TY - JOUR
T1 - Transmission of Rat Hepatitis E Virus Infection to Humans in Hong Kong
T2 - A Clinical and Epidemiological Analysis
AU - Sridhar, Siddharth
AU - Yip, Cyril Chik Yan
AU - Wu, Shusheng
AU - Chew, Nicholas Foo Siong
AU - Leung, Kit Hang
AU - Chan, Jasper Fuk Woo
AU - Zhao, Pyrear Suhui
AU - Chan, Wan Mui
AU - Poon, Rosana Wing Shan
AU - Tsoi, Hoi Wah
AU - Cai, Jian Piao
AU - Chan, Helen Shuk Ying
AU - Leung, Anthony Wai Shing
AU - Tse, Cindy Wing Sze
AU - Zee, Jonpaul Sze Tsing
AU - Tsang, Owen Tak Yin
AU - Cheng, Vincent Chi Chung
AU - Lau, Susanna Kar Pui
AU - Woo, Patrick Chiu Yat
AU - Tsang, Dominic Ngai Chong
AU - Yuen, Kwok Yung
N1 - Publisher Copyright:
© 2020 by the American Association for the Study of Liver Diseases.
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
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U2 - 10.1002/hep.31138
DO - 10.1002/hep.31138
M3 - Article
C2 - 31960460
AN - SCOPUS:85081129563
SN - 0270-9139
VL - 73
SP - 10
EP - 22
JO - Hepatology
JF - Hepatology
IS - 1
ER -