Phylogenetic analysis of hepatitis E virus isolates from Egypt

Is Hepatitis E Virus a Neglected or Emerging Pathogen in Egypt?

Though Egypt ranks among the top countries for viral hepatitis and death-related liver disease, Hepatitis E virus (HEV) is a neglected pathogen. Living in villages and rural communities with low sanitation, use of underground well water and contact with animals are the main risk factors for HEV infection. Domestic animals, especially ruminants and their edible products, are one source of infection. Contamination of water by either human or animal stools is the main route of infection. In addition, HEV either alone or in coinfection with other hepatotropic viruses has been recorded in Egyptian blood donors. HEV seropositivity among Egyptian villagers was 60-80%, especially in the first decade of life. Though HEV seropositivity is the highest among Egyptians, HEV infection is not routinely diagnosed in Egyptian hospitals. The initial manifestations of HEV among Egyptians is a subclinical infection, although progression to fulminant hepatic failure has been recorded. With the improvement in serological and molecular approaches and increasing research on HEV, it is becoming clear that HEV represents a threat for Egyptians and preventive measures should be considered to reduce the infection rate and possible complications.

Hepatitis E in Israel: A nation-wide retrospective study

AIM: To investigate the epidemiology, risk factors and clinical course of acute hepatitis E virus (HEV) infection in Israel, an industrialized country.

METHODS: A retrospective analysis of acute HEV cases diagnosed in Israel from 1993 to 2013. Acute HEV was defined by ALT/AST elevation and a positive HEV PCR test or positive anti-HEV-IgM serology. HEV RNA was tested by quantitative reverse transcription PCR. Antibodies to HEV were tested retrospectively using an ELISA assay. HEV-RNA was sequenced using RT-PCR of ORF1 and ORF2 regions to diagnose genotype of the virus. Epidemiologic and clinical data were collected by reviewing the clinical files and through a telephone interview according to a structured questionnaire.

RESULTS: Acute HEV was diagnosed in 68 patients. Among the 59 patients who gave an informed consent and were interviewed, 41% of infections were autochthonous (acquired in Israel), 44% travel-related and 15% imported by foreign workers. Autochthonous patients were mainly females (62.5%), more than half of them pregnant, 26% recalled consuming food or water in areas with poor sanitation, 44% ate non-kosher meat. Fulminant hepatitis developed in 3 patients (5%), all of them were females, two of them with post-partum infection, all acquired the disease in Israel (autochthonous). Israeli travelers with imported infection were predominantly males (73%), acquired the disease in the Indian subcontinent (81%), with 100% reporting having consumed fresh vegetables and drinks with ice cubes abroad. Six patients’ sera were tested for genotype and revealed HEV genotype 1 (all cases acquired in the Indian subcontinent).

CONCLUSION: This is the first report which highlights the existence of hepatitis E as an autochthonous infection in Israel. Imported HEV originates mostly from the Indian subcontinent.

Identification of 5’ capped structure and 3’ terminal sequence of hepatitis E virus isolated from Morocco

AIM: To examine 5’ and 3’ terminal sequences of hepatitis E virus (HEV) isolated from Morocco, to confirm 5’ methylated cap structure of the genome, and to investigate whether the 3’ UTR can be used to distinguish HEV genotypes instead of HEV complete genome sequence.

METHODS: RNA ligase-mediated rapid amplification of cDNA ends (RLM-RACE) was employed to obtain the 5’ and 3’ terminal sequences of HEV Morocco strain. The 3’ UTR sequence of the Morocco strain was compared with that of the other 29 HEV strains using the DNAStar software.

RESULTS: The 5’ PCR product was obtained only from the RLM-RACE based on the capped RNA template. The 5’ UTR of the Morocco strain had 26 nucleotides, and the 3’ UTR had 65 nucleotides upstream to the polyA. The 5’ UTR between HEV strains had only point mutations of nucleotides. The phylogenetic tree based on the sequences of 3’ UTR was not the same as that based on the complete sequences.

CONCLUSION: The genome of HEV Morocco strain was methylated cap structure. The 3’ terminal sequence can not be used for distinguishing HEV genotype for all HEV strains in place of the whole HEV genome sequence.