Hepatitis E, what is the real issue?

Knowledge about Hepatitis E and Influencing Factors among Residents in Qingdao: a Cross-Sectional Study

Hepatitis E infection poses a serious health problem in developing countries. Hepatitis E vaccination is important for prevention, but it is influenced by residents' knowledge. Qingdao residents' knowledge of hepatitis E remains unknown. This study used an online survey on the WeChat platform. The chi-square test was used to compare the hepatitis E influencing factors between the subgroups. Binary logistic regression was used for multiple factor analysis to explore the hepatitis E influencing factors. The total awareness rate of hepatitis E was 60.51%. Females aged between 51 and 60, aged 61 and above, and working in government-affiliated departments were found to have higher awareness rates than other subgroups. Participants with family members infected with hepatitis E had a lower awareness rate. The government and relevant departments should focus on education regarding the hepatitis E vaccination and disease process.

Jaundice, Coombs Positive Hemolytic Anaemia, and Liver Failure: An Unusual Trio

Hepatitis E virus (HEV) is a single-stranded RNA virus with 20 million cases reported worldwide. Infected individuals may either remain asymptomatic or develop acute or even fulminant hepatitis. HEV has been implicated in causing Acute-on-Chronic Liver Failure (ACLF) among patients with underlying cirrhosis. Among the causes of cirrhosis, Wilson's disease is an identified cause that results in an increased accumulation of copper in the liver, brain, and other organs. It is noted that Coombs negative hemolytic anaemia is also seen in the clinical spectrum of Wilson's disease, however, Coombs positivity has not been documented. We present a case of a young female who had an undiagnosed chronic liver disease (CLD). The patient developed acute decompensation with HEV infection along with Coombs positive hemolytic anaemia. Her autoimmune hepatitis screen was negative, so the patient was worked up for other causes of CLD, which led to a diagnosis of underlying Wilson's disease. The patient was started on penicillamine and zinc acetate. However, during the disease, the patient developed acute decompensation and unfortunately expired before her transplant could take place. Our case documentation is of importance as Coombs positivity in patients with Wilson's disease has not been reported before. Attending physicians should be suspicious of Wilson's disease in a patient with Coombs positive hemolytic anaemia when other causes cannot be identified. It is also important to promptly identify any other cause of CLD to educate patients regarding factors leading to acute decompensation and progression to ACLF.

Calibrating Hepatitis E Virus Serological Assays Using Asymptomatic Specimens Obtained in Japan

This study aimed to calibrate hepatitis E virus (HEV) serological assays. We optimized the previously developed in-house HEV antibody enzyme-linked immunosorbent assay (ELISA) by setting the cutoff with an in-house serological performance panel consisting of broad HEV antibody titers and subtracting nonspecific background values for anti-HEV IgM, IgA, and IgG. We also compared the assay's performance with that of commercial serological assay kits (four kits for IgM, one for IgA, and two for IgG). Although all serological assays readily detected HEV antibodies at high titers in the symptomatic hepatitis E population, considerable variations between assays were observed in the asymptomatic population. The in-house ELISA showed a higher sensitivity for HEV IgM, IgA, and IgG than the commercial kits and detected the seroconversion of HEV IgM and IgG earlier when testing a commercially available HEV seroconversion panel. The low sensitivity of the commercial kits was due to the high setting of the original cutoff, which was demonstrated by receiver operating characteristic analysis. However, the corrected cutoff value reduced assay specificity. Background subtraction is essential to achieve high specificity because the in-house ELISA without background subtraction reduced its specificity. These results indicate that asymptomatic specimens and background subtraction contribute to the optimization of HEV serological assays. IMPORTANCE Accurate diagnosis of hepatitis E virus (HEV) infection is essential for public health surveillance and for preventing HEV-contaminated blood transfusion. Anti-HEV IgM or IgA is used as a reliable marker of recent HEV infection. However, considerable variability in the sensitivity and specificity of HEV antibody detection is observed among several commercially available assay kits. In addition, none of the HEV antibody detection methods have been approved by the U.S. Food and Drug Administration (FDA). Here, we show that the in-house enzyme-linked immunosorbent assay (ELISA) could detect HEV IgM and IgA more sensitively than commercial kits in the asymptomatic population. We also suggest that the assay performance of commercial kits might be improved by optimizing the cutoff and reducing nonspecific background noise. A sensitive serological (IgM or IgA) assay in addition to HEV RNA testing will contribute to accurate diagnosis of acute HEV infection because HEV RNA-positive duration is relatively short.

Predicting incidence of hepatitis E for thirteen cities in Jiangsu Province, China

Hepatitis E has placed a heavy burden on China, especially in Jiangsu Province, so accurately predicting the incidence of hepatitis E benefits to alleviate the medical burden. In this paper, we propose a new attentive bidirectional long short-term memory network (denoted as BiLSTM-Attention) to predict the incidence of hepatitis E for all 13 cities in Jiangsu Province, China. Besides, we also explore the performance of adding meteorological factors and the Baidu (the most widely used Chinese search engine) index as additional training data for the prediction of our BiLSTM-Attention model. SARIMAX, GBDT, LSTM, BiLSTM, and BiLSTM-Attention models are tested in this study, based on the monthly incidence rates of hepatitis E, meteorological factors, and the Baidu index collected from 2011 to 2019 for the 13 cities in Jiangsu province, China. From January 2011 to December 2019, a total of 29,339 cases of hepatitis E were detected in all cities in Jiangsu Province, and the average monthly incidence rate for each city is 0.359 per 100,000 persons. Root mean square error (RMSE) and mean absolute error (MAE) are used for model selection and performance evaluation. The BiLSTM-Attention model considering meteorological factors and the Baidu index has the best performance for hepatitis E prediction in all cities, and it gets at least 10% improvement in RMSE and MAE for all 13 cities in Jiangsu province, which means the model has significantly improved the learning ability, generalizability, and prediction accuracy when comparing with others.

Hepatitis E virus is effectively inactivated by methylene blue plus light treatment

BACKGROUND AND OBJECTIVES

Photodynamic treatment with methylene blue (MB) and visible light is a well-established pathogen inactivation system for human plasma. This technique is routinely used in different countries. MB/light treatment was shown to inactivate several transfusion-transmittable viruses, but its efficiency for the inactivation of the quasi-enveloped hepatitis E virus (HEV) has not yet been investigated.

MATERIALS AND METHODS

Plasma units were spiked with cell culture-derived HEV and treated with the THERAFLEX MB-Plasma system using various light doses (30, 60, 90, and 120 J/cm² ). HEV titers in pre- and post-treatment samples were determined by virus titration and a large-volume plating assay to improve the detection limit of the virus assay.

RESULTS

THERAFLEX MB-Plasma efficiently inactivated HEV in human plasma. Even the lowest light dose of 30 J/cm² inactivated HEV down to the limit of detection, with a mean log reduction factor of greater than 2.4 for the total process.

CONCLUSION

Our study demonstrates that the THERAFLEX MB-Plasma system effectively inactivates HEV in human plasma.