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- Title
Hepatitis E Virus Species C Infection in Humans, Hong Kong.
- Authors
Sridhar, Siddharth; Yip, Cyril Chik Yan; Lo, Kelvin Hon Yin; Wu, Shusheng; Situ, Jianwen; Chew, Nicholas Foo Siong; Leung, Kit Hang; Chan, Helen Shuk Ying; Wong, Sally Cheuk Ying; Leung, Anthony Wai Shing; Tse, Cindy Wing Sze; Fung, Kitty S C; Tsang, Owen Tak Yin; Hon, Kam Lun; Cheng, Vincent Chi Chung; Ng, Ken Ho Leung; Yuen, Kwok Yung
- Abstract
Background Hepatitis E virus (HEV) variants belonging to Orthohepevirus species A (HEV-A) are the primary cause of human hepatitis E. However, we previously reported that Orthohepevirus species C genotype 1 (HEV-C1), a divergent HEV variant commonly found in rats, also causes hepatitis in humans. Here, we present a clinical-epidemiological investigation of human HEV-C1 infections detected in Hong Kong, with an emphasis on outcomes in immunocompromised individuals. Methods A surveillance system for detecting human HEV-C1 infections was established in Hong Kong. Epidemiological and clinical characteristics of HEV-C1 cases identified via this system between 1 August 2019 and 31 December 2020 were retrieved. Phylogenetic analysis of HEV-C1 strain sequences was performed. Infection outcomes of immunocompromised individuals with HEV-A and HEV-C1 infections were analyzed. Results HEV-C1 accounted for 8 of 53 (15.1%) reverse-transcription polymerase chain reaction (RT-PCR)–confirmed HEV infections in Hong Kong during the study period, raising the total number of HEV-C1 infections detected in the city to 16. Two distinct HEV-C1 strain groups caused human infections. Patients were elderly and/or immunocompromised; half tested negative for HEV immunoglobulin M. Cumulatively, HEV-C1 accounted for 9 of 21 (42.9%) cases of hepatitis E recorded in immunocompromised patients in Hong Kong. Immunocompromised HEV-C1 patients progressed to persistent hepatitis at similar rates (7/9 [77.8%]) as HEV-A patients (10/12 [75%]). HEV-C1 patients responded to oral ribavirin, although response to first course was sometimes poor or delayed. Conclusions Dedicated RT-PCR–based surveillance detected human HEV-C1 cases that evade conventional hepatitis E diagnostic testing. Immunosuppressed HEV-C1–infected patients frequently progress to persistent HEV-C1 infection, for which ribavirin is a suitable treatment option.
- Subjects
HONG Kong (China); PUBLIC health surveillance; PHYLOGENY; CHRONIC diseases; IMMUNOCOMPROMISED patients; HEPATITIS E; ZOONOSES; RIBAVIRIN; INFECTION; POLYMERASE chain reaction
- Publication
Clinical Infectious Diseases, 2022, Vol 75, Issue 2, p288
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab919