Identification of genotype 3 hepatitis E virus in fecal samples from a pig farm located in a Shanghai suburb

Prevalence of hepatitis E virus in domestic animals in the Chinese mainland: a systematic review and meta-analysis

BACKGROUND

China, especially the Chinese mainland, is a highly endemic area of hepatitis E, and its incidence rate has been increasing in recent years. Hepatitis E virus (HEV) is the causative agent of hepatitis E, with a variety of domestic animals as potential hosts. The shift in the main epidemic strain and the increasing trend of zoonotic HEV infection in the Chinese mainland need urgent attention. This systematic review aimed to provide a summary of HEV detection and its characteristics in domestic animals in the Chinese mainland.

METHODS

A total of 1,019 literatures published in Chinese and English before 2024.1.15 were retrieved from four databases including Pubmed, ScienceDirect, Wan Fang and CNKI. Eventually, 73 eligible studies were included in this review, involving HEV detection data of 64,813 samples collecting from 13 kinds of common domestic animals, locating in 28 provinces and municipalities.

RESULTS

HEV antibodies and RNA were detected among 12 and 7 kinds of domestic animals respectively, with the pooled prevalence of 37.94% (95% CI:32.28-43.77) and 7.62% (95% CI: 5.56-9.96) respectively. The prevelance of HEV for swine samples was higher than other species. In addition, the prevalence of HEV among Tibetan swine, cattle and goats were also at a relatively high level. Further subgroup analysis focusing on comprehensive data from swine was conducted. The results showed, the seroprevalence of HEV antibodies gradually decreased over the time of sampling. HEV RNA was detected in various samples, including bile, feces, liver, and serum. The detection rate for fecal samples was the highest, which was 16.60% (95% CI: 12.17-21.55). Further genotyping of HEV RNA was classified. The results warn us about the circulation of genotype 3 HEV in the eastern region of the Chinese mainland.

CONCLUSION

The results collected from the included studies provided valuable data on HEV prevalence across various species, and the characteristics, trends, and potential influencing factors were fully discussed. This review provides public health professionals, policymakers, and researchers with comprehensive and up-to-date research data on zoonotic HEV.

Contamination of Hepatitis E Virus in Pig Livers of Different Market Types Collected from Seven Provinces of China

Foodborne transmission of the Hepatitis E virus (HEV) is becoming an important public health problem in China, but the food associated with the HEV transmission route remains unclear. Pig liver is among the suspected food products involved in HEV transmission. Our research aimed to survey the contamination rate and genotype identification of HEV in pig livers from different types of markets in selected provinces of China. reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to screen for HEV in pig livers, nest RT-PCR was used for partial amplification of opren reading frame (ORF) 2, followed by sequencing, and phylogenetic analysis to determine the genotype of positive samples. A total of 787 pig liver samples from 7 provinces were collected. The average positive rate of HEV was 8.13% (64/787), Inner Mongolia (14.29%, 1/7) and Hebei province (14.29%, 23/161) showed the highest positive rate. There was a significant difference among the provinces (p < 0.01). Three major market types (wholesale market, supermarket, and butcher's shop) were included in this study, and the positive rates were 5.28% (21/398), 15.86% (23/145), and 8.20% (20/244), respectively. There was no significant difference among the three market types. Eleven of the positive samples were partially sequenced and identified genotypes 4a, 4d, and 3a.

Laboratory-based Surveillance and Clinical Profile of Sporadic HEV Infection in Shanghai, China

The study aimed to describe the epidemiological, virological and clinical features of sporadic HEV infection in eastern China. A total of 6112 patient sera were tested for anti-HEV IgG or anti-HEV IgM during one consecutive year (between August 2018 and July 2019). HEV RNA presence was evaluated by RT-PCR and HEV sequences were phylogenetically analyzed. Clinical features of confirmed HEV-infected patients were delineated. The sero-positivity rate of anti-HEV IgG maintained stable around 40%, while an obvious winter spike of anti-HEV IgM prevalence was observed. A total of 111 patients were confirmed of HEV viremia by molecular diagnosis. Subtype 4d was predominant. Phylogenetic analyses suggest that certain strains circulate across species and around the country. Subjects with confirmed current HEV infection had a high median age (58 years) and males were predominant (62.2%). Most patients presented with jaundice (75.7%) and anorexia (68.0%). Significantly elevated levels of liver enzymes and bilirubin were observed. Remarkably, the baseline bilirubin level was positively correlated with illness severity. Pre-existing HBV carriage may deteriorate illness. The clinical burden caused by locally acquired HEV infection is increasing. Surveillance should be enforced especially during the transition period from winter to spring. Patients with higher level of bilirubin at disease onset had slower recovery from HEV infection.

Epidemiological survey and sequence information analysis of swine hepatitis E virus in Sichuan, China

Hepatitis E is an important zoonosis that is prevalent in China. Hepatitis E virus (HEV) is a pathogen that affects humans and animals and endangers public health in China. In this study, the detection of HEV epidemics in swine in Sichuan Province, China, was carried out by nested real-time PCR. A total of 174 stool samples and 160 bile samples from swine in Sichuan Province were examined. In addition, software was used to analyse the biological evolution of HEV. The results showed that within 2 years of swine HEV (SHEV) infection in China, SHEV was first detected in Sichuan Province. HEV was endemic in Sichuan; the positive rate for pig farms was 11.1%, and the total positive sample rate was 10.5%. The age of swine with the highest positive rate (17.9%) was 5–9 weeks. The examined swine species in order of highest to lowest HEV infection rates were Chenghua pig, Large White, Duroc, Pietrain, Landrace and Hampshire. Nucleotide and amino acid sequence analysis showed that the HEV epidemic in swine in Sichuan Province was related to genotype IV, which had the highest homology to HEV in Beijing. Sichuan strains have greater variation than Chinese representative strains, which may indicate the presence of new HEV strains.

Hepatitis E virus infection in Wuhan, Central China

Hepatitis E virus (HEV) is an emergent virus of global importance. Previous studies of HEV infection in China mainly focused on the rural areas. This work aims to study the epidemiology of HEV in a large urban environment. With a registered population of 10 million, the dense city of Wuhan presents itself as a prime opportunity to better understand this emergent virus. The epidemiological data from 2011 to 2016 were analyzed. A cross-sectional study on the seroprevalence of anti-HEV IgG was conducted among the general population (age range 0-59) in 2013. Serum and fecal samples of hepatitis E patients were collected over a period of two years: serum samples were tested for anti-HEV IgM and IgG, and fecal samples were tested for HEV-RNA. The overall seroprevalence of anti-HEV IgG was 35% in Wuhan. Among 415 hepatitis E patients, 286 cases (68.9%) were positive for HEV-IgM, 108 cases (26%) were positive for HEV-IgG alone, and 21 cases (5.1%) were negative for both IgM and IgG. Phylogenetic analysis showed that the detected genotype of HEV was genotype 4. Reported cases occurred sporadically throughout the year with the peak value appearing in the first quarter and a large proportion of male cases (2.1:1). The incidence increased with age for persons under 60 years, reaching its peak level after 60 years of age. Wuhan is endemic for HEV with its currently detected genotype being genotype 4. It is estimated that 68.9% hepatitis E cases were due to primary infection between 2012 and 2013 in Wuhan.

Full genome analysis of swine genotype 3 hepatitis E virus isolated from eastern China

Hepatitis E is believed to occur in both endemic and sporadic forms in developing countries, which causes a major public health problem in Asia and Africa (Meng, 2010; Wang et al., 2016a). Recent studies have documented that the disease is also endemic in many industrialized countries (Wenzel et al., 2011). The causative agent, hepatitis E virus (HEV), belonging to the genus Orthohepevirus, is a non-enveloped RNA virus with a single-stranded, positive-sense genome of approximately 7.2 kb (Smith et al., 2014). The genome consists of a short 5' un-translated region (UTR), three open reading frames (ORFs), and a 3' UTR containing a poly(A) tail (Meng, 2011). Four recognized major genotypes of HEV are identified: genotype 1 (Asian and African strains), genotype 2 (a Mexican strain), genotype 3 (primarily from America and Europe, and some Asian countries), and genotype 4 (mainly Asian strains) (Smith et al., 2016). Previous study revealed that HEV genotype 4 is the dominant zoonotic HEV genotype in China (Wang et al., 2016a). However, infections with HEV 3 have been found more commonly in recent years in China (Liu et al., 2012; Zhang et al., 2013). To date, only one full genome of Chinese swine genotype 3 HEV strain from Shanghai has been documented (Si et al., 2009). We report here the first full genome sequence of a genotype 3 swine HEV strain from Zhejiang, China.

Landscape of emerging and re-emerging infectious diseases in China: impact of ecology, climate, and behavior

For the past several decades, the infectious disease profile in China has been shifting with rapid developments in social and economic aspects, environment, quality of food, water, housing, and public health infrastructure. Notably, 5 notifiable infectious diseases have been almost eradicated, and the incidence of 18 additional notifiable infectious diseases has been significantly reduced. Unexpectedly, the incidence of over 10 notifiable infectious diseases, including HIV, brucellosis, syphilis, and dengue fever, has been increasing. Nevertheless, frequent infectious disease outbreaks/events have been reported almost every year, and imported infectious diseases have increased since 2015. New pathogens and over 100 new genotypes or serotypes of known pathogens have been identified. Some infectious diseases seem to be exacerbated by various factors, including rapid urbanization, large numbers of migrant workers, changes in climate, ecology, and policies, such as returning farmland to forests. This review summarizes the current experiences and lessons from China in managing emerging and re-emerging infectious diseases, especially the effects of ecology, climate, and behavior, which should have merits in helping other countries to control and prevent infectious diseases.

Hepatitis E Virus in Pork and Variety Meats Sold in Fresh Markets

Swine is an economically important livestock, yet pork consumption and close contact with pigs are associated with the risk of hepatitis E virus (HEV) infection. Limited data on the prevalence of HEV in Southeast Asia have mainly examined farm animals. To investigate the potential zoonotic transmission of HEV from dietary consumption of pork and variety meats (i.e., offal or organ meats), we obtained 1090 liver, 559 pork meat, and 556 intestine samples from fresh markets in the Bangkok metropolitan area between November 2014 and February 2015. The presence of HEV was assessed using reverse-transcription polymerase chain reaction. Concurrently, 720 bile and 553 fecal samples from a slaughterhouse were also examined. Overall, HEV RNA was found in 0.23 % of the market samples and 3.93 % of the slaughterhouse samples. Fecal and bile samples were more likely to test positive compared to liver, pork, and intestine samples (p < 0.001). Phylogenetic analysis showed that all HEV sequences obtained in this study formed a cluster closely related to genotype 3f. Pork and variety meats derived from pigs are commonly sold in fresh markets throughout Southeast Asia. Here, a relatively low HEV prevalence from pork and variety meats sold in Bangkok was found. Additional studies will be required to further assess potential dietary transmission of HEV elsewhere in the region.

A novel subgenotype 3a hepatitis E virus isolated from pigs in China

Hepatitis E virus (HEV) infection is an emerging disease with zoonotic transmission that represents a serious public health concern, especially in developing countries. Here we characterize a novel HEV strain CCST-517, which possesses a complete genome sequence of 7284 bp with typical HEV genome organization including 5' and 3' non-coding regions and three open reading frames. The sequence identities of CCST-517 with known HEV genotype 1, 2, 3, and 4 were 73.4-73.7, 73.2, 80.4-90.4, and 75.1-75.7%, respectively. Phylogenetic analysis clustered CCST-517 to the clade of HEV genotype 3a, together with the Japanese human HEV isolate (HE-JA10) and United States human HEV isolate (HEV-US2). Similarity plot analysis indicated that the fragment extending from 4500 to 5500 nt included evidence of one intra-genotype recombination event in the genome sequence of the CCST-517 strain. To our knowledge, this is the first report of HEV genotype 3a with its complete genome sequence revealed in China. Our findings revealed a close phylogenetic relationship of CCST-517 to human HEV-US2 and HE-JA10, implying cross-species transmission of HEV between pigs and humans.

Molecular detection of hepatitis E virus in sheep from southern Xinjiang, China

Hepatitis E virus (HEV) is a causative agent of infectious hepatitis in animals and humans both in developing and developed countries. Here, we collected 500 sheep sera and 75 raw sheep liver samples from a slaughterhouse in the southern part of the Xinjiang region, China, along with 26 sera of butchers from the same slaughterhouse. All serum samples were tested for anti-HEV antibody by enzyme-linked immunosorbent assay. Both serum and liver samples were evaluated for the presence of HEV RNA by nested polymerase chain reaction targeting partial nucleotide sequences of open reading frame 2 (ORF2). The results indicate that sheep seroprevalence was 35.20 % (176/500) and that four of the 75 (5.3 %) sheep livers showed detectable amounts of HEV RNA. The seroprevalence of the butchers was 57.7 % (15/26). The four amplicons shared 97.8-100 % nucleotide sequence identity and had pairwise sequence identities of 81.6-85.3 %, 84.2-85.3 %, 82.1-85.3 % and 84.7-97.9 % with the corresponding regions of genotypes 1, 2, 3 and 4 of HEV, respectively. A phylogenetic tree was constructed based on alignments of an amplified 186-bp ORF2 sequence and corresponding reference strains. The analysis showed that the four sheep strains detected in our study formed a lineage within a genotype 4 cluster that contains hb-3, bjsw1, T1, swCH189 and swCH25, all of which belong to genotype 4, subtype 4d. The results indicated a high level of seroconversion in sheep and suggested that sheep liver may be a source of foodborne HEV infection in humans.

Genetic characterization and serological prevalence of swine hepatitis E virus in Shandong province, China

Hepatitis E virus (HEV), the causative agent of hepatitis E, is classified into four major genotypes (1 to 4) and swine is the main natural reservoir for genotypes 3 and 4. In this study, a total of 106 bile samples from a slaughterhouse in the Shandong province of China were tested for the partial ORF2 gene of HEV by RT-nPCR to determine the virus genotypes, and two indirect ELISA were developed for the detection of swine HEV specific IgM and IgG antibodies in 980 serum samples from 24 farms, in order to investigate the seroprevalence. Thirty-two out of 106 (30.2%) bile samples were positive for HEV and a high degree of partial ORF2 sequence similarity (86.8-100%) was observed among 20 samples. The viral sequences belonged to genotype 4, subtypes 4a and 4d. One complete genome sequence of a subtype 4d HEV was further determined and characterized. The seroprevalence of HEV IgG and IgM antibodies was 100% (24/24) and 41.7% (10/24) for herds, and 66.4% (651/980) and 1.6% (16/980) for the individual pigs, respectively. These results suggested a high prevalence of genotype 4 of swine HEV infection both in swine farms and at the slaughterhouse in Shandong province, which further raise public-health concerns for zoonosis and pork safety.

Construction of an infectious cDNA clone of a swine genotype 3 HEV strain isolated in Shanghai, China

OBJECTIVES

Infectious cDNA clones are important tools for studying molecular mechanisms in RNA viruses. The aim of this study was to construct an infectious cDNA clone for SAAS-JDY5, which is a genotype 3 HEV strain of swine origin.

METHODS

Construction employed overlapping PCR and restriction analysis to ligate nine cDNA fragments into a full-length cDNA clone containing 14 mutations compared to the consensus HEV genome sequence. Megaprimer PCR-directed mutagenesis restored nine non-silent mutations back to the consensus sequence while the other five silent mutations were maintained as genetic markers.

RESULTS

HEV proteins were identified by an immunofluorescence assay in Huh7 cells infected with capped RNA transcripts of the full-length cDNA clone, while HEV viremia, fecal HEV RNA and seroconversion were recorded in inoculated Sprague-Dawley rats.

CONCLUSIONS

Our data confirmed the successful construction of an infectious cDNA clone of swine HEV strain pGEM4z-SAAS-JDY5, and support the use of rats as an HEV infectious model.

Validation of an internally controlled multiplex real time RT-PCR for detection and typing of HEV genotype 3 and 4

Hepatitis E virus (HEV) genotypes 1 and 2 are restricted to humans, whereas genotypes 3 (HEV 3) and genotype 4 (HEV 4) infect humans and a variety of animal species. Cross-species infections by animal strains raise potential public health concerns for zoonotic HEV transmission. Therefore, a real-time reverse transcription polymerase chain reaction (RT-qPCR) combining the HEV 3-tpye specific RT-qPCR assay with the HEV 4-tpye specific assay was developed. Furthermore, a heterologous RNA, an in vitro transcript of the enhanced green fluorescent protein (EGFP) gene, was introduced as an internal control. The data showed that EGFP gene provided a very reliable and simple way of monitoring both the sample manipulation and amplification procedures. The final multiplex RT-qPCR assay showed a high analytical sensitivity of less than 50 copies RNA per reaction for both HEV genotypes. The specificity and amplification efficiency of the multiplex assay for the respective HEV were confirmed by co-amplification of the other target. By comparing with the results of mono-specific assay and nested PCR as well as sequencing, HEV infection in a panel of clinical samples was reliably detected and typed, which indicated that the novel multiplex RT-qPCR assay could be used for sensitive detection and rapid differentiation of zoonotic HEV genotype 3 and 4.

Infectivity of a genotype 4 hepatitis E virus cDNA clone by intrahepatic inoculation of laboratory rats

A cDNA clone of a genotype 4 swine hepatitis E virus (HEV) strain (SAAS-FX17), identified in Shanghai, has been constructed. Capped RNA transcripts were prepared in vitro and shown to be replication-competent in Huh7 cells. Sprague-Dawley (SD) rats administered the RNA transcripts by intrahepatic inoculation developed active infections as evidenced by fecal virus shedding and sero-conversion to anti-HEV. The former was first detected between 23 and 30 days post-inoculation (dpi) and persisted until 45 dpi. Sera of rats inoculated with RNA transcripts became anti-HEV positive between 30 and 40 dpi, and reverted to anti-HEV negative at 52 dpi. Our data indicate for the first time that intrahepatic inoculation of rats with RNA transcripts of an HEV cDNA clone may serve as an alternative animal model for HEV research.

Determination of the full-genome sequence of hepatitis E virus (HEV) SAAS-FX17 and use as a reference to identify putative HEV genotype 4 virulence determinants

Background

Four major genotypes of hepatitis E virus (HEV), the causative agent of hepatitis E, have so far been recognized. While genotypes 3 and 4 are both zoonotic, the disease symptoms caused by the latter tend to be more severe. To examine if specific nucleotide/amino acid variations between genotypes 3 and 4 play a role in determining the severity of hepatitis E disease, the complete genome of one swine HEV genotype 4 isolate, SAAS-FX17, was determined and compared with other genotype 4 and genotype 3 genomes to identify putative HEV genotype 4 virulence determinants.

Results

A total of 42 conformable nt/aa variations between genotype 3 and 4 HEVs were detected, of which 19 were proposed to be potential disease severity determinants for genotype 4 strains.

Conclusions

One potential determinant was located in each of the 5'-UTR and 3'-UTR, 3 and 12 within ORF1 and ORF2 respectively, and 2 in the junction region.

Phylogenetic analysis of hepatitis e virus in northwest India

Genotyping and subtyping are important to understand epidemiology of the hepatitis E virus so as to improve control measures to prevent transmission of virus in the community. Hence, the aim of the current study was to identify the prevalent HEV genotypes in Rajasthan in acute sporadic hepatitis E cases with varying degree of liver failure. We studied hepatitis E virus (HEV) isolates from hospitalized patients in Rajasthan, western India. In a total of seventeen HEV sequences, six acute viral hepatitis, seven acute liver failure, and 4 acute- on-chronic cases were analyzed. Subtypes 1a and 1c of HEV are prevalent in Northwest India.

Hepatitis E virus genotype 4 isolated from a patient with liver failure: full-length sequence analysis showing potential determinants of virus pathogenesis

The full-length genome sequence of a genotype 4 strain of Hepatitis E virus (HEV) (CHN-NJ-H2011) from a patient (in Nanjing, China) with liver failure has been determined. Phylogenetic analysis showed that CHN-NJ-H2011 belongs to genotype 4, subtype 4h. Comparative sequence analysis carried out on a 301-bp fragment of ORF2 showed that CHN-NJ-H2011 shares high nucleotide sequence identity (94.3-94.7 %) with porcine viruses (ch-shsw1 and Ch-estw2) isolated in the same geographical region, pointing to the strong possibility of zoonotic transmission of HEV genotype 4. A broader comparison with other genotype 4 isolates revealed 12 unique amino acid substitutions in ORF1 and three in ORF2 that might serve as signatures of disease severity for genotype 4 HEV infection.

Prevalence of hepatitis e virus in swine fed on kitchen residue

The aim of this study was to investigate the prevalence of swine hepatitis E virus (HEV) in pigs fed different feedstuffs (kitchen residue or mixed feeds) and genetic identification of HEV isolated in Hebei province, China. Serum and fecal samples were collected from adult swine. Anti-HEV antibody was evaluated by double sandwich antigen enzyme immunoassay. HEV RNA was extracted from fecal samples and amplified by nested RT-PCR. The reaction products were sequenced, and the sequence analyzed. Virus-like particles were distinguishable by negative staining in the electron microscope. Histopathological observation and immunohistochemical localization were used in the animal models. Overall, the anti-HEV positive percentage of serum samples from pigs fed on kitchen residue was 87.10% (27/31), and 53.06% (130/245) from pigs fed on complete feed. The HEV RNA positivity rate of fecal samples from pigs fed on kitchen residue was 61.54% (8/13), but zero for pigs fed on complete feed. Sequence analysis of these eight samples and comparison with the published sequence showed that there were eight groups that belonged to genotype 4 d and the nucleotide identity was 95.6–99.3%. swHE11 is most closely related to strain CCC220, and the other seven HEV isolates were most closely related to strains swGX40, SwCH189 and V0008ORF3, which are isolates from human and pigs. Histopathological observation showed that there was liver damage in the experimental group, and immunohistochemistry indicated that the HEV antigens were strongly positive at 7 days after infection. The results demonstrated that the prevalence of HEV in pigs fed on kitchen residue was higher than in those fed on complete feed (P<0.05).

Seroprevalence and molecular detection of hepatitis E virus in Yunnan Province, China

In this study, the prevalence and characteristics of hepatitis E virus (HEV) in pigs and the general population in the Yunnan province, China, were evaluated. Nine hundred sixty sera, 95 liver and 60 feces samples were randomly collected from pig farms and abattoirs, in addition 173 human sera were sampled in the provincial capital city for a serological survey and an RT-nPCR assay. The screening results showed that among 621 samples collected from five pig farms, the HEV-specific IgG positive rate ranged from 73.2% to 83.5%, and the overall seroprevalence was 78.9% (490/621). A further analysis revealed that the seroprevalence increased with age. The positive rate of human serum samples was 39.9% (69/173). HEV RNA was detected in five swine feces, six swine liver and one anti-HEV-IgM-positive human serum sample by RT-nPCR. Sequence and alignment of the 348-nt PCR-amplified products of 12 HEV strains identified nine distinct nucleotide sequences. Phylogenetic and molecular evolutionary analysis revealed that these nine sequences shared 84.2% to 100.0% nucleotide sequence identity with each other, with all isolates belonging to genotype 4 HEV and clustering with other Chinese swine and human HEV sequences determined earlier. This study results suggest that the prevalence of genotype 4 HEV is serious, both in pig herds and in the human population, and authorities should pay more attention to the prevalence of HEV in southwest China.

Both swine and human cells are capable to support the replication of swine hepatitis E virus type 4 in vitro

Using swine anal swab or liver as inocula, cell-culture systems were developed for swine hepatitis E virus (HEV) in swine cells (IBRS-2) and human cells (A549). Both positive and negative strand of swine HEV RNA were detected continuously. Cytopathic effect appeared from passage 8 in IBRS-2 and passage 22 in A549. Viral antigen was detected by indirect immunofluorescent assay in infected cells. Progenies harbored mutations in the third nucleotide of codon. Amino acid changes occurred in passage 8 in IBRS-2 and rescued in passage 10. Full-length genome sequence of a swine HEV isolate from liver was determined to be genotype 4. Taken together, our data suggest that swine HEV is able to replicate in both swine and human cells in vitro.

Hepatitis E virus genotype diversity in eastern China

We studied 47 hepatitis E virus (HEV) isolates from hospitalized patients in Nanjing and Taizhou, eastern China. Genotypes 1, 3, and 4 were prevalent; genotype 3 and subgenotype 4b showed a close relationship with the swine strains in eastern China, thus indicating that HEV genotype 3 had infected humans in China.

Molecular and serological survey of hepatitis E virus infection among domestic pigs in Inner Mongolia, China

To evaluate the prevalence and characteristics of swine hepatitis E virus (HEV) infection in Inner Mongolia, China, serum samples obtained from 356 2- to 4-month-old pigs on 14 farms in Inner Mongolia were tested for the presence of anti-HEV antibodies and HEV RNA. Overall, 186 pigs (52%) tested positive for anti-HEV antibodies, while 30 pigs (8%) had detectable HEV RNA levels. The 30 HEV isolates recovered from the viremic pigs were phylogenetically classified into genotype 4 and differed from each other by up to 15.3% in a 412 nt sequence within ORF2. The Inner Mongolian swine HEV strains were most similar to human or swine HEV strains isolated in the other provinces of China but differed by 15.9-18.9% from those in Mongolia (formerly known as Outer Mongolia). These results indicate that farm pigs in Inner Mongolia are frequently infected with markedly divergent genotype 4 HEV strains that may be indigenous to China.

Fusion of C3d molecule with neutralization epitope(s) of hepatitis E virus enhances antibody avidity maturation and neutralizing activity following DNA immunization

Previous studies have identified that a hepatits E virus peptide (HEV-p179), spanning amino acids (aa) 439-617 in the 660-aa protein encoded by open reading frame 2(ORF2) of the Chinese epidemic strain (genotype 4), is the minimal size fragment of conformation-dependent neutralization epitope(s). We report here the successful immunization of mice with DNA vaccines expressing the secreted form of HEV-p179 (fused with a human tissue plasminogen activator (tPA) signal sequence) and the tPA-p179-C3d fusion protein (fused with three tandem copies of the murine complement C3d). Analysis of antibody responses in vaccinated mice revealed that immunizations with tPA-p179-C3d3 DNA vaccine dramatically increased both the level and avidity maturation of antibodies against HEV-p179 compared to p179 and tPA-p179 DNA vaccines. In addition, this increased antibody response correlated with neutralizing titers in a PCR-based cell culture neutralization assay. These results indicate that vaccination with C3d conjugated p179 DNA vaccine enhances antibody responses to HEV, and this approach may be applied to overcome the poor immunogenicity of DNA vaccines to generate HEV neutralizing antibodies.

Serological prevalence of hepatitis E virus in domestic animals and diversity of genotype 4 hepatitis E virus in China

Pigs have been confirmed to be reservoirs of some genotypes of hepatitis E virus (HEV), and other nonhuman species are also likely infected with the virus. To assess the prevalence of HEV infection in domestic animals in China, 3579 serum samples, including 1967 swine, 700 goat, and 912 cattle sera, were collected from 26 provinces across the country and tested for HEV antibodies and antigen using enzyme immunoassays. The results showed that 82.2% of the swine samples, but only 10.4% and 28.2% of cattle and goat sera, were anti-HEV positive respectively. The prevalence of anti-HEV antibody in animals varied from province to province, ranging from 10.9% to 100% in pigs, 0% to 48% in goats, and 0% to 92.9% in cattle. About 1.9% of pigs, 1.6% of goats, and 0.8% of cattle tested in the study were positive for HEV antigen. Some samples, including all HEV antigen-positive samples, were tested for HEV-specific RNA using reverse transcription polymerase chain reaction. Fifteen swine samples, but none from the goats or cattle, were found to be HEV RNA positive. Sequence and phylogenetic analyses classified all the swine HEV isolates into HEV genotype 4, which was further divided into four subgroups. This study demonstrated that HEV infection is widespread in domestic animals, particularly pigs, in China. The HEV genotype infecting pigs in China was genotype 4. However, the isolates displayed considerable genetic diversity.

Hepatitis E virus infection in central China reveals no evidence of cross-species transmission between human and swine in this area

Hepatitis E virus (HEV) is a zoonotic pathogen of which several species of animal were reported as reservoirs. Swine stands out as the major reservoir for HEV infection in humans, as suggested by the close genetic relationship of swine and human virus. Since 2000, Genotype 4 HEV has become the dominant cause of hepatitis E disease in China. Recent reports showed that genotype 4 HEV is freely transmitted between humans and swine in eastern and southern China. However, the infection status of HEV in human and swine populations in central China is still unclear. This study was conducted in a rural area of central China, where there are many commercial swine farms. A total of 1476 serum and 554 fecal specimens were collected from the general human and swine populations in this area, respectively. The seroepidemiological study was conducted by enzyme-linked immunosorbent assay. Conserved genomic sequences of open reading frame 2 were detected using reverse transcription-PCR. The results indicated that the overall viral burden of the general human subjects was 0.95% (14/1476), while 7.0% (39/554) of the swine excreted HEV in stool. The positive rate of anti-HEV IgG and IgM in the serum samples was 7.9% (117/1476) and 1.6% (24/1476), respectively. Phylogenetic analysis based on the 150 nt partial sequence of the capsid protein gene showed that the 53 swine and human HEV isolates in the current study all belonged to genotype 4, clustering into three major groups. However, the HEV isolates prevalent in the human and swine populations were classified into known distinct subgenotypes, which suggested that no cross-species transmission between swine and humans had taken place in this area. This result was confirmed by cloning and phylogenetic analysis of the complete capsid protein gene sequence of three representative HEV strains in the three major groups. The cross reactivity between anti-HEV IgG from human sera and the two representative strains from swine in central China was confirmed by Dot-blot assay. In conclusion, although all the HEV strains prevalent in central China belonged to genotype 4, there is no evidence of cross-species transmission between human and swine in this area.

Zoonotic risk of hepatitis E virus (HEV): A study of HEV infection in animals and humans in suburbs of Beijing

AIM

To investigate hepatitis E virus (HEV) infection among different animals and workers in pig farms and slaughterhouses, and analyze the genotype of HEV isolated in this study.

METHODS

Serum samples were collected from adult swine, cows, sheep, younger swine (< 3 months), and workers in pig farms and slaughterhouses (professional group). Fecal samples were collected from younger swine in the south suburbs of Beijing. Anti-HEV antibody was evaluated by direct sandwich enzyme immunoassay. HEV RNA was extracted from fecal samples and amplified by nested reverse transcription polymerase chain reaction (RT-nPCR). The PCR products were sequenced, and the sequence homology and phylogenetics of the HEV strains isolated from swine were analyzed.

RESULTS

The anti-HEV positivity rates in adult swine, cows, sheep, younger swine, professional group and general population were 98.23% (222/226), 29.35% (54/184), 9.80% (20/207), 60.73% (99/164), 42.51% (105/247) and 20.29% (522/2572), respectively. The HEV RNA positivity rate of fecal samples was 22.89% (19/83) and 16/19 samples were positive for HEV RNA amplified with both primers, HEV open reading frame (ORF)1 and HEV ORF2. Sequence analysis of these 16 samples showed that there were two groups, designated BJ-1 and BJ-2. The nucleotide homology of BJ-1 and BJ-2 was 99%. Phylogenetic analysis indicated that both of these groups belonged to genotype 4d.

CONCLUSION

Workers in pig farms and slaughterhouses were more likely to contract HEV infection than the general population because of close contact with swine with a high prevalence of anti-HEV.

Full-genome nucleotide sequence and analysis of a Chinese swine hepatitis E virus isolate of genotype 4 identified in the Guangxi Zhuang autonomous region: evidence of zoonotic risk from swine to human in South China

BACKGROUND

Hepatitis E virus (HEV) is one of the leading causes of the enteric-transmitted acute hepatitis. Many studies have found high identities between human and animal HEV isolates using partial sequence comparison analysis.

AIMS

To determine and phylogenetically analyse the complete genome of the swGX40 isolate from the Guangxi Zhuang autonomous region.

METHODS

The overlapping fragments of HEV isolate swGX40 were amplified with reverse transcription-nested polymerase chain reaction (PCR) and the 5' and 3' ends of viral genome were amplified with rapid amplification of cDNA ends. The PCR products were cloned and sequenced. The sequence and phylogenetic analysis of swGX40 were performed.

RESULTS

The full genome of the swGX40 strain consisted of 7233 nucleotides, excluding the poly (A) tail of 36 residues. There are three open reading frames (ORFs), encoding 1705, 674 and 114 amino acids (aa) respectively. The full-genomic sequencing showed that the swGX40 strain shared similarity with all known HEV genotype 1, 2 and 3 isolates by 73.4-76.5% and with an identity of 83.1-91.2% among genotype 4 HEV isolates. The partial ORF2 sequencing (249 nt) showed that swGX40 shared a high nucleotide identity of 94 and 97% with the Chinese human strain LZ-105 and the Vietnamese human strain HE-JVN-1 respectively.

CONCLUSIONS

The swine isolate swGX40 was closely related to the human isolate LZ-105, both of which were collected from Liuzhou, the same district in the Guangxi Zhuang autonomous region. This molecular biological evidence strongly supported the zoonosis hypothesis of hepatitis E.

Full genomic sequence analysis of swine genotype 3 hepatitis E virus isolated from Shanghai

The full genomic nucleotide sequence of a previously identified genotype 3 hepatitis E virus (HEV), strain SAAS-JDY5, was obtained using RT-PCR and rapid amplification of cDNA ends (RACE). The genome consisted of 7225 nucleotides, excluding a poly-A tail at the 3' terminus, and contained three open reading frames (ORFs), ORF-1, ORF-2 and ORF-3, encoding 1702, 660 and 113 amino acids, respectively. Phylogenetic analysis confirmed that SAAS-JDY5 belonged to genotype 3 HEV and was most closely related to the Japanese isolate wbJYG1 (AB222184). SAAS-JDY5 shared approximately 87% nucleotide similarity to human and swine strains from the United States, compared with 74-75% similarity to Asian (genotype 4) and Mexican strains (genotype 2). Alignment of the SAAS-JDY5 genomic sequence with reference sequences of the same genotype revealed one nucleotide substitution and one deletion at positions 5145 and 7189 (3' UTR), respectively. Moreover, SAAS-JDY5 contained two additional nucleotides (AC) at the very end of the 3'-terminus preceding the poly-A tail of the genome. Comparison of the putative amino acid sequence encoded by the SAAS-JDY5 genome with sequences of other genotype 3 isolates revealed 15 unique amino acid substitutions and one deletion in ORF-1, and three substitutions in ORF-2.

Reduced prevalence of genotype 3 HEV in Shanghai pig farms and hypothetical homeostasis of porcine HEV reservoir

A total of 493 fecal samples collected from local Shanghai pig farms were examined for Hepatitis E virus (HEV) after the introduction of stricter sanitary measures following outbreaks of a high fever-associated pig disease during 2006 and 2007. Our investigation revealed that, while the overall occurrence of HEV RNA positives decreased by only 3.7%, the incidence of HEV genotype 4 increased from 9.8% to 20.6% whereas the incidence of HEV genotype 3 decreased from 16.2% to 1.6%. As well as demonstrating that HEV genotype 3 was more sensitive than genotype 4 to the stricter sanitation procedures, our data also suggested that a homeostasis mechanism, whereby the overall incidence of HEV is maintained at a specific population level, might exist in the porcine HEV reservoir. Furthermore, in one case, we encountered the coexistence of HEV genotypes 3 and 4 within the same sample, indicating the possibility of future HEV infections of increased severity and even the occurrence of a HEV pandemic due to genetic recombination and species evolution.

Swine hepatitis E virus in rural southern China: genetic characterization and experimental infection in rhesus monkeys (Macaca mulatta)

BACKGROUND

In rural areas of southern China, where hepatitis E is endemic, residents generally rear pigs in pigsties near their houses. The study was conducted to assess the possibility that hepatitis E virus (HEV) infections in this region are acquired primarily through contact with swine.

METHODS

One hundred twenty swine fecal samples collected from pigsties located in eight rural communities of southern China were tested for HEV RNA. The swine HEV isolates were analyzed genetically and were experimentally inoculated into rhesus monkeys to determine the potential risk of cross-species infection.

RESULTS

Twenty-nine of the 120 swine fecal samples were positive for HEV RNA. The nucleotide sequences of these swine HEV strains shared 85%-99% identities with the local human genotype 4 isolates and belonged to two subgroups of genotype 4. Importantly, swine HEV strains representing both subgroups induced hepatitis in rhesus monkeys by inoculation with the virus, evidenced by elevated serum alanine transaminase (ALT), viremia, fecal viral shedding, anti-HEV seroconversion, and liver histopathological changes.

CONCLUSIONS

Swine may be the principal reservoir for human HEV infection in rural southern China.

Hepatitis E virus infection among domestic animals in eastern China

Hepatitis E virus (HEV) is a zoonotic pathogen of which several species of animal were reported as reservoirs. Antibodies to HEV and HEV RNA have been detected in some Chinese population and swine groups but few other domestic animals. In this study, to investigate the HEV prevalence, we tested sera from 788 pigs, 100 cows, 50 goats, 49 horses, 101 pet dogs, 105 chickens, 47 duck and 45 pigeons in eastern China for anti-HEV immunoglobulin G (IgG). We also tested 50% of the swine sera, all of sera from the other domestic animals and 13 Shanghai human sera which were positive for anti-HEV immunoglobulin M (IgM) for HEV RNA using reverse transcriptase-polymerase chain reaction. Our results indicated that 82.5% (222/269) of the sows, 53.9% (104/193) of the 4- to 6-month-old swine, 63.4% (168/265) of the 1- to 3-month-old swine, 55.7% (34/61) of the slaughterhouse swine, 24% (12/50) of the goats, 16.3% (8/49) of the horses, 17.8% (21/101) of the pet dogs, 6% (6/100) of the cows, 12.8% (6/47) of the ducks, 4.4% (2/45) of the pigeons and 1.9% (2/105) of the chickens exhibited positive for anti-HEV IgG. Inhibition assay confirmed the infection with HEV or HEV-like viruses in these domestic animals except pigeons and chickens. From the sera, we isolated 18 swine HEV strains, one horse HEV strain and two human HEV strains. Sequence analysis showed that the horse HEV isolate and one swine isolate belonged to genotype 3. The other isolates belonged to genotype 4. The two human isolates were phylogenetically closely related to eight of the swine isolates. In short, the presence of anti-HEV antibody had been confirmed in several species of domestic animals in eastern China and HEV RNA has been identified in swine, human and horse. This suggested that the authorities should pay more attention to the prevalence of HEV in eastern China.

Prevalence of hepatitis E virus in swine under different breeding environment and abattoir in Beijing, China

This study was to investigate the prevalence of HEV in pig herds under different breeding environment and in abattoirs located in Beijing, China. In total 638 sera samples and 114 liver samples were collected for a serological survey and a RT-PCR assay, respectively. The average prevalence rate of HEV in pig herds in Beijing suburb were 47.5-100%. Seropositive rate was 76.6% for pig herds of large-scale and 90% for family-scale farms. For sera samples collected from abattoir, 127 samples (78.4%) were found to be positive. Among four liver samples (3.5%) that positive for HEV RNA detection, two strains of HEV has been identified. the two detected HEV sequences shared 99.1% nucleotide sequence identity with each other, and 76.4-81.0%, 76.5-76.8%, 75.7-79.0% and 85.2-96.4% with related strains representing genotype 1, 2, 3, and 4, respectively. Further phylogenetic analysis revealed two HEV sequences belonged to genotype 4 and exhibited a high identity with strain JKO-ChiSai98C (95.4 and 95.7%), and with strains 87, 277 and 292 (96.1-96.4%) isolated from patients with sporadic acute hepatitis E in Beijing, China. The results of this study indicated that the prevalence of HEV in the pig herds were quite high. Additional public-health concerns might be placed on pork safety.

Prevalence of four different subgenotypes of genotype 4 hepatitis E virus among swine in the Shanghai area of China

Background

Hepatitis E virus (HEV) is a zoonotic pathogen of which swine was reported as major reservoirs. HEV has been divided into 4 different genotypes according to phylogenetic analysis. Recent reports showed that genotype 4 HEV is freely transmitted between humans and swine in eastern China, including Shanghai area. This paper investigated the recent infection status of HEV among swine population of Shanghai area in China.

Methods

480 swine faecal specimens were collected from 23 farms which distribute all over Shanghai from September to November, 2007 and tested for the presence of HEV RNA by the polymerase chain reaction (PCR).

Results

Our results showed that 26.1% (6/23) of the swine farms were positive for HEV RNA and the positive rate of the six farms were ranged from 9.1% to 33.3%. The HEV RNA positive rate for total samples were 5% (24/480). The resulted positive band specific for HEV was sequenced and sequence analysis indicated that all of these isolates belonged to genotype 4 HEV. Phylogenetic analysis showed that the 24 isolates clustered into 4 distinct subgroups, sharing 83.3–89.7% inter-subgroup and 97–99% intra-subgroup identities. More over, isolates in three of the four subgroups closely clustered with previous identified strains, sharing up high to 97% identity with them.

Conclusion

These results suggested that there were 4 different subgenotypes of HEV prevalent in Shanghai, and some of them may not be indigenous to Shanghai but introduced from other geographic regions.

Seroepidemiology and molecular characterization of hepatitis E virus in Jilin, China

BACKGROUND

In order to develop region-specific diagnostic assays and prevent hepatitis E virus (HEV), it is essential to understand epidemiology and genotypic variation within different populations. However, the epidemiological data of HEV infections in Jilin is shortage.

METHODS

The seroepidemiological study was conducted by enzyme-linked immunosorbent assay, and the conserved genomic sequences of open reading frame 2 (348 bp) was detected using reverse transcription-PCR.

RESULTS

Overall, 1,289 serum samples were positive to HEV-specific immunoglobulin G (IgG), and 180 serum samples were positive to HEV-specific immunoglobulin M (IgM). The seroprevalence of HEV-specific IgG was 26.3%, 27.9%, 25.3%, 32.7% in 2003, 2004, 2005, 2006, respectively. Acute HEV infection mainly occurred in male, people aged from 20 to 69 were more susceptible to infection, and cases with IgM anti-HEV reaction mainly occurred from July to November. HEV RNA was detectable in the serum samples or stool suspension of 15 patients with HEV-specific IgM, and all of these belonged to genotype IV.

CONCLUSIONS

Our results indicate that HEV is widely spread in Jilin and confined to genotype IV.

Comparison of real-time fluorescent RT-PCR and conventional RT-PCR for the detection of hepatitis E virus genotypes prevalent in China

To compare the specificity and sensitivity of a real-time fluorescent RT-PCR assay with conventional RT-PCR, sera from 110 healthy blood donors, 120 patients with a clinical diagnosis of chronic hepatitis B, and 416 patients with non-A-C acute hepatitis, as well as serial dilutions of HEV genotypes 1 and 4, were tested with both assays. All samples from healthy blood donors and patients with chronic hepatitis B were negative by both assays. Real-time RT-PCR could detect the same final dilution of genotype 1 as conventional RT-PCR but could detect a 10-fold lower concentration of genotype 4 than conventional RT-PCR. Of 416 samples from patients with a clinical diagnosis of non-A-C acute hepatitis, 127 (30.5%) and 83 (20.0%) were positive for HEV by real-time and conventional RT-PCR, respectively. The concordance of real-time and conventional RT-PCR was 80.8%. Furthermore, 96 and 57 of 171 samples were positive for anti-HEV IgM by real-time and conventional RT-PCR, respectively, and 31 and 26 of 245 samples negative for anti-HEV IgM, were positive by real-time and conventional RT-PCR, respectively. All amplicons positive by conventional RT-PCR were sequenced. Of 83 isolates, 7 and 76 belonged to genotypes 1 and 4, respectively. Thus, both assays have a high specificity, but the real-time RT-PCR assay is more sensitive than conventional RT-PCR. Furthermore, HEV genotype 4 is responsible for most sporadic cases of hepatitis E in the north of China.

Cloning of full genome sequence of hepatitis E virus of Shanghai swine isolate using RACE method

Genotype 4 hepatitis E virus (HEV) was reportedly transmitted freely between humans and swine in eastern China. The full-length genomic sequence of Shanghai swine isolate (SH-SW-zs1) recovered from feces sample of a pig which was infected with HEV RNA positive swine serum was determined using RT-PCR and RACE (Rapid Amplification of cDNA Ends) methods. The full genome of the SH-SW-zs1 isolate was 7265 nucleotides in length and phylogenetic analysis indicated that this isolate belonged to genotype 4. Comparison of the 3' UTR sequence with the corresponding regions of other 38 HEV strains from different region revealed that the Shanghai swine isolate is 21–49 bp longer than the other stains.

Genotype 3 hepatitis E has been widespread in pig farms of Shanghai suburbs

Hepatitis E virus (HEV) genotype 3 was first identified in swine raised on a Shanghai suburban pig farm in late 2006. To accurately determine the prevalence of HEV infections among Shanghai pig farms, 426 pig fecal samples were collected from 37 pig farms located in all 10 Shanghai suburban districts and tested for the presence of HEV RNA using RT-PCR. Genetic analysis based on an amplified 150-bp ORF2 fragment revealed 111 samples to be HEV positive, and the prevalence of HEV infection within the different districts varied between 0 and 41.7%. Thirty-two samples were sequenced, and phylogenetic analysis indicated that 10 isolates belonged to HEV genotype 4 and were most closely related to 3 human and 2 swine HEV strains, all of which had originally been isolated from Asian countries including Japan and China. The remaining 22 isolates belonged to genotype 3 and were most closely related to a strain of swine HEV, US-SW, isolated from pigs in the United States. Our data indicated that genotype 3 HEV was widespread among suburban Shanghai pig farms although further study is required to determine the source and zoonotic nature of the virus.