Abstract
Over the last decade the seroprevalence of immunoglobulin (IgG) anti hepatitis E virus (HEV) has been increasing in European countries and shows significant variability among different geographical areas. In this review, we describe the serological data concerning the general population and risk groups in different European countries. Anti-HEV antibody prevalence ranged from 1.3% (blood donors in Italy) to 52% (blood donors in France). Various studies performed on risk groups in Denmark, Moldova and Sweden revealed that swine farmers have a high seroprevalence of HEV IgG (range 13%–51.1%), confirming that pigs represent an important risk factor in HEV infection in humans. Subtypes 3e,f are the main genotypes detected in the European population. Sporadic cases of autochthonous genotype 4 have been described in Spain, France, and Italy. Although most HEV infections are subclinical, in immune-suppressed and transplant patients they could provoke chronic infection. Fulminant hepatitis has rarely been observed and it was related to genotype 3. Interferon and ribavirin treatment was seen to represent the most promising therapy.
Highlights
hepatitis E virus (HEV) represents the main cause of enterically transmitted hepatitis worldwide, being responsible for more than 50% of the cases of acute hepatitis in endemic countries
In the first part of the review, we describe the general aspects of HEV virus, serological data in European countries, and HEV genotypes circulating among humans, while in second part we describe HEV chronic infection in immune-depressed patients and the therapies used in their care
Many factors are associated with failure of immune-suppressed transplant recipients to clear HEV after acute infection factors include the degree of immune-suppression, the time between the last episode of acute rejection and HEV infection, time since transplantation, low leukocyte level, and low total-lymphocyte count [70]
Summary
HEV (hepatitis E virus) represents the main cause of enterically transmitted hepatitis worldwide, being responsible for more than 50% of the cases of acute hepatitis in endemic countries. ORF-2 consists of approximately 1980 nt and encodes for capsid protein It occupies the 3′ end of the coding region. HEV genotype 1 is the cause of severe clinical fulminant hepatic failure in pregnant women and is associated with high mortality, in the third trimester, and in obstetric complications such as eclampsia or hemorrhage [12,14] This genotype is endemic in Africa and Asia, but it is frequently isolated from hepatitis E cases among travelers to these regions from non-endemic areas. Genotype 3b has been isolated in Japan, China, and Canada while subtype 3c is mainly described in France [34,35], Germany [36], Holland [33], and Italy [37].
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