Transmission of Rat Hepatitis E Virus Infection to Humans in Hong Kong: A Clinical and Epidemiological Analysis

Autor: Susanna K. P. Lau, Kit-Hang Leung, Pyrear S.H. Zhao, Owen Tak-Yin Tsang, Anthony Wai-Shing Leung, Patrick C. Y. Woo, Helen Shuk-Ying Chan, Siddharth Sridhar, Vincent C.C. Cheng, Kwok-Yung Yuen, Cindy W. S. Tse, Wan-Mui Chan, Shusheng Wu, Dominic N.C. Tsang, Jasper Fuk-Woo Chan, Rosana W.S. Poon, Nicholas Foo-Siong Chew, Jonpaul Sze-Tsing Zee, Jian-Piao Cai, Hoi-Wah Tsoi, Cyril C. Y. Yip
Rok vydání: 2020
Předmět:
Zdroj: Hepatology. 73:10-22
ISSN: 1527-3350
0270-9139
DOI: 10.1002/hep.31138
Popis: Background and aims Hepatitis E virus (HEV) variants causing human infection predominantly belong to HEV species A (HEV-A). HEV species C genotype 1 (HEV-C1) circulates in rats and is highly divergent from HEV-A. It was previously considered unable to infect humans, but the first case of human HEV-C1 infection was recently discovered in Hong Kong. The aim of this study is to further describe the features of this zoonosis in Hong Kong. Approach and results We conducted a territory-wide prospective screening study for HEV-C1 infection over a 31-month period. Blood samples from 2,860 patients with abnormal liver function (n = 2,201) or immunosuppressive conditions (n = 659) were screened for HEV-C1 RNA. In addition, 186 captured commensal rats were screened for HEV-C1 RNA. Sequences of human-derived and rat-derived HEV-C1 isolates were compared. Epidemiological and clinical features of HEV-C1 infection were analyzed. HEV-C1 RNA was detected in 6/2,201 (0.27%) patients with hepatitis and 1/659 (0.15%) immunocompromised persons. Including the previously reported case, eight HEV-C1 infections were identified, including five in patients who were immunosuppressed. Three patients had acute hepatitis, four had persistent hepatitis, and one had subclinical infection without hepatitis. One patient died of meningoencephalitis, and HEV-C1 was detected in cerebrospinal fluid. HEV-C1 hepatitis was generally milder than HEV-A hepatitis. HEV-C1 RNA was detected in 7/186 (3.76%) rats. One HEV-C1 isolate obtained from a rat captured near the residences of patients was closely related to the major outbreak strain. Conclusions HEV-C1 is a cause of hepatitis E in humans in Hong Kong. Immunosuppressed individuals are susceptible to persistent HEV-C1 infection and extrahepatic manifestations. Subclinical HEV-C1 infection threatens blood safety. Tests for HEV-C1 are required in clinical laboratories.
Databáze: OpenAIRE
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