Abstract
Simple SummaryHepatitis E virus (HEV) is an important causative agent of acute and chronic hepatitis worldwide. Originally identified in epidemics associated with flooding in Asia, it nowadays shows very distinct genetic and epidemiological patterns. While HEV genotypes (HEV-) 1 and 2 are associated with the original outbreaks (waterborne diseases), HEV-3 and HEV-4 present a zoonotic pattern (associated with consumption of meat from infected animals), HEV-5 and 6 have been found only in wild boar in Japan, and HEV-7 and 8 have been detected in camels and dromedary seldom affecting humans. Brazil, with a precarious sanitary structure and being an important world meat producer, was the focus of this study in order to identify patterns of occurrence of HEV. After reviewing scientific studies, it was identified that the only genotype found in Brazil is HEV-3 and the area where there were more reports was the South region of the country. This is the region that produces more pork. These results indicate that HEV-3 is widespread in the country and sanitary surveillance is essential in the national production of pigs, as well as the implementation of monitoring protocols in hospitals.Brazil is the fifth largest country in the world with diverse socioeconomic and sanitary conditions, also being the fourth largest pig producer in the world. The aim of the present systematic review was to collect and summarize all HEV published data from Brazil (from 1995 to October 2020) performed in humans, animals, and the environment, in a One Health perspective. A total of 2173 papers were retrieved from five search databases (LILACs, Mendeley, PubMed, Scopus, and Web of Science) resulting in 71 eligible papers after application of exclusion/inclusion criteria. Data shows that HEV genotype 3 (HEV-3) was the only retrieved genotype in humans, animals, and environment in Brazil. The South region showed the highest human seroprevalence and also the highest pig density and industry, suggesting a zoonotic link. HEV-1 and 2 were not detected in Brazil, despite the low sanitary conditions of some regions. From the present review we infer that HEV epidemiology in Brazil is similar to that of industrialized countries (only HEV-3, swine reservoirs, no waterborne transmission, no association with low sanitary conditions). Hence, we alert for the implementation of HEV surveillance systems in swine and for the consideration of HEV in the diagnostic routine of acute and chronic hepatitis in humans.
Highlights
In the last years, hepatitis E virus (HEV) has captured widespread attention when autochthonous hepatitis E cases started to be reported in industrialized countries [1]
After the recognition of HEV genotypes 3 (HEV-3) as being responsible for autochthonous hepatitis E in industrialized countries [81,82], HEV studies in Brazil started to focus on cases of acute non-A-C viral hepatitis in order to clarify the potential role of HEV in these undiagnosed cases [17,28,35], efforts that still motivate publications nowadays [15,36]
This systematic review shows that HEV-3 was the only retrieved genotype in humans, animals, and environment in Brazil
Summary
Hepatitis E virus (HEV) has captured widespread attention when autochthonous hepatitis E cases started to be reported in industrialized countries [1]. HEV-3 and HEV-4 are zoonotic viruses, common in domestic and wild pigs that infect humans as an accidental host through the consumption of uncooked contaminated pork products, being associated with sporadic human hepatitis cases [2,4]. Clinical features of these genotypes are unique, with infections mostly asymptomatic in immunocompetent but with the capacity to progress to chronic hepatitis with liver cirrhosis in immunocompromised patients (such as organ transplant recipients and HIV patients), being associated to diverse extra-hepatic manifestations (neurological and haematological) [2]
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