Hepatitis E virus genotypes and subgenotypes causing acute hepatitis, Bulgaria, 2013–2015

Bruni, Roberto; Villano, Umbertina; Equestre, Michele; Chionne, Paola; Madonna, Elisabetta; Trandeva-Bankova, Dilyana; Peleva-Pishmisheva, Maria; Tenev, Tencho; Cella, Eleonora; Ciccozzi, Massimo; Pisani, Giulio; Golkocheva-Markova, Еlitsa; Ciccaglione, Anna Rita

doi:10.1371/journal.pone.0198045

Cited by 29 publications

(45 citation statements)

References 17 publications

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“…However, none of the studies investigated if there is a correlation between HEV in humans and pigs. In Bulgaria, two HEV phylogenetic studies confirmed the presence of HEV Subtypes 3e, 3f, 3c, 3i, and 3hi, and Subtype 1, in human samples [31,52]. Most of these subtypes refer to domestic pigs and wild boar, which reveals the probability of zoonotic transmission of HEV infection to humans.…”

Section: Discussionmentioning

confidence: 94%

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Increasing Hepatitis E Virus Seroprevalence in Domestic Pigs and Wild Boar in Bulgaria

Takova

Koynarski

Minkov

et al. 2020

Animals

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(1) Background: Hepatitis E virus (HEV) is a causative agent of acute viral hepatitis, predominantly transmitted by the fecal–oral route. In developed countries, HEV is considered to be an emerging pathogen since the number of autochthonous cases is rising. Hepatitis E is a viral disease with a proven zoonotic potential for some of its genotypes. The main viral reservoirs are domestic pigs and wild boar. Consumption of undercooked meat, as well as occupational exposure, are key factors for the spread of HEV. In order to evaluate the risks of future viral evolution, a detailed examination of the ecology and distribution of the virus is needed. The aim of the present study is to investigate the prevalence of anti-HEV IgG Ab in domestic pigs and wild boar in Bulgaria; (2) Methods: In this study, during the period of three years between 2017 and 2019, 433 serum samples from 19 different pig farms and 1 slaughterhouse were collected and analyzed. In addition, 32 samples from wild boar were also collected and analyzed during the 2018–2019 hunting season. All samples were analyzed by commercial indirect ELISA; (3) Results: Overall, HEV seroprevalence was 60% (95% CI 42.7–77.1) in domestic pigs and 12.5% (4/32) in wild boar. The observed seroprevalence of the slaughter-aged pigs was 73.65% (95% Cl 58.7–87.3). Prevalence in domestic pigs was significantly higher in the samples collected during 2019 (98% (95% Cl 96.1–99.9)) compared to those collected during 2017 (45.33% (95% CI 2.7–87.3)) and 2018 (38.46% (95% CI 29.1–49.7.); (4) Conclusions: Our findings suggest that domesticated pigs and wild boar might be the reason for the increased HEV transmission across Bulgaria. The genotypic characterization of HEV found in pigs, wild boar and humans will give a more accurate view of the zoonotic transmission of this virus.

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Section: Discussionmentioning

confidence: 94%

“…Studies on the distribution of HEV in humans across Bulgaria show that the most acute hepatitis E cases in the country are caused by the HEV-3 subtypes 3 e , 3 f and 3 c [ 31 , 32 ]. The first immunological study of pigs in Bulgaria from 2017 reported over 75% seropositivity.…”

Section: Introductionmentioning

confidence: 99%

Increasing Hepatitis E Virus Seroprevalence in Domestic Pigs and Wild Boar in Bulgaria

Takova

Koynarski

Minkov

et al. 2020

Animals

View full text Add to dashboard Cite

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“…We found 23 papers (PubMed databases – 5; Bulgarian medical databases – 18). Seven articles fulfilled the inclusion and exclusion criteria and were included in the final data analysis (Table 1) [5], [8], [9], [10], [11], [12], [13]. All articles described hospitalised patients with clinical presentation of acute HEV infection.…”

Section: Resultsmentioning

confidence: 99%

Hepatitis E Virus Infection in Bulgaria: A Brief Analysis of the Situation in the Country

Baymakova¹,

Popov²,

Pepovich³

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: Over the past two decades, more thorough investigations for hepatitis E virus (HEV) infection have been done in the world. Reports from Southeast European countries have increased. AIM: The current article presents a critical analysis of all studies for HEV in Bulgaria. MATERIAL AND METHODS: A literature search was done using available medical databases. We analysed the literature in PubMed databases and Bulgarian medical databases for English and Bulgarian languages sources. Preference was given to the sources published within the past 24 years (January 1995 – September 2018). RESULTS: Two thousand two hundred and fifty-seven blood serums were tested for the analysed period (1995 – 2018), and 13.1% of them were positive for acute HEV (Mean ± SD: 20.38 ± 25.77%; 95% CI: 1.29 – 39.47%). The following subtypes were established in the country – HEV Subtype 3e, HEV Subtype 3f, HEV Subtype 3c, HEV Subtype 3i, HEV Subtype 3hi and HEV Subtype 1. CONCLUSION: We hope that the National Health Organizations will take adequate and timely measures to increase the knowledge and research for HEV among Bulgarian citizens.

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“…Phylogenetic relationships were analysed by constructing a Neighbor‐Joining phylogenetic tree calculated on the Maximum Composite Likelihood distances by MEGA 6.0 as previously described, using a recommended set of standard reference HEV sequences plus additional sequences (Figure ) . Tree reliability was assessed by setting bootstrap replicates to 1000.…”

Section: Methodsmentioning

confidence: 99%

“…Nested PCR and sequencing were performed to obtain an ORF2 472nt sequence from the viremic participant. 33 Briefly, serum-extracted RNA was reverse transcribed with random hexamers, and cDNA was used as nested-PCR template. Purified PCR product underwent automated DNA sequencing (Beckman Coulter, Inc., Fullerton, CA).…”

Section: Hev Sequencing and Sequence Analysismentioning

confidence: 99%

Incidence of hepatitis E virus infection among blood donors in a high endemic area of Central Italy

Marcantonio¹,

Pezzotti²,

Bruni³

et al. 2019

Journal of Viral Hepatitis

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Summary In Europe, autochthonous hepatitis E virus (HEV) infection is mainly a foodborne zoonosis, but it is also transmitted by blood transfusion. Despite the numerous prevalence surveys, only a few studies have investigated HEV incidence. We aimed to determine HEV incidence and risk factors among blood donors in a hyperendemic area in Central Italy. Of 296 blood donors who had tested HEV negative in two previous seroprevalence surveys in L'Aquila, 198 agreed to undergo at least another blood sampling for estimating HEV incidence nearly 2 years after the prevalence surveys. Ten newly acquired infections were detected, yielding an overall incidence of 2.1/100 person‐years (95%CI: 1.0‐3.9), with an estimated participant's cumulative probability of becoming HEV infected of 6.5% (95%CI: 3.5‐12.0) at 4 years after enrolment. Seven newly infected blood donors were IgG positive only, two were IgM positive (one also IgG positive) and one was HEV RNA positive only, harbouring subtype 3c. Incident infection was most strongly associated with eating game meat, raw‐dried pork liver sausage and raw‐dried wild boar sausage. None of these exposures was statistically significant, even if eating raw‐dried wild boar sausage approached significance (P = 0.06). The HEV incidence we found was considerable compared with other similar studies. The nearly significant association of incident infection with wild boar and other game meat consumption was in agreement with the 3c subtype isolation in the viremic donor. However, beyond eating habits, also other exposure sources are likely important in hyperendemic areas, where incidence and risk exposure studies need to be undertaken for effectively preventing HEV transmission.

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Hepatitis E virus genotypes and subgenotypes causing acute hepatitis, Bulgaria, 2013–2015

Cited by 29 publications

References 17 publications

Increasing Hepatitis E Virus Seroprevalence in Domestic Pigs and Wild Boar in Bulgaria

Increasing Hepatitis E Virus Seroprevalence in Domestic Pigs and Wild Boar in Bulgaria

Hepatitis E Virus Infection in Bulgaria: A Brief Analysis of the Situation in the Country

Incidence of hepatitis E virus infection among blood donors in a high endemic area of Central Italy

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