Hepatitis E in High-Income Countries: What Do We Know? And What Are the Knowledge Gaps?
Abstract
:1. Introduction
2. Discovery
3. HEV, a Naked Virus?
4. Taxonomy
5. Genome
6. Putative Replication Cycle of HEV
7. Clinical
7.1. Acute Hepatitis
7.2. Fulminant Hepatitis
7.3. Chronicity
7.4. Extrahepatic Manifestations
7.5. HEV Infection during Pregnancy
8. Different Routes of Transmission
8.1. Zoonotic Transmission
8.2. Waterborne Transmission
8.2.1. Irrigation Water
8.2.2. Contaminated Environmental Water
8.2.3. Filter Feeders: Evidence of Water Contamination and Possible Route of Foodborne Transmission
8.3. Risk of Transfusion-Related Transmission
8.4. Sexual Transmission
8.5. Other Routes of Transmission
9. Infection Markers and Diagnosis
10. Treatment, Prevention, and Vaccine
11. What Do We still Need to Know?
- Even if zoonotic transmission has been identified as an important risk factor in high-come countries, the detection of HEV has been reported in several studies performed in environmental and irrigation water, sewage, and filter feeders. These results arise questions about the role of HEV in other routes of transmission and about its denomination as an environmental virus.
- The epidemiology of HEV in high-income countries is difficult to understand because of the small number of studies, the heterogeneity between them caused by the different assays used, and the type of population included. Gaps related to different suspected animal reservoirs, including food other than pork, need to be explored in order to improve the control and prevention of HEV.
- About the clinical part, the transition to chronicity and the real numbers of symptomatic cases are still poorly understood. Studies could be conducted to deepen knowledge.
- Concerning the replication cycle of HEV, many points are still unknown, especially on the HEV receptor cell and on the exact role of the pORF3 protein. Cell culture progress and discoveries in these areas could lead to advances in treatment and vaccines. A HEV vaccine is currently available in China, but not in other countries worldwide. The development of a vaccine in pigs could reduce the spread of the virus between species and humans.
- The discovery of “quasi-enveloped” HEV particles in blood raises questions about the effects on infectivity, immunity, transmission, and the virus replication cycle.
- Regarding prevention, despite the growing number of cases, Hepatitis E remains unknown to the general public. The population could be sensitized, particularly in the hyperendemic regions. Risky behaviors may thus decrease, especially among people at risk.
Author Contributions
Conflicts of Interest
References
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Country | Rate of Positive Blood Products | References |
---|---|---|
Australia | 1/14,799; 1/74,131 | [155] |
Austria | 1/8416 | [156] |
Denmark | 1/2231 | [157] |
England | 1/7040; 1/2848 | [158,159] |
France | 1/2218; 1/744 | [160,161] |
Germany | 1/1240; 1/4525 | [162,163] |
Ireland | 1/4997 | [164] |
Japan | 1/8173 | [165] |
Netherlands | 1/2700; 1/726 | [166] |
Poland | 1/1266 | [167] |
Scotland | 1/14,520 | [168] |
Spain | 1/3333 | [169] |
Sweden | 1/7986 | [111,163] |
USA | 1/9500; 0/51,075; 1/42,674 | [170] |
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Capai, L.; Charrel, R.; Falchi, A. Hepatitis E in High-Income Countries: What Do We Know? And What Are the Knowledge Gaps? Viruses 2018, 10, 285. https://doi.org/10.3390/v10060285
Capai L, Charrel R, Falchi A. Hepatitis E in High-Income Countries: What Do We Know? And What Are the Knowledge Gaps? Viruses. 2018; 10(6):285. https://doi.org/10.3390/v10060285
Chicago/Turabian StyleCapai, Lisandru, Rémi Charrel, and Alessandra Falchi. 2018. "Hepatitis E in High-Income Countries: What Do We Know? And What Are the Knowledge Gaps?" Viruses 10, no. 6: 285. https://doi.org/10.3390/v10060285