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Zhang J, Zhang XF, Huang SJ, Wu T, Hu YM, Wang ZZ, Wang H, Jiang HM, Wang YJ, Yan Q, Guo M, Liu XH, Li JX, Yang CL, Tang Q, Jiang RJ, Pan HR, Li YM, Shih JWK, Ng MH, Zhu FC, Xia NS. Long-term efficacy of a hepatitis E vaccine. N Engl J Med 2015; 372:914-22. [PMID: 25738667 DOI: 10.1056/nejmoa1406011] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) is a leading cause of acute hepatitis. The long-term efficacy of a hepatitis E vaccine needs to be determined. METHODS In an initial efficacy study, we randomly assigned healthy adults 16 to 65 years of age to receive three doses of either a hepatitis E vaccine (vaccine group; 56,302 participants) or a hepatitis B vaccine (control group; 56,302 participants). The vaccines were administered at 0, 1, and 6 months, and the participants were followed for 19 months. In this extended follow-up study, the treatment assignments of all participants remained double-blinded, and follow-up assessments of efficacy, immunogenicity, and safety were continued for up to 4.5 years. RESULTS During the 4.5-year study period, 60 cases of hepatitis E were identified; 7 cases were confirmed in the vaccine group (0.3 cases per 10,000 person-years), and 53 cases in the control group (2.1 cases per 10,000 person-years), representing a vaccine efficacy of 86.8% (95% confidence interval, 71 to 94) in the modified intention-to-treat analysis, rather than (95% confidence interval, 71 to 84) [corrected]. Of the participants who were assessed for immunogenicity and were seronegative at baseline, 87% of those who received three doses of the hepatitis E vaccine maintained antibodies against HEV for at least 4.5 years; HEV antibody titers developed in 9% in the control group. The rate of adverse events was similar in the two groups. CONCLUSIONS Immunization with this hepatitis E vaccine induced antibodies against HEV and provided protection against hepatitis E for up to 4.5 years. (Funded by the Chinese Ministry of Science and Technology and others; ClinicalTrials.gov number, NCT01014845.).
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Affiliation(s)
- Jun Zhang
- From the State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University (J.Z., S.-J.H., T.W., J.W.-K.S., M.-H.N., N.-S.X.), and Xiamen Innovax Biotech Company (Q.Y., M.G., X.-H.L., H.-R.P., Y.-M.L.), Xiamen, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing (X.-F.Z., Y.-M.H., H.W., J.-X.L., F.-C.Z.), Dongtai Center for Disease Control and Prevention, Dongtai (Z.-Z.W., H.-M.J., Y.-J.W., C.-L.Y.), and Yancheng Center for Disease Control and Prevention, Yancheng (Q.T., R.-J.J.) - all in China
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2
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Krain LJ, Nelson KE, Labrique AB. Host immune status and response to hepatitis E virus infection. Clin Microbiol Rev 2014; 27:139-65. [PMID: 24396140 PMCID: PMC3910912 DOI: 10.1128/cmr.00062-13] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatitis E virus (HEV), identified over 30 years ago, remains a serious threat to life, health, and productivity in developing countries where access to clean water is limited. Recognition that HEV also circulates as a zoonotic and food-borne pathogen in developed countries is more recent. Even without treatment, most cases of HEV-related acute viral hepatitis (with or without jaundice) resolve within 1 to 2 months. However, HEV sometimes leads to acute liver failure, chronic infection, or extrahepatic symptoms. The mechanisms of pathogenesis appear to be substantially immune mediated. This review covers the epidemiology of HEV infection worldwide, the humoral and cellular immune responses to HEV, and the persistence and protection of antibodies produced in response to both natural infection and vaccines. We focus on the contributions of altered immune states (associated with pregnancy, human immunodeficiency virus [HIV], and immunosuppressive agents used in cancer and transplant medicine) to the elevated risks of chronic infection (in immunosuppressed/immunocompromised patients) and acute liver failure and mortality (among pregnant women). We conclude by discussing outstanding questions about the immune response to HEV and interactions with hormones and comorbid conditions. These questions take on heightened importance now that a vaccine is available.
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Affiliation(s)
- Lisa J. Krain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenrad E. Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alain B. Labrique
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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3
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Purcell RH, Engle RE, Rood MP, Kabrane-Lazizi Y, Nguyen HT, Govindarajan S, St Claire M, Emerson SU. Hepatitis E virus in rats, Los Angeles, California, USA. Emerg Infect Dis 2012; 17:2216-22. [PMID: 22172320 PMCID: PMC3311208 DOI: 10.3201/eid1712.110482] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This virus is unlikely to be a zoonotic threat. The role of rats in human hepatitis E virus (HEV) infections remains controversial. A genetically distinct HEV was recently isolated from rats in Germany, and its genome was sequenced. We have isolated a genetically similar HEV from urban rats in Los Angeles, California, USA, and characterized its ability to infect laboratory rats and nonhuman primates. Two strains of HEV were isolated from serum samples of 134 wild rats that had a seroprevalence of antibodies against HEV of ≈80%. Virus was transmissible to seronegative Sprague-Dawley rats, but transmission was spotty and magnitude and duration of infection were not robust. Viremia was higher in nude rats. Serologic analysis and reverse transcription PCR were comparably sensitive in detecting infection. The sequence of the Los Angeles virus was virtually identical to that of isolates from Germany. Rat HEV was not transmissible to rhesus monkeys, suggesting that it is not a source of human infection.
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4
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Teshale EH, Hu DJ. Hepatitis E: Epidemiology and prevention. World J Hepatol 2011; 3:285-91. [PMID: 22216368 PMCID: PMC3246546 DOI: 10.4254/wjh.v3.i12.285] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 09/15/2011] [Accepted: 11/08/2011] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E is caused by the hepatitis E virus (HEV), the major etiologic agent of enterically transmitted non-A hepatitis worldwide. HEV is responsible for major outbreaks of acute hepatitis in developing countries, especially in many parts of Africa and Asia. The HEV is a spherical, non-enveloped, single-stranded, positive sense RNA virus that is approximately 32 nm to 34 nm in diameter and is the only member in the family Hepeviridae and genus Hepevirus. There are four distinct genotypes of HEV (genotypes 1-4). While genotype 1 is predominantly associated with large epidemics in developing countries, genotype 3 has recently emerged as a significant pathogen in developed countries. The clinical manifestations and the laboratory abnormalities of hepatitis E are not distinguishable from that caused by other hepatitis viruses. However, high mortality among pregnant women particularly during the third trimester distinguishes HEV from other causes of acute viral hepatitis. Specific etiologic diagnosis among infected cases can be made by serological testing or detection of viral nucleic acid by reverse transcription polymerase chain reaction. Although there are vaccine candidates that had been shown to be safe and efficacious in clinical trials, none are approved currently for use. There is no specific therapy for acute hepatitis E as treatment remains supportive.
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Affiliation(s)
- Eyasu H Teshale
- Eyasu H Teshale, Dale J Hu, Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, TB Prevention, Atlanta, GA 30333, United States
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5
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Yamamoto H, Li TC, Koshimoto C, Ito K, Kita M, Miyashita N, Arikawa J, Yagami K, Asano M, Tezuka H, Suzuki N, Kurosawa T, Shibahara T, Furuya M, Mohri S, Sato H, Ohsawa K, Ibuki K, Takeda N. Serological evidence for hepatitis e virus infection in laboratory monkeys and pigs in animal facilities in Japan. Exp Anim 2008; 57:367-76. [PMID: 18633159 DOI: 10.1538/expanim.57.367] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
In laboratory animal facilities, monkeys and pigs are used for animal experiments, but the details of hepatitis E virus (HEV) infection in these animals are unknown. The risk of infection from laboratory animals to humans has become a concern; therefore, much attention should be paid to the handling of these animals during their care and use, including surgical procedures performed on infected animals. In this connection, serum samples collected from 916 monkeys and 77 pigs kept in 23 animal facilities belonging to the Japanese Association of Laboratory Animal Facilities of National University Corporations (JALAN) and the Japanese Association of Laboratory Animal Facilities of Public and Private Universities (JALAP) in Japan were examined for the purpose of detecting antibodies to HEV and HEV RNA by using ELISA and RT-PCR, respectively. One hundred and seven serum samples of 916 (11.7%) monkeys were positive for anti-HEV IgG, and 7 and 17 serum samples of 916 (0.8% and 5.3%) monkeys were positive for anti-HEV IgM and IgA, respectively. Thirty-six samples from 62 (58.1%) farm pigs were positive for anti-HEV IgG, whereas all samples tested from miniature pigs were negative (0/15, 0%). Seven samples from 62 (9.1%) farm pigs and 7 samples from 916 (0.8%) monkeys were positive for IgM antibody, but these HEV-IgM antibody positive serum samples were HEV-RNA negative by RT-PCR. The IgM antibody positive rate (9.1%) of farm pigs was much higher than that of monkeys (0.8%). These results suggest the relative levels of risk of HEV infection from these animals to animal handlers and researchers who work with them in laboratory animal facilities.
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Affiliation(s)
- Hiroshi Yamamoto
- Division for Animal Resources and Development, Life Science Research Center, University of Toyama, Sugitani, Toyama, Japan
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6
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Kase JA, Correa MT, Luna C, Sobsey MD. Isolation, detection and characterization of swine hepatitis E virus from herds in Costa Rica. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2008; 18:165-176. [PMID: 18569145 DOI: 10.1080/09603120701498311] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Although swine HEV isolates from North America, Europe, and Asia have been genetically characterized, little is known about the strains presumed to be circulating in Latin America. In this study, seven commercial swine production sites in Costa Rica were surveyed for HEV. Using RT-PCR, with primers located in ORF2, 19/52 fecal samples produced a product of the expected size following two rounds of amplification. Most positive samples were from swine between the ages of 1.5 and 4 months. This study provides documented evidence for the endemicity of HE infections in swine residing in Central America. Through nucleic acid sequencing, isolates were found to be genetically similar, if not identical, with no amino acid substitutions. By comparison of swine and human HEV strains representing all four genotypes and phylogenetic analysis, our isolates closely resembled the US swine and human and other Genotype III strains, with 85-93% nucleic acid identity.
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Affiliation(s)
- Julie A Kase
- Department of Environmental Sciences and Engineering, the School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
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7
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Fukuda S, Ishikawa M, Ochiai N, Suzuki Y, Sunaga J, Shinohara N, Nozawa K, Tsuda F, Takahashi M, Okamoto H. Unchanged high prevalence of antibodies to hepatitis E virus (HEV) and HEV RNA among blood donors with an elevated alanine aminotransferase level in Japan during 1991-2006. Arch Virol 2007; 152:1623-35. [PMID: 17533550 DOI: 10.1007/s00705-007-0996-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 05/02/2007] [Indexed: 12/28/2022]
Abstract
Hepatitis E is rare in Japan but is occurring more frequently than previously thought. To investigate whether de novo subclinical infection of hepatitis E virus (HEV) has recently increased in Japan, HEV RNA was assayed in serum samples obtained from 4019 Japanese voluntary blood donors with alanine aminotransferase (ALT) of > or =61 IU/l, who are likely to have ongoing HEV infection, during 1991-2006. The overall rates of IgG-class antibody to HEV (anti-HEV IgG), anti-HEV IgM/IgA and HEV RNA among 3185 donors in 2004-2006 were comparable with those among 594 donors in 1998 (5.3 vs. 5.2%, 0.2 vs. 0.5%, and 0.2 vs. 0.3%, respectively). Among blood donors with ALT > or = 201 IU/l in three groups according to the year of blood collection (1991-1995 [n = 156], 1996-1999 [n = 116] and 2004-2006 [n = 61]), there were no appreciable differences in the prevalence of anti-HEV IgG (5.8, 4.3, and 6.6%, respectively), anti-HEV IgM/IgA (1.9, 3.4, and 3.3%, respectively) and HEV RNA (1.3, 3.4, and 3.3%, respectively). The eleven HEV isolates obtained in the present study differed from each other by 1.7-22.8% in the ORF2 sequence and segregated into genotype 3 or 4. The occurrence rate of subclinical infection with divergent HEV strains has essentially remained unchanged during 1991-2006 in Japan.
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Affiliation(s)
- S Fukuda
- Japanese Red Cross Tochigi Blood Center, Tochigi, Japan
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8
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Matsuura Y, Suzuki M, Yoshimatsu K, Arikawa J, Takashima I, Yokoyama M, Igota H, Yamauchi K, Ishida S, Fukui D, Bando G, Kosuge M, Tsunemitsu H, Koshimoto C, Sakae K, Chikahira M, Ogawa S, Miyamura T, Takeda N, Li TC. Prevalence of antibody to hepatitis E virus among wild sika deer, Cervus nippon, in Japan. Arch Virol 2007; 152:1375-81. [PMID: 17431737 DOI: 10.1007/s00705-007-0965-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
We examined 976 sika deer serum samples, 159 liver tissue samples and 88 stool samples collected from 16 prefectures in Japan, and performed ELISA and RT-PCR assays to detect antibodies to HEV and HEV RNA, respectively. Although 25 (2.6%) of 976 samples were positive for anti-HEV IgG, the antibody titers were very low. The OD values ranged between 0.018 and 0.486, forming a single distribution rather than a bimodal distribution, suggesting that the antibody detected in this study was not induced by HEV infection, or that deer have low sensitivity to HEV. HEV RNA was not detected in these samples, also suggesting that deer may not play a role as an HEV reservoir.
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Affiliation(s)
- Y Matsuura
- Institute for Animal Experimentation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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9
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Cheng PN, Wang RH, Wu IC, Wu JC, Tseng KC, Young KC, Chang TT. Seroprevalence of hepatitis E virus infection among institutionalized psychiatric patients in Taiwan. J Clin Virol 2007; 38:44-8. [PMID: 17067852 DOI: 10.1016/j.jcv.2006.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 06/13/2006] [Accepted: 09/08/2006] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hepatitis E virus infection (HEV) remains unclear in institutionalized psychiatric patients. OBJECTIVES To investigate the prevalence and risk factors of HEV infection in a psychiatric institution in Taiwan. STUDY DESIGN A total of 754 patients with psychiatric disorders were enrolled in the study. Clinical features, review of patient charts, and interviews with families were recorded for analysis. Antibody to HEV was tested using a commercial enzyme-linked immunosorbent assays. RESULTS The prevalence of HEV infection in institutionalized patients was as high as 14.5%. Males had higher prevalence than females. It was also found prevalence increased significantly by age group. When compared with patients 30 years old or less, those in the 31-40 year old age group had an odds ratio of 4.89 [95% confidence interval (CI), 1.15-20.82], 41-50 years old of 6.30 (95% CI, 1.48-26.83), and 50 years or older of 6.20 (95% CI, 1.44-26.74). In multivariate logistic regression analysis, age and male gender were the independent risk factors. CONCLUSIONS Institutionalized psychiatric patients had higher prevalence of HEV infection. In addition, there was an age-related increase in exposure to HEV with males that had a higher HEV seropositivity.
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Affiliation(s)
- Pin-Nan Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, Taipei, Taiwan, ROC
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10
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Abstract
Sporadic and epidemic acute viral hepatitis E in many developing countries is caused by hepatitis E virus (HEV). The HEV genome has been classified into three major genotypes. However, extensive diversity has been noted among HEV isolates from patients with acute hepatitis in China and Taiwan. Some reports indicated that multiple genotypes of HEV could cocirculate in the same area; even distinct genotypes of HEV could exist in the same patient. Pakistan is a highly endemic area for hepatitis E. So far only two Pakistan HEV isolates Sar-55 (87-Pakistan-A) and Abb-2B (88-Pakistan-2B) have been characterized, and the nucleotide sequences of these two HEV isolates show only 90% homology. In this study, a third HEV isolate from Pakistan (87-Pakistan-B) is reported. The sequences of a 438-bp fragment from ORF-2 and a 259-bp fragment from the ORF-1-3 region of this new HEV isolate were obtained and sequenced. The sequence analysis showed that this new HEV isolate was very closely related to the Sar-55 but different from the Abb-2B HEV isolate. These results indicated that the Sar-55 (87-Pakistan-A) genotype is the main endemic HEV strain in the Sargodha area. These data will be useful for HEV epidemiological studies, diagnosis and vaccine development.
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Affiliation(s)
- J He
- Department of Virus Diseases, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Silver Spring, MD, USA.
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11
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12
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Walker JE, Brown TM, Hagood TL, Cassidy WM. Acute hepatitis E infection in a visitor to Louisiana. South Med J 2005; 98:721-2. [PMID: 16108241 DOI: 10.1097/01.smj.0000157559.93628.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A man from Africa had been visiting Mississippi and Louisiana when he had development of acute hepatitis. Although hepatitis E is endemic to many parts of the world and has been associated with large outbreaks, it has remained relatively uncommon in this country. With growing foreign travel and an ever-increasing number of cases reported nationally, hepatitis E infection should be considered more frequently in the differential diagnosis of acute hepatitis.
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Affiliation(s)
- James Edward Walker
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Earl K. Long Memorial Hospital, Baton Rouge, LA, USA
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13
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Purcell RH, Nguyen H, Shapiro M, Engle RE, Govindarajan S, Blackwelder WC, Wong DC, Prieels JP, Emerson SU. Pre-clinical immunogenicity and efficacy trial of a recombinant hepatitis E vaccine. Vaccine 2003; 21:2607-15. [PMID: 12744897 DOI: 10.1016/s0264-410x(03)00100-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We have demonstrated that recombinant hepatitis E vaccine suitable for clinical evaluation was highly immunogenic and efficacious in preventing hepatitis E and even infection in rhesus macaques following intravenous challenge with three different genotypes of hepatitis E virus (HEV). Two doses of vaccine were essential for optimal protection; the two-dose regimen was more important than the formulation of the vaccine for achieving efficacy. The titers of anti-HEV that were protective in this study were quantified against a World Health Organization (WHO) standard. This permits direct comparison of the results with other studies. The results of this pre-clinical trial of a candidate hepatitis E vaccine strongly suggest that it will be highly efficacious for preventing hepatitis E in the field trial of this vaccine that is currently in progress in Nepal.
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Affiliation(s)
- Robert H Purcell
- Hepatitis Viruses and Molecular Hepatitis Sections, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive MSC-8009, Bethesda, MD 30333, USA.
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14
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Abstract
The hepatitis E virus (HEV) is a non-enveloped, positive-sense, single-stranded RNA virus with icosahedral symmetry. Although it is related to the alpha-virus superfamily, the HEV is classified as a separate Hepatitis E-like viruses genus. Infection in humans occurs in sporadic and epidemic forms and can cause an acute, self-limited, icteric hepatitis. Recent studies indicate the existence of a reservoir in animals.
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Affiliation(s)
- Harald C Worm
- Second Department of Medicine, Department of Gastroenterology and Hepatology, LKH-Universitätsklinikum Graz, Auenbruggerplatz 15, Austria.
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15
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Mateos ML, Camarero C, Lasa E, Teruel JL, Mir N, Baquero F. Hepatitis E Virus: Relevance in Blood Donors and Risk Groups. Vox Sang 1999. [DOI: 10.1046/j.1423-0410.1999.7620078.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Mateos ML, Camarero C, Lasa E, Teruel JL, Mir N, Baquero F. Hepatitis E Virus: Relevance in Blood Donors and Other Risk Groups. Vox Sang 1998. [DOI: 10.1046/j.1423-0410.1998.7540267.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Abstract
Currently, six distinct types of hepatitis virus have been identified: A, B, C, D, E, and G. Hepatitis A virus infection does not cause a chronic carrier state, and perinatal transmission is extremely uncommon. Hepatitis B can be transmitted perinatally, but immunization of the newborn with hepatitis B immune globulin and hepatitis B vaccine markedly reduces the risk of neonatal infection. Hepatitis D virus is dependent on coinfection with the hepatitis B virus for replication. Immunoprophylaxis against hepatitis B also is effective against hepatitis D. Hepatitis C virus is primarily transmitted by the parenteral route and is particularly likely to cause chronic liver disease. Perinatal transmission of hepatitis C principally occurs in women who have high titers of HCV-RNA or who are coinfected with human immunodeficiency virus. At this time, no immunoprophylaxis for hepatitis C is available. Hepatitis G, a recently described organism, is related to hepatitis C. Its clinical significance remains undetermined. Hepatitis E is transmitted in a manner similar to hepatitis A. Perinatal transmission is unusual, but maternal disease is often severe.
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MESH Headings
- Female
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
- Hepatitis, Viral, Human/congenital
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/prevention & control
- Hepatitis, Viral, Human/therapy
- Hepatitis, Viral, Human/transmission
- Humans
- Infant, Newborn
- Pregnancy
- Pregnancy Complications, Infectious
- Risk Factors
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Affiliation(s)
- P Duff
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville 32610-0294, USA
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Abstract
The care of the pregnant traveler is both challenging and rewarding. It requires clinical information and skills that are derived from many disciplines. This article reviews preparatory guidelines for safe travel by the pregnant mother and her most important travel companion, the developing fetus. Issues considered are pretravel risk assessment, immunizations, and prevention of travelers' diarrhea and hepatitis. The safety and efficacy of malaria chemoprophylaxis in the present context of widespread multidrug-resistant malaria is discussed, and guidelines are offered for both prevention and treatment. A safety profile of commonly used travel medications, antibiotics, and antiparasitic drugs is reviewed.
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Affiliation(s)
- B U Samuel
- Department of Internal Medicine, Yale University School of Medicine, New Haven,Connecticut, USA
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Gouvea V, Hoke CH, Innis BL. Genotyping of hepatitis E virus in clinical specimens by restriction endonuclease analysis. J Virol Methods 1998; 70:71-8. [PMID: 9506814 DOI: 10.1016/s0166-0934(97)00172-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The genomic variability of hepatitis E virus (HEV) was examined by restriction endonuclease analysis (REA) of four genomic cDNA copies comprising a 499 bp segment of the putative polymerase gene, a 264 bp segment of the helicase gene, and two, 680 bp and 448 bp, segments of the capsid gene. Analysis of the deduced restriction sites of all 27 HEV sequences currently available in the GenBank, and digestion of reverse-transcribed and nested PCR amplified segments obtained from six Nepali isolates were used to devise and test a REA genotyping assay. The assay allowed easy discrimination between the Mexico and Asian genotypes, and the classification of the Asian genotypes into three, or perhaps four subgenotypes. In addition, endonucleases identifiers of individual isolate or clusters of isolates were found. This assay permits rapid identification of a large number of HEV isolates directly from clinical specimens for studies on the molecular epidemiology and evolution of HEV.
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Affiliation(s)
- V Gouvea
- Department of Virus Diseases, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA.
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20
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Gouvea V, Snellings N, Cohen SJ, Warren RL, Myint KS, Shrestha MP, Vaughn DW, Hoke CH, Innis BL. Hepatitis E virus in Nepal: similarities with the Burmese and Indian variants. Virus Res 1997; 52:87-96. [PMID: 9453147 DOI: 10.1016/s0168-1702(97)00112-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis E has been the predominant type of acute hepatitis in Nepal both in adults and children, in sporadic and epidemic forms. We examined six hepatitis E virus (HEV) isolates obtained during an 8-year period, from 1987 to 1995, in the Kathmandu valley of Nepal. Analysis of portions of the putative helicase, polymerase and capsid genes demonstrated close genetic relatedness among themselves (> 96.4% identity) and with the Burmese (> 95.5%) and Indian (> 95.3%) isolates, and less so with the African (> 94.4%) and the Chinese (> 91%) isolates within the Asian genotype. Phylogenetic analysis placed the Nepali isolates in the Burma-India evolutionary branch and showed that the oldest isolate, TK78/87 was more similar to the Burmese isolates whereas the most recent isolates were closer to the Indian ones. Assuming no frameshifts, the Nepali isolates showed high amino acid conservation, but also unique changes when compared to other HEV isolates. Amino acid residue 614 of the capsid protein was identified as a possible marker to distinguish the Burma-Nepal-India from the China-Central Asian Republics subgenotype, and the Mexico genotype.
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Affiliation(s)
- V Gouvea
- Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA.
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Ke WM, Tan D, Li JG, Izumi S, Shinji Y, Hotta H, Yao JL. Consecutive evaluation of immunoglobulin M and G antibodies against hepatitis E virus. J Gastroenterol 1996; 31:818-22. [PMID: 9027645 DOI: 10.1007/bf02358608] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hepatitis E virus (HEV) infection is sporadic in the Guangzhou city southern China. However, the evaluation of antibodies to HEV during consecutive time periods after infection has not been reported. We utilized enzyme immunosorbent assay (ELISA) to defect IgM and IgG anti-HEV in consecutive serum specimens from patients with acute hepatitis E and compared that data with detection rates of IgM and IgG anti-HAV in patients with acute hepatitis A. IgM anti-HEV can be detected as early as 4 days after onset of disease symptoms in some patients. The detection rate of IgM anti-HEV is significantly higher in specimens collected within 4 weeks (95%) of onset than in those specimens collected 4 to 18 weeks after onset (67.6%) (P < 0.005). IgM anti-HEV had a similar pattern to IgM anti-HAV and can be used as a marker of acute HEV infection. In contrast with IgG anti-HAV, 56.8% of the specimens did not contain detectable levels of IgG anti-HEV (P < 0.005). One should be cautioned against making a diagnosis of HEV infection solely by the currently available assays for IgG anti-HEV. In conclusion, IgM anti-HEV can be used as a reliable and sensitive marker for recent HEV infection, but serum specimens should be collected within 4 weeks after onset of symptoms to avoid false-negative results. In contrast, we should be aware of the failure to develop IgG anti-HEV in some patients. These patients carry the risk of reinfection.
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Affiliation(s)
- W M Ke
- Department of Infectious Diseases, Third affiliated Hospitol of Sun Yat-Sen University of Medical Sciences, Shipai, Guangzhou, P.R. China
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22
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al-Fawaz I, al-Rasheed S, al-Mugeiren M, al-Salloum A, al-Sohaibani M, Ramia S. Hepatitis E virus infection in patients from Saudi Arabia with sickle cell anaemia and beta-thalassemia major: possible transmission by blood transfusion. J Viral Hepat 1996; 3:203-5. [PMID: 8871882 DOI: 10.1111/j.1365-2893.1996.tb00096.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The seroprevalence of antibodies against hepatitis E virus (HEV) and hepatitis C virus (HCV) was investigated in Saudi children with sickle cell anaemia (SCA) (50 patients: 28 boys, 22 girls; age range 2-14 years) and beta-thalassemia major (28 patients: 12 boys, 16 girls; age range 2-12 years). The SCA patients were from the Gizan area (South) while the thalassemics were from the Riyadh area (Central province). The prevalence of hepatitis E virus antibody (HEVAb) in patients with SCA (18.0%) and in those with beta-thalassemia major (10.7%) was higher than in the control groups (5.5% and 2.8%) but this did not reach the level of statistical significance. In contrast to the situation with HEV, hepatitis C virus antibody (HCVAb) positivity was significantly higher in patients with SCA (16.0%) and in thalassemics (57.1%) than in the respective control groups. Although the difference in HEV seropositivity between beta-thalassemia major, SCA patients and their respective controls is not statistically significant, the possibility of blood-borne HEV in the Saudi population cannot be excluded. Further investigations using HEV-specific polymerase chain reaction techniques are required to confirm whether transmission of HEV through blood preparations or transfusion is possible.
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Affiliation(s)
- I al-Fawaz
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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23
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Abstract
Hepatitis E has a worldwide distribution and causes substantial morbidity and mortality in some developing countries, particularly among pregnant women. Hepatitis E virus (HEV) has recently been cloned and sequenced and new diagnostic tests have been developed; these tests have been used to begin to characterize the natural history and epidemiologic features of HEV infection. Experimental vaccines have also been developed that offer the potential to prevent hepatitis E. However, to develop effective strategies to prevent this disease, much remains to be learned about HEV, including the vehicles of transmission, the reservoir(s) of the virus, and the natural history of protective immunity.
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Affiliation(s)
- E E Mast
- Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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24
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Favorov MO, Khudyakov YE, Fields HA, Khudyakova NS, Padhye N, Alter MJ, Mast E, Polish L, Yashina TL, Yarasheva DM. Enzyme immunoassay for the detection of antibody to hepatitis E virus based on synthetic peptides. J Virol Methods 1994; 46:237-50. [PMID: 8188817 DOI: 10.1016/0166-0934(94)90106-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Five synthetic peptides were prepared based on the nucleotide sequence of open reading frames 2 and 3 encoded in the hepatitis E virus (HEV) genome and were used to develop an enzyme immunoassay (EIA) for the detection of anti-HEV activity in sera. Three different approaches were employed to ascertain the optimal preparation of these peptides as an immunodiagnostic reagent, including (1) a mixture of unconjugated peptides, (2) conjugating individual peptides to bovine serum albumin (BSA) followed by mixing each conjugate at various concentrations, and (3) mixing the peptides before conjugation with BSA to create an artificial antigen complex. The third method was superior in discriminating anti-HEV activity in sera previously tested by Western blot (WB). A frequency distribution of optical density values demonstrated that the peptide-based EIA was able to readily discriminate anti-HEV positive sera from sera devoid of anti-HEV activity. To confirm anti-HEV activity a neutralization test was developed using a mixture of 5 unconjugated peptides. With the exception of sera containing high levels of anti-HEV activity, all sera were neutralized greater than 50%. Strong sera required a higher dilution before a 50% neutralization was achieved. The sensitivity of the WB compared to EIA was 89.5% with and overall concordance of 94.8%. The peptide-EIA was used to determine anti-HEV activity in sera collected from various populations worldwide. In six outbreaks of ET-NANB hepatitis in various geographic regions, anti-HEV activity was demonstrated in 78-100% of cases. The peptide-EIA also detected anti-HEV activity in 14 out of 14 follow-up sera obtained 4-6 months after onset of disease and in 2 of 2 of these patients 5 yr after the acute episode. Anti-HEV activity was found in 8.5% of sera obtain from a healthy population residing in an HEV endemic region and 0.5% in two non-endemic regions (P < 0.001). These data demonstrate that a synthetic peptide-based EIA is sensitive for detecting anti-HEV activity in the sera of patients with acute hepatitis E, convalescents, and among healthy individuals.
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Affiliation(s)
- M O Favorov
- Division of Viral and Rickettsial Diseases, National Center of Infection Disease, Centers for Disease Control and Prevention, Atlanta, GA 30333
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25
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Lok AS, Kwan WK, Moeckli R, Yarbough PO, Chan RT, Reyes GR, Lai CL, Chung HT, Lai TS. Seroepidemiological survey of hepatitis E in Hong Kong by recombinant-based enzyme immunoassays. Lancet 1992; 340:1205-8. [PMID: 1359270 DOI: 10.1016/0140-6736(92)92901-q] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The agent that causes the enterally transmitted form of non-A, non-B hepatitis has been cloned and called hepatitis E virus (HEV). We have carried out a seroepidemiological survey on the prevalence of hepatitis E in Hong Kong. In a retrospective study, serum from 394 patients with acute viral hepatitis and 355 healthy subjects was tested for antibodies to HEV (anti-HEV) with a recombinant-based enzyme immunoassay. 65 (16.5%) patients with hepatitis were positive for IgM anti-HEV and 23 (5.8%) were also positive for IgM anti-HEV. Of 18 patients diagnosed as having acute non-A, non-B, non-C hepatitis, 6 were IgM anti-HEV positive. 17 (6%) patients in whom acute hepatitis A was diagnosed were also infected with HEV. None of 70 patients with acute hepatitis B or C or exacerbation of chronic hepatitis B was IgM anti-HEV positive. 57 (16.1%) of the healthy subjects were positive for IgG anti-HEV. The prevalence of IgG anti-HEV was higher in subjects over 20 years old than in younger subjects (24% vs 4%, p < 0.0001). IgG anti-HEV was detected in 26% of subjects who were positive for IgG antibody to HAV and in 7% of those negative for that antibody (p < 0.0001). We demonstrated the validity of the recombinant-based enzyme immunoassays for the diagnosis of hepatitis E. Our results suggest that hepatitis E accounts for a third of non-A, non-B, non-C hepatitis in Hong Kong and that coinfection of hepatitis A and E can occur.
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Affiliation(s)
- A S Lok
- Department of Medicine, Queen Mary Hospital, University of Hong Kong
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26
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27
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Dawson GJ, Chau KH, Cabal CM, Yarbough PO, Reyes GR, Mushahwar IK. Solid-phase enzyme-linked immunosorbent assay for hepatitis E virus IgG and IgM antibodies utilizing recombinant antigens and synthetic peptides. J Virol Methods 1992; 38:175-86. [PMID: 1644893 DOI: 10.1016/0166-0934(92)90180-l] [Citation(s) in RCA: 191] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Four recombinant antigens representing two distinct antigenic domains from two different strains of hepatitis E virus (HEV), were used individually to develop four ELISAs designed to detect antibodies to HEV. Both IgG and IgM class antibodies to HEV were detected in 7 of 8 pedigreed serum/plasma from known outbreaks of HEV in Mexico, Burma, Somalia and Pakistan. In addition, specific HEV-antibodies were detected in cynomolgus macaques following inoculation with various HEV strains. Anti-HEV was also detected in 8 of 386 (2.1%) randomly selected American blood donors. Supplemental tests utilizing both synthetic peptides and specific blocking assays provided additional serologic data confirming the presence of anti-HEV. Similar prevalence studies on a limited number of available sera from other geographical regions (Alaska, Japan, Germany, New Zealand, Thailand and Mexico) confirmed the presence of anti-HEV in at least 1.1 to 7.6% of the specimens.
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Affiliation(s)
- G J Dawson
- Experimental Biology Research, Abbott Laboratories, North Chicago, Illinois 60064
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28
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Reyes GR, Yarbough PO, Tam AW, Purdy MA, Huang CC, Kim JS, Bradley DW, Fry KE. Hepatitis E virus (HEV): the novel agent responsible for enterically transmitted non-A, non-B hepatitis. GASTROENTEROLOGIA JAPONICA 1991; 26 Suppl 3:142-7. [PMID: 1909254 DOI: 10.1007/bf02779285] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A normally endemic form of viral hepatitis is the cause of major epidemic outbreaks in developing countries. This disease has a global distribution and has been referred to as water-borne, epidemic or enterically transmitted non-A, non-B hepatitis (ET-NANBH). Although the fecal-oral route of transmission predominates, person-to-person routes of exposure were also suggested in some epidemiologic studies. The disease has been documented as having an extremely high mortality in pregnant women (approximately 20%). Sporadic cases of ET-NANBH, as well as imported travel exposures, have been reported in developed countries. Molecular cloning was hampered by the lack of a tissue culture system for virus propagation, however, an available animal model and a newly developed non-specific amplification procedure were used to clone and identify an exogenous cDNA (ET1.1) from a Burma-isolate infected animal. Molecular clones were also identified by immunoscreening of a cDNA library made from a fecal specimen collected from a Mexican outbreak of ET-NANBH. The isolation and sequencing of a set of overlapping cDNA clones had led to the recognition that this form of hepatitis is caused by a virus unlike any of the other viral hepatitis agents. The molecular characterization of HEV will lead to important pathobiologic insights and hasten the development of potentially useful diagnostic and therapeutic products for ET-NANBH.
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Affiliation(s)
- G R Reyes
- Molecular Virology Department, Genelabs Incorporated, Redwood City, CA 94063
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