Abstract
Antibodies against hepatitis E virus (anti-HEV) were found in 248 Swedish and Danish patients between 1993 and 2007. Most patients were symptomatic and tested for anti-HEV due to travel abroad. Among patients with known country of infection, most were infected in Asia, mainly on the Indian subcontinent. However, 29 patients were infected in Europe, nine of these had HEV IgM and/or HEV RNA in serum. In sera from 65 of 141 tested patients HEV RNA could be detected, and 63 strains could be typed by limited sequencing within ORF2. HEV RNA was found in sera from 71% of the patients with HEV IgM and IgG and in 18% of the patients with only detectable HEV IgG. It was also found up to three weeks after the onset of disease in 67% of the patients with known date of onset. Patients infected in Europe were infected by genotype 3, and were older than those infected by genotype 1 (mean age 55.3 vs 30 years, p<0.001). Since it is known that genotype 3 can infect domestic pigs, HEV strains from 18 piglets in 17 herds in Sweden and Denmark were sequenced. Phylogenetic analyses of the genotype 3 strains showed geographical clades and high similarity between strains from patients and pigs from the same area. There are thus autochthonous hepatitis E cases in Scandinavia, and there are probably many undiagnosed ones. Patients with hepatitis of unknown etiology should therefore be investigated for anti-HEV even if they have not been outside Europe, since infections acquired from pigs or other animals should be taken into consideration.
Highlights
Hepatitis E virus (HEV) is a non-enveloped positive-strandedRNA virus of 27-34 nm in diameter [1]
hepatitis E virus (HEV) RNA could be detected in serum from 65 of 141 tested anti-HEV positive patients (Table 2)
The PCR in the ORF1 region was more sensitive and could amplify 63 of the strains, while 51 of the strains were amplified in the ORF2 region
Summary
Hepatitis E virus (HEV) is a non-enveloped positive-strandedRNA virus of 27-34 nm in diameter [1]. Genotypes 1 and 2 only infect humans, mainly in Asia, and Africa, where they are endemic and may cause large outbreaks. Strains of the other two genotypes, and 4, have been shown to infect humans, and domestic pigs, wild boars, deer, and other mammals. These two genotypes have not been reported to cause outbreaks. As India, genotype 1 infects humans, while HEV isolates from swine belong to genotype 3 or 4 [3]. Genotype 3 strains have been isolated from sporadic human cases of hepatitis E, and from domesticated pigs in several European countries, in the United States (US) and in Japan, while genotype strains have been found in humans and pigs exclusively in Asia, as China, Taiwan, Japan and Vietnam [4,5,6,7]
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