Search Results (83)

Acute hepatitis B virus (HBV) infection is rare during infancy, and severe symptomatic HBV-associated hepatitis is even less common. We describe two siblings who developed severe HBV-associated liver injury during infancy, two years apart, but experienced markedly divergent clinical outcomes. Clinical, laboratory, virological, microbiological, imaging, therapeutic, and follow-up data were retrospectively reviewed. Household members were subsequently tested for HBV and HDV. The first infant, a 5-month-old girl, presented with HBsAg positivity, negative serological markers for HAV, HCV, and HEV, and severe acute liver injury with a fulminant clinical course that resulted in death. Because anti-HBc IgM, HBV DNA, repeat HBsAg testing, and follow-up serology were unavailable, acute HBV infection could not be confirmed, and the episode was therefore classified as presumed HBV-associated fulminant hepatitis. The rapidly fatal clinical course precluded a comprehensive etiological evaluation, and the available medical records did not fully document the diagnostic work-up. The second patient, a 4-month-old boy, presented with serological and molecular evidence of acute HBV infection, including low-level HBV DNA, total anti-HDV positivity of uncertain clinical significance, and positive CMV IgM/IgG serology. He also had a urinary tract infection (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. Without HDV RNA and CMV DNA testing, active HDV infection and clinically significant CMV disease could not be definitively confirmed, while passive transfer of maternal anti-HDV antibodies could not be excluded. The patient required prolonged hospitalization, during which he received supportive, replacement, and antimicrobial therapy. He recovered, and long-term follow-up demonstrated HBsAg clearance with undetectable HBV DNA. Testing of household members revealed chronic HBV infection in the mother and maternal grandmother, both of whom had detectable HDV RNA, consistent with ongoing HBV/HDV circulation within the family. However, without viral sequence data from the infants, the source, route, timing, and direction of transmission could not be established. These cases illustrate the potential severity of HBV-associated hepatitis during infancy and its highly variable clinical outcomes. They also underscore the importance of antenatal HBV screening, timely immunoprophylaxis, and cautious interpretation of suspected viral coinfections when molecular confirmation is unavailable. Full article

Background: Hepatitis A (HA) and E (HE) represent a significant global health burden. Despite the development of effective vaccines against hepatitis A virus (HAV) and hepatitis E virus (HEV), outbreaks of acute HA and HE continue to occur worldwide. This study aimed to assess the seroprevalence of anti-HAV and anti-HEV IgG antibodies (Abs) in the population of Belgrade and to analyze their association with socio-demographic and clinical factors. Materials and Methods: A cross-sectional study was conducted on a sample of 2533 healthy volunteers in Serbia in May 2024. Participation was voluntary and web-based, leading to an overrepresentation of women and middle-aged adults, while children were underrepresented. Due to this non-probabilistic recruitment, the absolute seroprevalence estimates have limited generalizability to the entire population of Belgrade. Serum samples were tested for anti-HAV and anti-HEV IgG using commercial ELISA kits. The anti-HEV estimate is based on a single ELISA without confirmatory testing and should be interpreted with this limitation in mind. Statistical analysis included confidence interval estimation, chi-square tests, and Spearman’s correlation. Results: Overall seroprevalence was 20.5% (95% CI: 18.9–22.1) for anti-HAV and 22.6% (95% CI: 21.0–24.3) for anti-HEV. A strong, non-linear increase in anti-HAV seroprevalence with age was observed, rising sharply from 2.8% in the 18–29 group to 78.3% in those aged 70+. Anti-HEV seroprevalence also featured a significant positive correlation with age (rs = 0.99, p < 0.0001), increasing from 4.2% in children (1–17 years) to 49.2% in the 70+ group. Men had significantly higher anti-HAV seroprevalence than women (23.1% vs. 19.3%, p = 0.029). Individuals with a history of surgical interventions or blood transfusions had significantly higher odds of being anti-HEV positive (OR = 1.41, p = 0.0005). Vaccination coverage against HAV was low (1.8%), and Abs were detected in only 28.6% of vaccinated individuals. Conclusions: This study suggests high HEV seroprevalence and an age-polarized HAV seroprevalence in Serbia, indicating a significant shift in the epidemiological landscape while acknowledging the sampling and assay limitations stated above. The findings underscore a growing population susceptible to HAV and highlight the need for reinforced vaccination strategies, improved diagnostics, and targeted public health interventions. Full article

Hepatitis E is a liver inflammation caused by the hepatitis E virus (HEV). In pregnant women, the infection significantly increases the risk of acute liver failure, fetal loss, and maternal death. According to the World Health Organization, infection by HEV during the third trimester of pregnancy may increase the risk of maternal mortality in 20–25% of cases. In Tunisia, little is known about HEV infection and its outcome, especially in pregnant women. This study aims to evaluate the prevalence of HEV infection in a large cohort of pregnant women in Tunisia. A total of 891 women who attended the Centre of Maternity and Neonatology of Tunis during 2021–2023 were included. Serum samples were screened to detect HEV-antibodies and RNA using commercial ELISA tests and molecular assays, respectively. Statistical analyses were conducted using SPSS 21.0 software and the EPISTAT package version 7.2.6. Seroprevalence of HEV infection was 3.82%, based on the detection of anti-HEV IgG. The distribution of the seroprevalence according to age was statistically significant (p < 0.05), showing a higher seroprevalence among women over 30 years. Among the 51 women with composite outcomes, viral RNA was detected in one case by real-time RT-PCR. Our findings indicate a low HEV prevalence among pregnant women in Tunisia. Expanding the study to other cohorts and to environmental surveillance would improve understanding of HEV burden in Tunisia and support hepatitis elimination efforts. Full article

Hepatitis E virus (HEV) is an emerging zoonotic pathogen of increasing concern in developed regions and represents a major cause of acute viral hepatitis worldwide, primarily transmitted via the fecal–oral route. Although most infections are self-limiting, immunocompromised individuals, such as people living with human immunodeficiency virus (PLWH) and pregnant women, are at risk of severe outcomes, including chronic infection and fatal liver failure, respectively. This study was aimed at evaluating the prevalence and genetic diversity of HEV in PLWH and relevant ecological niches (swine and wastewater) in Venezuela. A total of 417 serum samples from PLWH, 85 wastewater samples, and 67 swine fecal samples were tested for serological or molecular HEV markers. The seroprevalence of anti-HEV antibodies among PLWH was 0.2% for IgM and 5.5% for IgG. HEV RNA was not detected in samples from PLWH or wastewater; however, a 1.5% prevalence of active infection was identified in swine. Phylogenetic analysis of a complete HEV genome revealed an unassignable subtype within genotype 3, tentatively designated as 3p. To the best of our knowledge, this study provides the first molecular characterization and report on HEV frequency in PLWH, wastewater, and swine in Venezuela. Full article

Background: Hepatitis E virus (HEV) is an increasingly recognized cause of acute viral hepatitis in Thailand as the burden of hepatitis A, B, and C has declined. HEV is a positive-sense RNA virus in the family Hepeviridae with three major open reading frames encoding replication proteins (ORF1), the capsid protein (ORF2), and an accessory protein involved in viral egress (ORF3). Unlike highly endemic regions where genotypes 1 and 2 are linked to waterborne outbreaks, infections in Thailand are reported mainly as sporadic cases associated with zoonotic transmission, most commonly genotype 3. Objectives: This review summarizes the epidemiology, transmission routes, and public health implications of HEV infection in Thailand. Methods: Peer-reviewed studies on HEV seroprevalence, molecular epidemiology, and transmission in Thailand were identified through PubMed using combinations of the keywords “HEV” and “Thailand”. Two investigators independently screened titles, abstracts, and full texts. Eligible studies were synthesized qualitatively. Results: Earlier studies suggested low population exposure, but more recent evidence indicates substantial cumulative risk. A nationwide survey among blood donors reported anti-HEV IgG seroprevalence of about 30%, with geographic variation and increasing prevalence with age. Detection of HEV RNA in pigs, slaughterhouse environments, and retail pork products, together with links to raw or undercooked pork consumption, supports pigs as the principal reservoir and foodborne exposure as an important route. Transfusion-associated infection has also been documented. Conclusions: In Thailand, HEV infection is linked mainly to zoonotic and foodborne transmission involving genotype 3. Stronger surveillance, food safety measures, and risk-based blood safety policies are needed. Full article

Hepatitis E virus (HEV) is recognized as one of the leading causes of acute viral hepatitis (AVH) in developing countries, where it is primarily transmitted through the consumption of contaminated food and water. Although often self-limiting, HEV infection poses a significant public health concern, particularly among pregnant women, due to its potential complications. The present study aimed to determine the seroprevalence of HEV infection in asymptomatic antenatal women attending a tertiary care center in South Punjab, Pakistan. A total of 100 asymptomatic pregnant women were screened for anti-HEV antibodies (IgM and IgG) using an ELISA kit (DIA PRO, Italy). The overall seropositivity rate was found to be 12%, indicating prior exposure to HEV infection in this cohort. Specifically, IgG antibodies were detected in 6% of women and IgM antibodies in 5%, while two women showed evidence of both IgG and IgM positivity, suggestive of recent or ongoing infection. Notably, the majority of participants reported reliance on untreated water sources irrespective of educational background, highlighting environmental risk factors. Although HEV is generally self-limiting, these findings underscore the importance of routine serological screening in antenatal populations to prevent adverse pregnancy outcomes. In addition, increased community awareness regarding transmission routes and preventive measures is essential. Given the scarcity of regional data, this study emphasizes the need for larger-scale epidemiological investigations to better understand the burden of HEV in South Punjab, Pakistan. Full article

Hepatitis A (HAV) and E (HEV) are clinically indistinguishable diseases. This study aimed to determine the seroprevalence of both viruses among 469 blood donor candidates at HEMOBA, Salvador, Brazil. The seroprevalence of anti-HAV IgG was determined by chemiluminescence (Abbott Diagnostics, Chicago, IL, USA) and that of anti-HEV (IgG/IgM) was determined by ELISA (Wantai-Biopharm, Beijing, China). The ineligibility rate was 16.8% (79/469), mostly temporary. There were no statistically significant demographic differences between ineligible and eligible donor candidates. The participants were predominantly male (52.7%), with the skin color Brown/Black (83.2%), and had completed secondary education or started/completed higher education (89.6%). The seroprevalence of anti-HAV IgG was 53.5% (193/361; 95%CI: 48.2–58.7%) among unvaccinated participants; the seroprevalence of anti-HEV IgG was 7.0% (33/469; 95%CI: 4.9–9.7%), and no case of anti-HEV IgM was found. In univariate analysis, HAV was associated with work with livestock and eating fresh fish; HEV was related to low incomes and eating game meat. However, only aging and being born in the interior of the state retained statistical significance in the final model. In conclusion, despite the availability of the HAV vaccine, this study revealed a higher burden of HAV when compared to HEV. Future studies must prioritize risk factor investigations of both viruses in non-metropolitan and rural areas. Full article

Infection with Hepatitis E Virus (HEV) is often asymptomatic but can also lead to chronic infection in immunosuppressed individuals. Although fecal–oral transmission of HEV is well established, transmission by blood transfusion has also been reported. Here, we studied HEV seroprevalence in a cohort of 1000 blood donors (50% male, age 18–73 years, mean 35 years) at the University Medical Center Hamburg–Eppendorf in Germany. We found a seroprevalence of anti-HEV IgG of 16.6%. Interestingly, 1.3% of the blood donors had positive IgM serology despite testing negative for HEV by polymerase chain reaction (PCR). Analysis of preceding and follow-up samples showed persistence of IgM antibodies for up to seven months in asymptomatic individuals. In eight individuals, anti-HEV IgM positivity persisted for 0 to 7 months (median 2 months), as confirmed by testing stored samples. This study demonstrates that anti-HEV IgM positivity can persist for more than six months in individuals who had neither clinically overt hepatitis E nor a viremia duration that would allow PCR positivity to be detected. Full article

Background and Objectives: The Hepatitis E Virus (HEV) is increasingly recognized as a cause of chronic infection in immunocompromised patients, but its precise role in cryptogenic cirrhosis (CC) is unclear. CC is defined as liver cirrhosis in which all known causes, including viral, autoimmune, metabolic, and alcohol-related etiologies, have been meticulously excluded. We aimed to address this gap by definitively assessing HEV’s etiological contribution in CC through seroprevalence comparison and evaluating its long-term prognostic impact on disease progression and adverse clinical outcomes. Materials and Methods: This is a retrospective, single-center, observational, and longitudinal cohort study, conducted between July 2017 and June 2025. The study included 52 CC patients, whose diagnosis was strictly confirmed by excluding all known etiologies, and 900 healthy blood donors from the same region. CC patients were retrospectively followed for five years to assess long-term clinical outcomes. We compared HEV seropositive and seronegative patients for accelerated disease progression (assessed by follow-up MELD-Na scores) and cirrhosis-related death. We employed multivariable logistic regression to adjust for demographic confounders in the prevalence comparison and multivariable COX regression for survival analysis to determine the independent prognostic role of HEV seropositivity. Results: The anti-HEV IgG seroprevalence in CC patients (42.3%) was significantly higher than in healthy donors (12.8%) (p < 0.001). Multivariable logistic regression confirmed CC status as an independent predictor of HEV seropositivity (Adjusted OR = 6.142, p < 0.001). During the five-year follow-up, the cirrhosis-related death rate was significantly higher in the anti-HEV IgG positive group (36.4% vs. 13.4%; p = 0.047), and their follow-up MELD-Na score was significantly higher (p = 0.029). However, multivariable COX analysis did not sustain anti-HEV IgG positivity as an independent risk factor for death (p = 0.294). Conclusions: HEV exposure is independently and significantly higher in CC patients. While anti-HEV IgG positivity correlates with higher mortality and accelerated disease progression in univariable analysis, its lack of independent prognostic significance suggests it may primarily function as a marker for a more advanced stage of CC or underlying immune dysfunction. Further rigorous prospective studies are necessary to precisely define HEV’s long-term prognostic role and evaluate its impact on disease progression. Full article

Knowledge gaps exist regarding foodborne zoonotic diseases in migrant populations. We assessed the seroprevalence of Campylobacter, Salmonella, Yersinia, Brucella, hepatitis E virus (HEV), and Trichinella, and identified potential exposure risks in populations with and without migration backgrounds. In a cross-sectional study (2014–2016), adults with Turkish, Russian, Vietnamese, or German backgrounds residing in Berlin, Germany, were recruited via convenience sampling. Sera were screened for anti-IgG antibodies, and risk factors were assessed via a structured questionnaire. Logistic regression was used for analysis. We included 1180 participants: 497 Germans and 215, 273, and 195 individuals with Russian, Turkish, and Vietnamese backgrounds, respectively. Salmonella seroprevalence was highest among Vietnamese (47–50%) and lowest among Turks (18–20%). Campylobacter seroprevalence ranged from 17% to 23%. Yersinia seroprevalence was highest among Germans (64–70%) and associated with raw pork consumption. HEV seropositivity was highest among Vietnamese (27–28%) and lowest among Russians (5%). No samples were positive for Brucella; two were positive for Trichinella. High seroprevalence of Campylobacter, Salmonella, Yersinia, and HEV suggests substantial exposure and frequent asymptomatic or mild infections. While Yersinia seropositivity was associated with raw pork consumption, high seroprevalence in Turks—who rarely consume pork—suggests other food sources or transmission routes. Full article

Introduction: Although Brazil includes industrialized regions, such as the Southeast, it also has underdeveloped areas with poor sanitation, such as the North and Northeast, resembling regions in Africa and Asia where HEV is endemic. In Brazil, HEV is suspected to occur mainly as a zoonosis. Given the wide variation in HEV prevalence across the five regions, a scoping review was conducted to systematically evaluate its prevalence and circulating genotypes. Aim: To investigate the epidemiological characteristics of HEV in Brazil, including modes of transmission, by reviewing genotyping studies in humans and swine. Methods: This scoping review followed the methodological framework of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. Gray literature was retrieved from Google Scholar, the Brazilian Digital Library of Theses and Dissertations, and the Thesis and Dissertation Catalog of the Coordination for the Improvement of Higher Education Personnel. Searches were performed in June and July 2025 in MEDLINE and LILACS. The evidence on HEV epidemiology in Brazil was mapped using the Population, Concept, and Context strategy. Results: Among 57 studies on HEV prevalence in Brazil, 45 (78.9%) involved humans and 12 (21.1%) involved swine. IgG prevalence ranged from 0.5% in the North to 59.4% in the South. IgM prevalence was lowest in the Northeast (0.1%) and highest in the North (16.3%). In swine, HEV was detected in all regions, with variation in sample types, husbandry practices, and prevalence. Genotyping revealed exclusively HEV-3 in all regions where analysis was performed. Conclusions: HEV infection is present throughout Brazil, with higher prevalence in the South and Southeast. The circulating genotype is HEV-3, and transmission is likely linked to swine breeding and consumption. Full article

Hepatitis E virus (HEV) is a significant yet understudied cause of viral hepatitis among liver transplant (LT) recipients in Central and South-eastern Europe. We conducted a combined cross-sectional and prospective cohort study to determine the seroprevalence, incidence, and risk factors of HEV infection in Croatian LT recipients. A total of 766 adult LT recipients were analyzed for anti-HEV IgG and HEV RNA. Additionally, 152 patients listed for LT were followed prospectively with sampling before and up to 12 months after transplantation. Anti-HEV IgG seroprevalence in the cross-sectional cohort was 19.8%, with no active infections detected via HEV RNA. In the prospective cohort, baseline seroprevalence was 20.4%, declining post-transplant, while 3.9% of initially seronegative patients seroconverted without detectable HEV RNA. Older age and non-tertiary level of education were associated with seropositivity, while dietary and animal contact factors were not. These findings indicate a moderately high level of prior HEV exposure among Croatian LT recipients, comparable to some European regions, but a low incidence of post-transplant infection and no evidence of chronic HEV infection. Our results suggest that despite frequent exposure, clinically significant HEV infection is uncommon in this immunosuppressed population. Full article

Hepatitis E virus (HEV) poses a significant public health concern, particularly among immunocompromised populations. This study aimed to investigate HEV seroprevalence, clinical characteristics, and associated risk factors in people living with HIV (PLWH) in Shanghai, China. A retrospective analysis was conducted on serum IgG and IgM antibodies specific to HEV in 670 PLWH and 464 HIV-negative health-check attendees. The overall anti-HEV seropositivity rate among PLWH was 30.15% (202/670, 95% CI 26.68–33.62), with an IgG positivity rate of 30.00% (201/670, 95% CI 26.53–33.47). IgM positivity was observed in 1.19% (8/670, 95% CI 0.59–2.39) of PLWH, and dual IgM/IgG positivity was observed in 1.04% (7/670, 95% CI 0.50–2.16) of PLWH. The seropositivity rate of anti-HEV IgG in the HIV-negative health-check attendees was 17.67% (82/464, 95% confidence interval: 14.20–21.14), with no IgM positivity, which was significantly lower than that in PLWH (χ² = 22.84, p < 0.001). Univariate and multivariate analyses identified advanced World Health Organization (WHO) HIV stage (III/IV) as an independent risk factor for HEV co-infection (p < 0.05). Notably, no significant associations were observed with age, gender, CD4 count, or liver function parameters. These findings underscore the importance of implementing HEV screening protocols and developing targeted preventive strategies for PLWH. Full article

Hepatitis E Virus (HEV) has gained public health attention as one of the causative agents of viral hepatitis. Our study aimed to provide data about HEV seropositivity in the Israeli general population, including its seroprevalence geographical distribution, and to identify variables as possible risk factors for HEV exposure. A seroprevalence cross-sectional study was conducted: HEV serological status was determined in 716 blood samples collected from the routine check-up blood samples. Demographic information was available for all samples. The overall prevalence of HEV IgG in an apparently healthy population in the north of Israel was 10.5%, with no evidence of positive HEV IgM. There was a significant association between HEV seropositivity and elderly age and low socioeconomic status (SES). The age-adjusted seroprevalence was significantly lower among Jews compared to Arabs with a rate ratio of 2.02. We identified clusters (hot spots) of HEV infection in three regions under study. Our results confirmed a high prevalence of anti-HEV in the country where clinical hepatitis E is not endemic. For the first time, this study showed that a hot spot analysis was able to provide new knowledge about actual exposure zones. As HEV infection is not a notifiable disease, it is probably underdiagnosed. Thus, better awareness among physicians is warranted. Full article

Hepatitis E virus (HEV) infection can become chronic in immunocompromised patients, like solid organ transplant recipients (SOTRs). We evaluated HEV prevalence, risk factors, and outcomes among SOTRs in a hyperendemic HEV area. Three hundred SOTRs were enrolled from April to July 2019 and tested for anti-HEV IgM and IgG and HEV RNA. Sixty-three recipients (21%) were positive for any HEV marker. HEV infection was independently associated with older age and pork liver sausage consumption. Three viremic recipients harbored genotype 3e and 3f according to HEV RNA sequencing and phylogenetic analysis. Overall, 10 recipients had markers of active/recent infection (HEV RNA and/or anti-HEV IgM) and were followed up prospectively. Five of them spontaneously resolved their HEV infection. In two recipients, HEV clearance was achieved only through immunosuppression reduction, while three needed ribavirin therapy to achieve virologic resolution. We observed a chronic course in 30% of SOTRs with active/recent HEV infection. No association was found between tacrolimus assumption and chronicization. In conclusion, we found a high prevalence of infection among SOTRs attending a transplant center in a hyperendemic Italian HEV region. Systematic screening for all HEV markers and dietary education for infection control are needed for transplant recipients. Full article