Abstract
The purpose of this research was to improve the epidemiological data on HEV infection in the human population in Romania. The analysis targeted hospitalized subjects with acute hepatitis (n = 94) of unknown etiology from the Infectious Diseases Regional Hospital in Iasi. Moreover, patients without liver disease (n = 40) from a different county hospital located in Eastern Romania were included. The presence of HEV infection and first characterization of human HEV strains was determined using serological and molecular assays. The apparent HEV seroprevalence varied between 29.16% (95% CI, 16.31–42.03) and 32.5% (95% CI, 17.98–47.02) according to patient grouping. Molecular analysis enhanced the detection of two HEV isolates, that clustered in subtype HEV-3c, the most commonly identified subtype in Europe. Identification of acute hepatitis E cases, together with the first detection and molecular characterization of human HEV in Romania represent the originality attributes of the present study.
Highlights
Hepatitis E virus (HEV) infection is an emerging health concern worldwide
Total HEV antibodies were detected in 14 out of 48 samples analyzed from patients with acute hepatitis of unknown etiology, with an overall prevalence of 29.16% The reported seroprevalence ranged according to the age group (Table 1), with significant differences observed between the first two categories and the last category taken as reference (p = 0.06 and p = 0.08, respectively)
In case of patients with non-A non-B acute hepatitis the serological exam consisted only in HEV-IgM detection considering the clinical form of the infection
Summary
Hepatitis E virus (HEV) infection is an emerging health concern worldwide. HEV is a quasi-enveloped RNA virus with a single-stranded, positive-sense genome, classified in the Hepeviridae family [1, 2]. HEV infections are common in humans and animals, being distributed globally in both developing and industrialized countries. Hepatitis E virus strains that infects humans belongs to the Orthohepevirus A species. Genotypes 1 and 2 (HEV-1 and HEV-2) only infect humans and are endemic to Asia, Africa, and Central America, where they cause large, usually waterborne, hepatitis epidemics, whereas zoonotic genotypes 3 and 4 (HEV-3 and HEV-4) cause sporadic cases worldwide [3]. In European countries, the incidence of confirmed HEV cases has been steadily increasing over the last decade, highlighting the relevance and emerging nature of this zoonotic infection [4]. HEV-3 predominates in high-income countries, including those in Europe
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