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Clinical characteristics and molecular epidemiology of hepatitis E in Shenzhen, China: a shift toward foodborne transmission of hepatitis E virus infection.
Emerg Microbes Infect. 2017 Dec 20; 6(12):e115.EM

Abstract

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in China. Recently, a shift in molecular epidemiology from hepatitis E genotype 1 (HEV-1) to hepatitis E genotype 4 (HEV-4) has been observed in Northern China, marking a switch from human-to-human transmission to zoonosis. However, similar data from cities in Southern China are lacking. This observational study of human hepatitis E cases in Shenzhen, a metropolitan city in the Pearl River Delta region, aimed to describe the clinical features and molecular epidemiology of hepatitis E in Southern China. Over a 55-month period, we identified 20 patients with acute hepatitis E. Most were middle-aged men, and 50% of patients had concomitant liver disease, of whom 70% were identified to have non-alcoholic fatty liver disease; such patients had a trend toward higher liver enzymes. Quantitative real-time RT-PCR using archived serum samples showed that 12 patients had hepatitis E viremia at presentation. Sequencing of the RNA-dependent RNA polymerase gene was performed for five of these patients, and phylogenetic analysis revealed that these five HEV isolates belonged to subgenotype 4b and were clustered with swine HEV isolates from Southern China. Combined with other studies showing similar findings, this suggests that the molecular epidemiology of hepatitis E in China is evolving toward low-level endemicity driven by foodborne transmission from seafood or pork products. The importance of concomitant liver disease, in particular non-alcoholic fatty liver disease, as a risk factor for severe hepatitis E requires further study.

Authors+Show Affiliations

State Key Laboratory of Emerging Infectious Diseases, Hong Kong, China. Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China. Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518053, China.Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518053, China.Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518053, China.Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518053, China.State Key Laboratory of Emerging Infectious Diseases, Hong Kong, China. Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China. Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518053, China.Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.State Key Laboratory of Emerging Infectious Diseases, Hong Kong, China. Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China. Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518053, China. Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China.State Key Laboratory of Emerging Infectious Diseases, Hong Kong, China. Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China. Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518053, China. Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29259325

Citation

Sridhar, Siddharth, et al. "Clinical Characteristics and Molecular Epidemiology of Hepatitis E in Shenzhen, China: a Shift Toward Foodborne Transmission of Hepatitis E Virus Infection." Emerging Microbes & Infections, vol. 6, no. 12, 2017, pp. e115.
Sridhar S, Lo SK, Xing F, et al. Clinical characteristics and molecular epidemiology of hepatitis E in Shenzhen, China: a shift toward foodborne transmission of hepatitis E virus infection. Emerg Microbes Infect. 2017;6(12):e115.
Sridhar, S., Lo, S. K., Xing, F., Yang, J., Ye, H., Chan, J. F., Teng, J. L., Huang, C., Yip, C. C., Lau, S. K., & Woo, P. C. (2017). Clinical characteristics and molecular epidemiology of hepatitis E in Shenzhen, China: a shift toward foodborne transmission of hepatitis E virus infection. Emerging Microbes & Infections, 6(12), e115. https://doi.org/10.1038/emi.2017.107
Sridhar S, et al. Clinical Characteristics and Molecular Epidemiology of Hepatitis E in Shenzhen, China: a Shift Toward Foodborne Transmission of Hepatitis E Virus Infection. Emerg Microbes Infect. 2017 Dec 20;6(12):e115. PubMed PMID: 29259325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics and molecular epidemiology of hepatitis E in Shenzhen, China: a shift toward foodborne transmission of hepatitis E virus infection. AU - Sridhar,Siddharth, AU - Lo,Simon Kf, AU - Xing,Fanfan, AU - Yang,Jin, AU - Ye,Haiyan, AU - Chan,Jasper Fw, AU - Teng,Jade Ll, AU - Huang,Chuan, AU - Yip,Cyril Cy, AU - Lau,Susanna Kp, AU - Woo,Patrick Cy, Y1 - 2017/12/20/ PY - 2017/09/04/received PY - 2017/11/04/revised PY - 2017/11/07/accepted PY - 2017/12/21/entrez PY - 2017/12/21/pubmed PY - 2018/8/31/medline SP - e115 EP - e115 JF - Emerging microbes & infections JO - Emerg Microbes Infect VL - 6 IS - 12 N2 - Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in China. Recently, a shift in molecular epidemiology from hepatitis E genotype 1 (HEV-1) to hepatitis E genotype 4 (HEV-4) has been observed in Northern China, marking a switch from human-to-human transmission to zoonosis. However, similar data from cities in Southern China are lacking. This observational study of human hepatitis E cases in Shenzhen, a metropolitan city in the Pearl River Delta region, aimed to describe the clinical features and molecular epidemiology of hepatitis E in Southern China. Over a 55-month period, we identified 20 patients with acute hepatitis E. Most were middle-aged men, and 50% of patients had concomitant liver disease, of whom 70% were identified to have non-alcoholic fatty liver disease; such patients had a trend toward higher liver enzymes. Quantitative real-time RT-PCR using archived serum samples showed that 12 patients had hepatitis E viremia at presentation. Sequencing of the RNA-dependent RNA polymerase gene was performed for five of these patients, and phylogenetic analysis revealed that these five HEV isolates belonged to subgenotype 4b and were clustered with swine HEV isolates from Southern China. Combined with other studies showing similar findings, this suggests that the molecular epidemiology of hepatitis E in China is evolving toward low-level endemicity driven by foodborne transmission from seafood or pork products. The importance of concomitant liver disease, in particular non-alcoholic fatty liver disease, as a risk factor for severe hepatitis E requires further study. SN - 2222-1751 UR - https://www.unboundmedicine.com/medline/citation/29259325/Clinical_characteristics_and_molecular_epidemiology_of_hepatitis_E_in_Shenzhen_China:_a_shift_toward_foodborne_transmission_of_hepatitis_E_virus_infection_ L2 - https://www.tandfonline.com/doi/full/10.1038/emi.2017.107 DB - PRIME DP - Unbound Medicine ER -