-epidemiological analysis of our experience

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