Incidence Of Hepatitis E Virus Research Articles

Epidemiological Characteristics and Spatiotemporal Clustering of Symptomatic Hepatitis E Virus Reinfection in Zhejiang Province, 2005-2023.

Hepatitis E virus (HEV) reinfection is prevalent among the population, posing a significant burden on prevention and control efforts. In this study, we conducted a comprehensive analysis of data from China's Disease Prevention and Control Information System's infectious disease surveillance system to identify the epidemiological characteristics, spatiotemporal clustering, and high-risk populations of HEV reinfection. From 2005 to 2023, HEV reinfection in Zhejiang Province exhibited a fluctuating trend, peaking in 2020, with a 3-5-year lag compared to the pattern of HEV incidence. The Cox model indicated that individuals aged 40-50 and females are at higher risk of reinfection. Spatial autocorrelation was observed in reinfection cases from 2011 to 2016, with high-high clustering areas concentrated in downtown Hangzhou. Additionally, spatiotemporal scanning revealed that the clustering of reinfection cases has shifted from Hangzhou to coastal areas in recent years. Our findings suggest that targeted prevention and control measures for HEV rein fection should be implemented based on the characteristics of high-risk populations and spatiotemporal clustering patterns.

Porcine-derived pancreatic enzyme replacement therapy may be linked to chronic hepatitis E virus infection in cystic fibrosis lung transplant recipients

ObjectivesIn high-income countries hepatitis E virus (HEV) is an uncommonly diagnosed porcine-derived zoonoses. After identifying disproportionate chronic HEV infections in persons with cystic fibrosis (pwCF) postlung transplant, we sought to...

Prevalence of Hepatitis A Virus and Hepatitis E Virus in a tertiary care hospital, East Delhi, India.

Background & Aim: Acute viral hepatitis (AVH) is a condition that is known to be caused by enterically transmitting Hepatitis A virus (HAV) and Hepatitis E virus (HEV). Usually, they result in self-limiting disease but can be seriously threatening if complications arise. This study was done to determine the prevalence rate of HAV and HEV in a tertiary care hospital in East Delhi, India.
 Material & Methods: The retrospective and observational study of 2-year duration was conducted in the Department of Microbiology at UCMS and GTBH Delhi, India. A total of 410 samples from patients presenting with a clinical diagnosis of acute hepatitis were considered in the study. The serum samples were analysed for IgM anti-HAV and IgM anti-HEV, respectively, using commercially available ELISA kits.
 Results: The seroprevalence of HAV and HEV were 2.19% and 0.24%, respectively. No case was found to be reactive for both parameters, indicating no case of co-infection. The majority of clinical samples were from female patients.
 Conclusion: The incidence of HEV and HAV illnesses suggests that East Delhi has a lower prevalence rate of the reported viral illnesses. This finding suggests one of the following: limited circulation of the agents, good sanitary conditions, and/or protective immunity among the population tested. Nonetheless, we should continue to assess the ongoing conditions and take measures to improve them.

Evaluating the prevalence of Hepatitis E virus infection in a large cohort of European blood donors, 2015-2018.

Hepatitis E virus (HEV) is endemic in Europe. However, standardized methods for the surveillance of HEV viremia in the general population are lacking. This study aimed to compare the incidence of HEV among blood donors in two European countries, Germany and Portugal, during the period 2015‐2018. The seasonal distribution of HEV infection, as well as host risk factors including age, sex, and blood group phenotype were explored. A total of 191,236 donations from Germany and Portugal were tested for HEV RNA in plasma mini‐pools of up to 96 donations using an internally controlled reverse transcription real‐time PCR (RT‐PCR) assay. The 95% cut‐off of the assay was 15 International Units (IU)/mL (CI 10‐35 IU/mL) as determined by dilution of the WHO International Standard for HEV RNA. Blood type was determined by agglutination and pattern recognition using the Beckmann Coulter PK 7300 AB0‐ and Rhesus‐Assay. The overall positivity rate was 0.09% with significantly more infections observed in the German cohort (p < 0.0001). Infections peaked in the summer months, and investigation of risk factors revealed that incidence was significantly higher amongst males (p = 0.0002), but was not associated with ABO or Rh(D) blood group phenotypes. No significant relationships between risk factors and viral load were observed. Our findings confirm that HEV infections are highly prevalent in Europe, even amongst otherwise healthy blood donors. Increasing awareness of the seasonal spread and risk factors for HEV transmission is of great importance for individuals susceptible to more severe forms of the disease, such as immunocompromised patients.

Hepatitis E in immunocompromised individuals.

Hepatitis E virus (HEV) originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States. While there are eight identified genotypes to date, genotype 1 (HEV1), HEV2, HEV3, HEV4 are the most common to infect humans. HEV1 and HEV2 are most common in developing countries including Latina America, Africa and Asia, and are commonly transmitted through contaminated water supplies leading to regional outbreaks. In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat. The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing. In majority of cases, HEV infection is a self-limiting hepatitis requiring only symptomatic treatment. However, this is not the case in immunocompromised individuals, including those that have undergone solid organ or stem cell transplantation. In this subset of patients, chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death. The need for re-transplantation as a result of post-transplant hepatitis is of great concern. In addition, there have been many reported incidents of extrahepatic manifestations, for which the exact mechanisms remain to be elucidated. The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies, while attempting to minimize the risk of organ rejection. Subsequent treatment options include ribavirin, and pegylated interferon alpha in those who have demonstrated ribavirin resistance. Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden. Given this concern, vaccination has been approved in China with other investigations underway throughout the world. In this review we introduce the epidemiology, diagnosis, clinical manifestations, and treatment of HEV, with emphasis on immunocompromised individuals in the United States.

The global trends and regional differences in incidence of HEV infection from 1990 to 2017 and implications for HEV prevention.

Hepatitis E virus (HEV) infection is an important cause of acute viral hepatitis worldwide, but it is long-neglected. We aimed to understand the global trends and regional differences in the incidence of HEV infection, thereby making global tailored prevention strategies. This study is a post-hoc analysis of the data from Global Burden of Disease Study 2017. Annual HEV incident cases and incidence rates from 1990 to 2017 were collected. Changes in incident cases and estimated annual percentage changes (EAPCs) of age-standardized incidence rates (ASRs) were calculated to quantify the temporal trends of HEV infection. Globally, HEV ASRs decreased by an average 0.16% (95% CI: 0.14%-0.17%) per year from 279.79 per 100000 in 1990 to 269.70 per 100000 in 2017; however, the number of HEV incident cases increased by 17.63% from 16.53million in 1990 to 19.44million in 2017. Against the global trend of ASR falling, an increasing trend was reported in Oceania (EAPC=0.03; 95% CI: 0.03-0.04) and Western Europe (EAPC=0.02; 95% CI: 0.01-0.03). The number of HEV incident cases increased remarkably in low (63.07%) and low-middle (37.46%) Socio-Demographic Index (SDI) regions between 1990 and 2017. Additionally, the number of HEV incident cases increased by 4.63% in high SDI regions, mainly in 40 plus age group. Surprisingly, more than 40% of HEV incident cases in Western Europe in 2017 were over 40years old. HEV is still pending in hyperendemic regions, and it is emerging in low endemic regions, suggesting more efforts should be done to make targeted prevention strategies.

Hepatitis E virus\xa0outbreak associated with rainfall in the Central African Republic in 2008-2009

BackgroundInfection by hepatitis E virus (HEV) can cause a high burden of morbidity and mortality in countries with poor access to clean water and sanitation. Our study aimed to investigate the situation of HEV infections in the Central African Republic (CAR).MethodsA retrospective analysis of the blood samples and notification forms collected through the national yellow fever (YF) surveillance program, but for which a diagnosis of YF was discarded, was carried out using an anti-HEV IgM ELISA and a HEV-specific RT-PCR.ResultsOf 2883 YF-negative samples collected between January 2008 and December 2012, 745 (~ 26%) tested positive by at least either of the 2 tests used to confirm HEV cases. The results revealed that the CAR was hit by a large HEV outbreak in 2008 and 2009. The results also showed a clear seasonal pattern with correlation between HEV incidence and rainfall in Bangui. A phylogenetic analysis showed that the circulating strains belonged to genotypes 1e and 2b.ConclusionsOverall, this study provides further evidences that HEV can be a significant cause of acute febrile jaundice, particularly among adults during rainy season or flood, in a country from Sub-Saharan Africa.

Seroprevalence of hepatitis E virus infection in acute leukemia patients with allogeneic transplantation

Aim: Hepatitis E Virus (HEV) infection is an emerging threat in allogeneic Hematopoietic Stem Cell Transplant (allo-HSCT) recipients. The aim of this study was to determine the prevalence of HEV infection in patients with acute leukemia before and after the transplantation.Material and Methods: The study was carried out with the serum samples taken before and after the transplantation from patients (n=42) with acute leukemia, who were 4 months to 64 years of age and who had allogenic transplant at Gazi University Hospital. All samples were tested in terms of HEV-specific anti-IgG and IgM positive value by using ELISA kit.Results: While 1 (2.3%) of the samples that were included in the study was positive anti-HEV IgG before transplantation, it was found negative after the transplantation (58th month). Positive anti-HEV IgM was not found before and after the transplantation in the collected samples. The average age of the seronegative group was determined as 30.8 ± 33.1 for male and female, respectively. There was no statistically significant difference in terms of anti-HEV IgM positivity and anti-HEV IgG positivity compared with seronegative cases of seropositive cases. Conclusions: This study was conducted to determine the prevalence of HEV infection in allogeneic stem cell patients. With this study, the incidence and importance of HEV can be determined in these patients before and after transplantation. This study can also create an important epidemiological data for our country.

Serological and molecular study of Hepatitis E virus in pediatric patients in Mexico

Introduction and objectivesCases of viral hepatitis reported in Mexico are typically identified as hepatitis A, B and C. However, unspecified cases are reported annually. Hepatitis E virus (HEV) is an emergent agent that causes a self-limiting infection that can evolve to chronic in immunosuppressed individuals. In Mexico, HEV genotype 2 is considered endemic, though it's the prevalence is not well known. Therefore, the present study was designed to determine the prevalence of HEV among patients at the “Hospital Infantil de Mexico Federico Gomez”. Materials and methodsThe study included 99 patients, anti-HEV antibody (IgG and IgM) were detected by indirect ELISA and viral genome was identified using RT-PCR technique. Two PCR products of positive cases were sequenced. ResultsELISA results were positive in 3% and 6%, for IgG and IgM respectively, 54.5% prevalence was found by PCR. Low lymphocyte count (p<0.05) and malnutrition (p<0.005) were significant factors for high PCR prevalence and could increase the possibility of infection. Two samples were sequenced and confirmed the presence of HEV genotype 3. ConclusionsThis report reveals the incidence of HEV in pediatric patients in Mexico. Moreover, the identification of HEV genotype 3 in human samples suggests a potential zoonotic risk that requires further research.

Mutations in the Progesterone Receptor (PROGINS) May Reduce the Symptoms of Acute Hepatitis E and Protect Against Infection.

BackgroundMutations in the progesterone receptor (PR) gene, PROGINS, have been studied in relation to hepatitis E virus (HEV) infection. Patients with the PROGINS gene may develop a worse clinical course of hepatitis E. The aim of our study was to evaluate the influence of PROGINS on the susceptibility to and the clinical course of HEV infection in HIV patients.MethodsThis study included patients with HIV who were evaluated in previous prospective studies for the prevalence and incidence of HEV. The following three groups of patients were studied: (i) never infected, (ii) past infections, and (iii) recently infected. We determined the PR genotype to evaluate the proportion of patients who were homozygous for PROGINS according to HEV infection. We also compared the proportion of PROGINS carriers with a recent HEV infection according to their symptomatology.ResultsIn this study, 311 patients infected with HIV were included. Of those patients, 198 were homozygous wild type (63.7%), 91 were heterozygous (29.3%), and 22 were homozygous PROGINS (7.1%). We found that the homozygous PROGINS genotype in women was associated with a lower HEV seroprevalence. In addition, in patients with a recent HEV infection, none of those homozygous for PROGINS presented symptoms.ConclusionThe PROGINS mutation plays a protective role against HEV infection and is associated with subclinical infection in HIV-infected patients, particularly women.

Incidence of hepatitis E virus infection among blood donors in a high endemic area of Central Italy.

In Europe, autochthonous hepatitis E virus (HEV) infection is mainly a foodborne zoonosis, but it is also transmitted by blood transfusion. Despite the numerous prevalence surveys, only a few studies have investigated HEV incidence. We aimed to determine HEV incidence and risk factors among blood donors in a hyperendemic area in Central Italy. Of 296 blood donors who had tested HEV negative in two previous seroprevalence surveys in L'Aquila, 198 agreed to undergo at least another blood sampling for estimating HEV incidence nearly 2years after the prevalence surveys. Ten newly acquired infections were detected, yielding an overall incidence of 2.1/100 person-years (95%CI: 1.0-3.9), with an estimated participant's cumulative probability of becoming HEV infected of 6.5% (95%CI: 3.5-12.0) at 4years after enrolment. Seven newly infected blood donors were IgG positive only, two were IgM positive (one also IgG positive) and one was HEV RNA positive only, harbouring subtype 3c. Incident infection was most strongly associated with eating game meat, raw-dried pork liver sausage and raw-dried wild boar sausage. None of these exposures was statistically significant, even if eating raw-dried wild boar sausage approached significance (P=0.06). The HEV incidence we found was considerable compared with other similar studies. The nearly significant association of incident infection with wild boar and other game meat consumption was in agreement with the 3c subtype isolation in the viremic donor. However, beyond eating habits, also other exposure sources are likely important in hyperendemic areas, where incidence and risk exposure studies need to be undertaken for effectively preventing HEV transmission.

Time trend of reported cases and publications: hepatitis E in comparison to hepatitis A – D in Germany from 2001 to 2016

The frequency of autochthonous hepatitis E virus (HEV) infections in Western countries has increased since the millennium, probably due to a higher awareness for HEV. The aim of this study was to analyze the epidemiological situation and regional distribution of HEV in comparison to hepatitis A - D in Germany. Data of the reported cases, patients' travel histories, and the regional distribution of hepatitis A - E virus infections from 2001 to 2017 were extracted from databases of the Robert Koch Institute. The number of publications per year on each hepatitis virus was used as a surrogate parameter for scientific awareness. The incidence of HEV infections increased from 31 reported cases in 2001 to 1991 cases in 2016 with a rate of autochthonous HEV infections of 44.4 % in 2001 and 83.9 % in 2016. In 2016, the HEV incidence was 4.4/100 000 in Eastern Germany and 2.0/100 000 in Western Germany. From 2001 to 2016, the numbers of hepatitis A and C virus infections decreased, while the number of hepatitis B virus infections initially decreased followed by an increase since 2014. The incidence of hepatitis D virus infections remained low. The incidence rates of hepatitis A - D virus infections were comparable between Eastern and Western Germany in 2016. There was a strong correlation between publications on HEV and reported HEV cases (Pearson r = 0.9803, p < 0.01). Especially in Eastern Germany, but also in Western Germany, the rate of reported HEV cases and the scientific awareness for this disease increased strongly since 2001.

Rural habitat as risk factor for hepatitis E virus seroconversion in HIV-infected patients: A prospective longitudinal study.

Our objective was to determine the incidence and clinical manifestations of acute hepatitis E virus (HEV) in HIV-infected patients. A prospective longitudinal study including HIV-infected HEV-seronegative patients was conducted; HEV seroconversion (to IgG and/or IgM) was the main outcome variable. All patients were tested for HEV antibodies every 3-6months. For patients who developed HEV seroconversion, a data collection protocol was followed to identify associated clinical manifestations and analytical alterations. A total of 627 patients (89.9%) were followed during a median of 11.96months (IQR: 8.52-14.52months) and formed the study population. Forty-one patients developed detectable anti-HEV antibodies (7.2 cases per 100 patients/year). Our study found a high incidence of HEV in HIV-infected patients in southern Spain strongly associated with a rural habitat.

Hepatitis E Viraemia in Transplant Recipients

▪Introduction:Hepatitis E Virus (HEV) is one of the leading causes of acute infectious hepatitis worldwide; while usually a self-limiting, sub-clinical illness, genotype 3 HEV infection may become chronic in immunosuppressed patients such as solid organ transplant (SOT) or haematopoietic stem cell transplant (HSCT) recipients and rapid progression to cirrhosis may occur. Recent seroprevalence from screening of English blood donors shows antibody prevalence of ~13%. RNA prevalence in donors has increased in the UK from 1:2850 to 1:1460 over the past 3 years. This study examines the point-prevalence of HEV in SOT and HSCT recipients transplanted between January 2013 - December 2015 at a major UK transplant centre. Data on HEV clearance rates and risk factors for infection were collected in the patient cohort.Methods:Stored extracts of blood from patients undergoing liver transplant (OLT), renal transplant (RT) or HSCT were tested by real-time reverse-transcriptase polymerase chain reaction for HEV RNA. Samples were tested at baseline, 30, 60 and 90 days post-transplant +/- 7 days. Time points were chosen to give good coverage of the early post-transplant period whilst avoiding a patient becoming viraemic and clearing the infection between sample time points. All positive samples were sent to the Public Health England reference laboratory for verification, viral RNA genotyping and quantification. Patients with confirmed positive samples underwent further testing and evaluation of clinical parameters to determine chronology of infection, blood product exposure, organ function and histopathology results.Results:259 HSCT, 262 OLT and 349 RT patients met the inclusion criteria. Of the HSCTs there were 111 allogeneic stem cell transplants, 145 autologous transplants and 3 CD34 "top ups". The OLTs comprised 259 deceased donor, 2 live donor and 2 domino liver transplant patients. The RTs comprised 241 deceased donor, 38 live unrelated, 63 live related transplants and 1 live transplant where the relationship of the donor was unrecorded. In total 4 patients (1 HSCT and 3 OLT) were found to have HEV viraemiain our study period. This represents 0.39% of the HSCT and 1.15% of the OLT patients. All were positive with HEV genotype 3.Virologicaland clinical data regarding these patients are presented in tables below.Conclusion:Chronic HEV, genotype 3 in transplant patients is associated with significant morbidity. With the increasing incidence of HEV, immunosuppressed patients with high transfusion burden have an infection risk equivalent to 7-9 years' dietary exposure.Our results show that prevalence of HEV viraemia in OLT, RT and HSCT patients is higher than expectedbased on comparison from UK blood donors. Secondly, infection is not cleared as would be expected in the general population with 3 of the 4 patients requiring treatment to clear the virus.The source of infection for these patients is unclear; on a population wide basis HEV is usually a dietary acquired infection, with pork products carrying the greatest risk. In the transplant patient population, the risk of iatrogenic infection via infected blood products or an infected transplanted organ is an important consideration and UK guidance has recently changed so that transplant recipients receive dietary advice and HEV-negative blood to avoid infection (SaBTO2016).In this study 2 patients were found to be positive for HEV RNA in the baseline sample. One, the recipient of HSCT, did not acquire it through transfusion as testing of the transfused products that the patient had received were negative for the virus. It is not clear how the two OLT patients who tested positive acquired the virus. The absence of any positive results in the renal transplant recipients may reflect the lower transfusion burden in this patient group. Given the multiple routes of possible infection with HEV, a strategy if screening recipients for the virus in addition to screening blood and organ donors would be an effective way of detecting viral transmission via all routes. [Display omitted] [Display omitted] DisclosuresSekhar:Novartis: Research Funding.

Hepatitis E virus infection in the Irish blood donor population.

Hepatitis E virus (HEV) Genotype 3 (G3) infection is a zoonosis that may be transmitted during the acute phase by transfusion. The aim of this study was to determine the incidence of HEV and seroprevalence among Irish blood donors. Anonymized samples from 1076 donations collected in 2012 were tested for HEV immunoglobulin (Ig)G using the Wantai enzyme-linked immunosorbent assay. A total of 24,985 anonymized donations collected between December 2013 and June 2014 were individually tested for HEV RNA using the Procleix HEV assay; reactive donations were confirmed by an in-house real-time polymerase chain reaction (PCR) test. Seroprevalence for anti-IgG was 5.3% (95% confidence interval [CI], 4.0%-6.8%), ranging from 1.1% in the 18- to 29-years age group to 33.3% in males over 60 years. HEV RNA screening of 24,985 samples yielded five PCR-confirmed donations (1:4997, 0.02%; 95% CI, 0.0065%-0.0467%), only one of which was serologically reactive (HEV IgM reactive only). Viral loads ranged from 10 to 44,550 IU/mL. Genotype analysis on three samples identified HEV G3 virus. Four of the five viremic donations were from donors in the 18- to 29-years age group (p=0.01). Seroprevalence for anti-HEV IgG was low compared to some European countries, but 1 in 5000 donations was viremic. Viremia was predominantly in younger Irish donors. After Department of Health approval the Irish Blood Transfusion Service implemented individual blood donation HEV RNA screening initially for a 3-year period from January 2016.

P0629 : First detection of genotype 3 and 4 hepatitis E virus (HEV) RNA among the general population in cambodia: Full-length sequence of HEV isolate, prevalence and incidence of HEV infection were clarified based on the Sero-epidemiological study

P0629 : First detection of genotype 3 and 4 hepatitis E virus (HEV) RNA among the general population in cambodia: Full-length sequence of HEV isolate, prevalence and incidence of HEV infection were clarified based on the Sero-epidemiological study

Past and present of hepatitis E in the Netherlands

BackgroundRecent studies show that endemic hepatitis E virus (HEV) infection occurs frequently in some developed countries. In the Netherlands in 2013, the routine screening of 35,220 plasma donations for HEV RNA showed 20 donors to be viremic (1:1761), which seems to contradict reports of declining HEV seroprevalence in the recent past.Study Design and MethodsTo asses HEV infection pressure changes over time, archived samples from Dutch blood donations collected in 1988 and 2000 were tested for anti-HEV immunoglobulin (Ig)G. The findings were compared to the HEV seroprevalence among donors in 2011.ResultsThe age-adjusted prevalence of anti-HEV IgG for Dutch donors aged 18 to 64 declined from 46.6% in 1988 to 27.3% in 2000 and to 20.9% in 2011. The reduction of seroprevalence was apparent for all age groups between 1988 and 2000, and for donors older than 40 between 2000 and 2011, but the seroprevalence among donors aged 18 to 29 increased between 2000 and 2011. Recent changes in HEV infection pressure are more apparent in the youngest donors, who to a lesser extent reflect cumulative exposure to HEV in the past. Donors aged 18 to 21 showed decreasing HEV seroprevalence from 19.8% in 1988 to 7.0% in 1995 and to 4.3% in 2000, followed by an increase to 12.7% in 2011.ConclusionHEV antibody patterns in young and old Dutch donors, in 1988 to 2011, suggest that decades ago, HEV was ubiquitous and most persons acquired infection. Subsequently HEV incidence was low during a prolonged period, to increase again in recent years.

Hepatitis E Outbreak, Dadaab Refugee Camp, Kenya, 2012

Hepatitis E Outbreak, Dadaab Refugee Camp, Kenya, 2012

Seroprevalence and incidence of hepatitis E virus infection in German blood donors

Hepatitis E virus (HEV) is transmissible by transfusion. More data are needed about seroprevalence, incidence, and viremia in blood donors for the assessment of risk of transfusion-transmitted (TT)-HEV infections. Samples from 1019 whole blood donors were tested for anti-HEV immunoglobulin (Ig)G by enzyme-linked immunosorbent assay and Western blot. The incidence of HEV and presence of HEV RNA in donors who seroconverted were determined by testing archive samples and recipients of viremic donations were traced. Anti-HEV IgM and alanine transaminase (ALT) testing were also performed to assess the value of such measures in the prevention of TT-HEV infections. A total of 69 of 1019 donors tested positive for anti-HEV IgG (6.8% seroprevalence), and seroconversion for anti-HEV IgG occurred in seven of 69 donors within 2 years (incidence, 0.35%/year). Three of seven (42.8%) seroconverting donors provided an archive sample in which HEV RNA was detectable. One recipient of these donations was traceable; anti-HEV IgG, IgM, and HEV RNA testing were negative 41 days after transfusion. Neither ALT levels nor anti-HEV IgM detection correlated with the presence of HEV RNA. The seroprevalence of HEV was 6.8%, and the annual incidence 0.35%. HEV RNA was detectable in several seroconverting donors, without evidence for HEV transmission in the only traceable recipient. Since neither ALT nor anti-HEV IgM testing correlate with the presence of HEV RNA, HEV nucleic acid testing currently provides the only method for the prevention of TT-HEV infection. However, before implementation, more data about clinical relevance of TT-HEV infections and infectious dose of HEV are required.

Chronic hepatitis E infection in lung transplant recipients

Hepatitis E virus (HEV) genotype 3 has been identified in patients with autochthonous HEV infections in developed countries and is currently being recognized as an emerging zoonotic pathogen. HEV infection may lead to a chronic hepatitis in immune-compromised patients. We studied the incidence of HEV in adult lung transplant recipients at the Medical University Vienna and the University Medical Center Groningen. These recipients presented with elevated liver test results during the post-transplant follow-up period. The time of infection was investigated using stored specimens, and the HEV genotype was determined by sequence analysis of the open reading frame (ORF)1 and ORF2 region. The study included 468 adult lung transplant recipients. Ten patients (2.1%) tested positive for HEV RNA. At the time of HEV detection, all patients had elevated liver test results, with median alanine aminotransferase levels of 77 U/liter and showed a mild hepatitis. A chronic HEV infection was diagnosed in the 8 lung transplant recipients who survived longer than 6 months after transplantation. Viral genotyping revealed only genotype 3 strains. In 2 of the lung transplant recipients treated with oral ribavirin monotherapy, HEV RNA was cleared from the plasma within 2 months with simultaneous normalization of alanine aminotransferase levels. Chronic HEV is an important cause of liver test abnormalities after lung transplantation; therefore, routine screening for HEV RNA is strongly recommended in lung transplant recipients. Oral ribavirin appears to be a safe and effective treatment for chronic HEV infection in lung transplant recipients.