Abstract
BackgroundHuman hepatitis E virus (HEV) infections are considered an emerging disease in industrialized countries. In the Netherlands, Hepatitis E virus (HEV) infections have been associated with travel to high-endemic countries. Non-travel related HEV of genotype 3 has been diagnosed occasionally since 2000. A high homology of HEV from humans and pigs suggests zoonotic transmission but direct molecular and epidemiological links have yet to be established. We conducted a descriptive case series to generate hypotheses about possible risk factors for non-travel related HEV infections and to map the genetic diversity of HEV.MethodsA case was defined as a person with HEV infection laboratory confirmed (positive HEV RT-PCR and/or HEV IgM) after 1 January 2004, without travel to a high-endemic country three months prior to onset of illness. For virus identification 148 bp of ORF2 was sequenced and compared with HEV from humans and pigs. We interviewed cases face to face using a structured questionnaire and collected information on clinical and medical history, food preferences, animal and water contact.ResultsWe interviewed 19 cases; 17 were male, median age 50 years (25–84 y), 12 lived in the North-East of the Netherlands and 11 had preexisting disease. Most common symptoms were dark urine (n = 16) and icterus (n = 15). Sixteen ate pork ≥ once/week and six owned dogs. Two cases had received blood transfusions in the incubation period. Seventeen cases were viremic (genotype 3 HEV), two had identical HEV sequences but no identified relation. For one case, HEV with identical sequence was identified from serum and surface water nearby his home.ConclusionThe results show that the modes of transmission of genotype-3 HEV infections in the Netherlands remains to be resolved and that host susceptibility may play an important role in development of disease.
Highlights
Human hepatitis E virus (HEV) infections are considered an emerging disease in industrialized countries
Human hepatitis E virus (HEV) infections are increasingly recognized as an emerging disease in the industrialized countries [1]
Laboratory confirmation was defined as a positive HEV RT-PCR result from either serum or stool sample and/or a positive IgM result combined with an IgG response after immunoblot confirmation performed as described by Herremans et al [18]
Summary
Human hepatitis E virus (HEV) infections are considered an emerging disease in industrialized countries. In the Netherlands, Hepatitis E virus (HEV) infections have been associated with travel to high-endemic countries. Non-travel related HEV of genotype 3 has been diagnosed occasionally since 2000. Human hepatitis E virus (HEV) infections are increasingly recognized as an emerging disease in the industrialized countries [1]. HEV infections are caused by an RNA virus recently classified in the genus Hepevirus of the family Hepeviridae which contains four major recognized genotypes (1–4) infecting humans, with distinct geographical distribution [7]. Following the discovery of genotype 3 HEV in pigs and humans in the US in the mid 1990s, there is an increased recognition of these non-travel related HEV infections in industrialized countries. HEV infection is a nonnotifiable disease in most countries and the national prevalence of infection and disease due to HEV is mostly unknown
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