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Abstract

Hepatitis E virus (HEV) has been detected in Spain among patients with acute hepatitis, swine livestock, wild fauna and urban sewage, but prospective studies have been scarce. The incidence of the infection among humans and the mechanisms for acquisition of local HEV strains are unknown. Serum samples from 46 prospectively selected patients displaying liver alterations were tested for IgG and IgM antibody to HEV (anti-HEV) and for HEV RNA. HEV RNA was investigated in 287 stool samples from piglets and in 45 sewage samples from a single region, and anti-HEV was tested in 94 serum samples from piglets from the same farms. Acute HEV infection was identified in six patients (13.4%), and evidence of contact with HEV in the past, but unrelated to the ongoing liver alterations, was obtained in eight (17.3%). Two imported and four autochthonous cases of acute infection were recorded. Most autochthonous cases were found in the Basque Country, where swine livestock is not of economic importance. HEV RNA was detected in stool samples from three piglets aged 6-8 weeks from a single farm (1%), and anti-HEV was found among piglets from all farms at rates ranging overall from 18.1 to 58.3%, but from 70.8 to 71.4% among the oldest ones (22-23 weeks old). All sewage samples tested negative for HEV RNA. The results show that locally acquired, human HEV infection might be significantly more frequent in the Northern regions of Spain, and that swine livestock might not be in the origin of most of these infections.