HEV infection in two referral centers in Spain; epidemiology and clinical outcomes
Section snippets
Background
Hepatitis E virus (HEV) is the causal agent of hepatitis E. Currently, it is considered to be the main cause of enterically transmitted hepatitis worldwide [1], [2]. In developing countries, HEV genotypes 1–2 are transmitted through water and are associated to epidemic outbreaks, affecting mostly young adults. On the contrary, genotypes 3–4 have been isolated not only in humans but also in animals, supporting the zoonotic nature of the infection responsible for most of the sporadic cases in
Objectives
To characterize the epidemiological pattern of HEV infection in two referral centers in Barcelona, with particular focus on recipients of solid organ transplants, and to analyze the clinical outcomes of confirmed HEV infection in our center.
Study design
Between 2011–2013, the Microbiology Department in our hospital received 392 samples to assess the presence of HEV infection. Approximately, half of the suspected cases had been attended in the Liver Unit, including those from another referral center. HEV was suspected in cases of acute hepatitis in patients with epidemiological risk factors (i.e., travel to endemic areas). After the first case of HEV infection in a liver transplant recipient in our center (2011), a diagnostic protocol was
Results
From 392 tested samples, isolated anti-HEV IgG was detected in twenty-three patients (6%); suggesting a past contact with HEV. Additionally, HEV-RNA was detected in ten patients (2.5%). The remaining patients did not present any serological or virological evidence of HEV infection.
Conclusions
HEV infection is a major global health problem that causes significant morbidity and mortality worldwide. However, in industrialized countries, zoonotic transmission seems to be the major cause of HEV infections [3]. During a three-year period we detected 10 cases of HEV. These included 5 cases diagnosed in solid organ transplant recipients, where a prospective diagnostic protocol was initiated after the first case of HEV infection, reported in 2011. In transplant recipients HEV genotype-3 was
Conflict of interest
The authors declare no conflict of interest.
Funding
X. Forns received support in part by grants from Instituto de Salud Carlos III (PI11/01907), Ministerio de Economía y Competitividad, co-funded by Fondo Europeo de Desarrollo Regional, Unión Europea, Una manera de hacer Europa. X. Forns also received a grant from the Roche Organ Transplantation Research Foundation (ROTRF, CI: 442035057).
Competing interests
None.
Ethical approval
The study was approved by local Ethics Committee and patients signed informed written consent.
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