Abstract
The Hepatitis E virus (HEV) is an emergent virus that causes acute hepatitis in immunocompetent hosts and chronic hepatitis in immunocompromised hosts. In Latin America, the main circulating genotype HEV-3 is usually of zoonotic origin. Diagnosis and seroprevalence studies mainly rely on the detection of specific antibodies. There are scarce data on the seroprevalence of HEV infection in Latin America mainly due to the lack of awareness of HEV circulation. Furthermore, in some countries, like Argentina, HEV testing is not included in routine assays. In order to provide tools to deepen the knowledge on HEV epidemiology in South America, we designed a new in-house ELISA based on the native recombinant protein ORF2 aa112–608 and demonstrated its potential for detecting anti-HEV immunoglobulin G (IgG) in human serum samples. The following conditions were determined: an optimal antigen concentration of 0.25 μg/ml, a serum dilution of 1:80, gelatin as a blocking agent, and a secondary antibody dilution of 1:2000. A relative sensitivity of 93.33% (95% CI: 77.9–99.2%) and a relative specificity of 99.4% (95% CI: 96.7–100%) were determined using a panel of previously characterized sera and a gold standard (HEV IgG ELISA, DIA.PRO, Italy). Further, we obtained a very good agreement (κ index = 0.94, 95% CI: 0.87–1.00) with the gold standard. We screened 813 blood donor samples with this newly developed ELISA and found a seroprevalence of 9.23% (95% confidence interval, 7.33–11.43%). We show for the first time evidence of past HEV infection in Tucuman, the most populated city in northern Argentina. We expect that this study will raise the interest of health decision makers who should intercede to include indirect testing of HEV in regular diagnostic protocols. In conclusion, the in-house ELISA developed in this work shows a very good agreement with an already licensed commercial HEV IgG ELISA (DIA.PRO, ITALY), which can be used as an epidemiologic tool for HEV surveillance.
Highlights
The Hepatitis E virus (HEV) is an emergent virus that is causing hepatitis worldwide
We developed a HEV-3 ELISA based on the ORF2 recombinant protein produced in E. coli under native conditions
The protein ORF2 is the structural component of the capsid, the most immunogenic HEV protein, and the antigen of choice for serological diagnostics (Table 2)
Summary
The Hepatitis E virus (HEV) is an emergent virus that is causing hepatitis worldwide. The clinical presentation of HEV infection varies from mild and self-limiting to severe cases with typical features of hepatitis: malaise, abdominal, muscle and joint pain, anorexia, and jaundice (Purcell and Emerson, 2008; Lewis et al, 2010), which can end up as fulminant hepatitis. The incidence of fulminant hepatitis in pregnant women is up to 20% (Purcell and Emerson, 2008; Lewis et al, 2010). Several extra-hepatic manifestations such as arthralgia, GuillainBarré syndrome, meningitis, and others have been attributed to HEV infection (Krain et al, 2014; Dalton et al, 2016; Pasha et al, 2018). These aspects of the disease underline the need to further investigate HEV, improve diagnostics, and increase the awareness of its circulation
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