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Paz MGOD, Bezerra MF, Mendes AF, da Silva A, Lima GBD, Gil LHVG, Pena LJ, Diniz GTN, Drexler JF, Oriá RB, Ferreira de Oliveira-Filho E, Reis CRDS. Development of a New Multispecies Protein A-Based ELISA for Serodiagnosis of Hepatitis E Infection with Validation in Domestic Swine. Foodborne Pathog Dis 2024. [PMID: 38708682 DOI: 10.1089/fpd.2023.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Hepatitis E virus (HEV) infects roughly 20 million people worldwide, causing self-limiting acute hepatic disease that can evolve into a chronic course. HEV-3, HEV-4, and HEV-7 genotypes are zoonotic and transmitted to humans by consuming raw or undercooked meat. Here, we developed an indirect ELISA based on the recombinant HEV-3 capsid and performed a seroprevalence study on domestic swine in northeastern Brazil. Our in-house ELISA was initially validated using a subset of 79 sera characterized by concordant results for two distinct commercial ELISA kits. Our ELISA exhibited excellent sensitivity (94%) and specificity (100%), with an area under the curve of 0.99 Further testing, including 212 swine sera, revealed a seroprevalence of 57.5% (95% confidence interval, 50.6-64.3%). Our findings indicate that the novel ELISA test could accurately detect specific anti-HEV antibodies in domestic pigs and should be further validated in humans and other mammals.
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Affiliation(s)
| | | | - Andrei Félix Mendes
- Department of Microbiology-Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Adalucia da Silva
- Department of Microbiology-Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Gustavo Barbosa de Lima
- Department of Microbiology-Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | - Lindomar José Pena
- Department of Virology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - George Tadeu Nunes Diniz
- Statistics and Geoprocessing Center, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Jan Felix Drexler
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Reinaldo Barreto Oriá
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology, Institute of Biomedicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Edmilson Ferreira de Oliveira-Filho
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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de Araújo LRMG, Batista AD, Côelho MRCD, Santos JC, Cunha GG, Leal GRA, Pinho JRR, Domingues ALC, Lopes EP. Seroprevalence of hepatitis E virus in patients with chronic liver disease. Braz J Microbiol 2024; 55:357-364. [PMID: 38123902 PMCID: PMC10920483 DOI: 10.1007/s42770-023-01197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION The seroprevalence of hepatitis E virus (HEV) in patients with chronic liver disease (CLD) is little known in Brazil. Studies have suggested that HEV may harmfully influence the course of CLD, with a higher risk of progression to cirrhosis. OBJECTIVE To estimate the prevalence of the anti-HEV antibody (IgG) in patients with CLD and to describe demographic data and risk factors, as well as clinical-laboratory and ultrasound parameters. PATIENTS AND METHODS Cross-sectional study that included 227 patients with CLD followed at a referral outpatient clinic from June 2022 to March 2023. The patients were investigated clinically and tested for liver functions, anti-HEV IgG and, in positive cases, for HEV-RNA. Ultrasonography of the upper abdomen was also carried out. RESULTS Investigation of 227 patients (50 with hepatitis B, 49 with nonalcoholic fatty liver disease, 33 with hepatitis C, 17 with alcoholic liver disease, 16 with schistosomiasis and 62 with mixed disease), 55.5% were female, with an average age of 57 ± 13 years; 37.9% had liver cirrhosis. Seven patients (3.08%) presented anti-HEV positive and HEV-RNA negative. Ultrasound identified association between anti-HEV and contact with pigs, presence of gynecomastia or palmar erythema, lower platelet count, higher APRI and FIB-4 values, and splenomegaly. CONCLUSION Although the prevalence of anti-HEV in patients with CLD was low in this study, the antibody was observed more frequently in cases with a history of contact with pigs and with clinical-laboratory or imaging evidence of more advanced chronic liver disease.
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Affiliation(s)
- Lílian Rose Maia Gomes de Araújo
- Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.
- Gastroenterology Division, Hospital das Clínicas - Universidade Federal de Pernambuco (UFPE), Avenida Professor Moraes Rego, 135, Recife, Pernambuco, 50670-901, Brazil.
| | - Andrea Dória Batista
- Gastroenterology Division, Hospital das Clínicas - Universidade Federal de Pernambuco (UFPE), Avenida Professor Moraes Rego, 135, Recife, Pernambuco, 50670-901, Brazil
| | - Maria Rosângela Cunha Duarte Côelho
- Laboratory of Virology, Keizo Asami Institute (LIKA), Departament of Phisiology and Pharmacology, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | | | - Gabriel Galindo Cunha
- Laboratory of Virology, Keizo Asami Institute (LIKA), Departament of Phisiology and Pharmacology, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Gabriela Rodrigues Aguiar Leal
- Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
- Laboratory of Virology, Keizo Asami Institute (LIKA), Departament of Phisiology and Pharmacology, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - João Renato Rebello Pinho
- Laboratory of Gastroenterology and Tropical Hepatology, Institute of Tropical Medicine and Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Lúcia Coutinho Domingues
- Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
- Gastroenterology Division, Hospital das Clínicas - Universidade Federal de Pernambuco (UFPE), Avenida Professor Moraes Rego, 135, Recife, Pernambuco, 50670-901, Brazil
| | - Edmundo Pessoa Lopes
- Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.
- Gastroenterology Division, Hospital das Clínicas - Universidade Federal de Pernambuco (UFPE), Avenida Professor Moraes Rego, 135, Recife, Pernambuco, 50670-901, Brazil.
- Department of Internal Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.
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Vasconcelos MPA, de Oliveira JM, Sánchez-Arcila JC, Faria SC, Rodrigues MM, Perce-da-Silva D, Rezende-Neto J, Pinto MA, Maia-Herzog M, Banic DM, Oliveira-Ferreira J. Seroprevalence of the Hepatitis E Virus in Indigenous and Non-Indigenous Communities from the Brazilian Amazon Basin. Microorganisms 2024; 12:365. [PMID: 38399768 PMCID: PMC10891770 DOI: 10.3390/microorganisms12020365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Hepatitis E virus (HEV) infection is a common cause of acute viral hepatitis in tropical regions. In Brazil, HEV G3 is the only genotype detected to date. Reports on HEV prevalence are heterogeneous. We aimed to compare the prevalence of anti-HEV among three populations living in the Brazilian Amazon basin. Two cross-sectional studies were conducted in urban, rural, and Yanomami indigenous areas. Plasma samples from 428 indigenous and 383 non-indigenous subjects were tested for anti-HEV IgG using enzyme-linked immunosorbent assays. The overall prevalence of anti-HEV was 6.8% (95%CI: 5.25-8.72), with 2.8% (12/428) found in the Yanomami areas, 3% (3/101) in an urban area, and 14.2% (40/282) in a rural area. Multivariate logistic analysis indicated that patients aged 31-45 years or ≥46 years are more likely to present anti-HEV positivity, with a respective aOR of 2.76 (95%CI: 1.09-7.5) and 4.27 (95%CI: 1.58-12.35). Furthermore, residence in a rural area (aOR: 7.67; 95%CI: 2.50-33.67) represents a relevant risk factor for HEV infection. Additional studies detecting HEV RNA in fecal samples from both humans and potential animal reservoirs are necessary to comprehensively identify risk factors associated with HEV exposure.
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Affiliation(s)
- Mariana Pinheiro Alves Vasconcelos
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz—FIOCRUZ/IOC, Rio de Janeiro 21045-900, Brazil; (M.P.A.V.); (J.C.S.-A.)
- Centro de Medicina Tropical de Rondônia—CEMETRON, Porto Velho 76812-329, Brazil
| | - Jaqueline Mendes de Oliveira
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro 21045-900, Brazil; (J.M.d.O.); (S.C.F.); (M.A.P.)
| | - Juan Camilo Sánchez-Arcila
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz—FIOCRUZ/IOC, Rio de Janeiro 21045-900, Brazil; (M.P.A.V.); (J.C.S.-A.)
| | - Sarah Castro Faria
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro 21045-900, Brazil; (J.M.d.O.); (S.C.F.); (M.A.P.)
| | | | - Daiana Perce-da-Silva
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz—FIOCRUZ/IOC, Rio de Janeiro 21045-900, Brazil; (D.P.-d.-S.); (D.M.B.)
| | | | - Marcelo Alves Pinto
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro 21045-900, Brazil; (J.M.d.O.); (S.C.F.); (M.A.P.)
| | - Marilza Maia-Herzog
- Laboratório de Referência Nacional em Simulídeos, Oncocercose e Mansonelose, Coleção de Simulídeos do Instituto Oswaldo Cruz—FIOCRUZ/IOC, Rio de Janeiro 21045-900, Brazil;
| | - Dalma Maria Banic
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz—FIOCRUZ/IOC, Rio de Janeiro 21045-900, Brazil; (D.P.-d.-S.); (D.M.B.)
| | - Joseli Oliveira-Ferreira
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz—FIOCRUZ/IOC, Rio de Janeiro 21045-900, Brazil; (M.P.A.V.); (J.C.S.-A.)
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Salgado CRS, Silva ADNE, Arruda IF, Millar PR, Amendoeira MRR, Leon LAA, Teixeira RBC, de Lima JTB, Chalhoub FLL, Bispo de Filippis AM, Fonseca ABM, de Oliveira JM, Pinto MA, Figueiredo AS. Serological Evidence of Hepatitis E Virus Infection in Brazilian Equines. Microorganisms 2023; 11:2743. [PMID: 38004754 PMCID: PMC10673136 DOI: 10.3390/microorganisms11112743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 11/26/2023] Open
Abstract
Hepatitis E virus (HEV) infection has been demonstrated in various animal species; those recognized as potential zoonotic reservoirs pose a considerable risk to public health. In Brazil, HEV-3 is the only genotype identified in humans and swine nationwide, in a colony-breeding cynomolgus monkey and, recently, in bovines and capybara. There is no information regarding HEV exposure in the equine population in Brazil. This study aimed to investigate anti-HEV antibodies and viral RNA in serum samples from horses slaughtered for meat export and those bred for sport/reproduction purposes. We used a commercially available ELISA kit modified to detect species-specific anti-HEV, using an anti-horse IgG-peroxidase conjugate and evaluating different cutoff formulas and assay precision. Serum samples (n = 257) were tested for anti-HEV IgG and HEV RNA by nested RT-PCR and RT-qPCR. The overall anti-HEV seroprevalence was 26.5% (68/257) without the detection of HEV RNA. Most municipalities (53.3%) and farms (58.8%) had positive horses. Animals slaughtered for human consumption had higher risk of HEV exposure (45.5%) than those bred for sports or reproduction (6.4%) (p < 0.0001). The statistical analysis revealed sex and breeding system as possible risk-associated factors. The first serological evidence of HEV circulation in Brazilian equines reinforces the need for the surveillance of HEV host expansion in a one-health approach.
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Affiliation(s)
- Caroline Roberta Soares Salgado
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (C.R.S.S.); (J.M.d.O.)
| | - Aldaleia do Nascimento e Silva
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (C.R.S.S.); (J.M.d.O.)
| | - Igor Falco Arruda
- Laboratório de Toxoplasmose e outras Protozooses, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (I.F.A.)
| | - Patrícia Riddell Millar
- Laboratório de Toxoplasmose e outras Protozooses, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (I.F.A.)
| | - Maria Regina Reis Amendoeira
- Laboratório de Toxoplasmose e outras Protozooses, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (I.F.A.)
| | - Luciane Almeida Amado Leon
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (C.R.S.S.); (J.M.d.O.)
| | | | - Jorge Tiburcio Barbosa de Lima
- Departamento de Clínica e Cirurgia Veterinárias, Universidade Federal de Minas Gerais—UFMG, Belo Horizonte 31270-901, MG, Brazil
| | - Flávia Löwen Levy Chalhoub
- Laboratório de Arbovírus e Vírus Hemorrágicos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Ana Maria Bispo de Filippis
- Laboratório de Arbovírus e Vírus Hemorrágicos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Ana Beatriz Monteiro Fonseca
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal Fluminense—UFF, Niterói 24210-346, RJ, Brazil
| | - Jaqueline Mendes de Oliveira
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (C.R.S.S.); (J.M.d.O.)
| | - Marcelo Alves Pinto
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (C.R.S.S.); (J.M.d.O.)
| | - Andreza Soriano Figueiredo
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil; (C.R.S.S.); (J.M.d.O.)
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Arce LP, Pavan MF, Bok M, Gutiérrez SE, Estein SM, Santos AT, Condorí WE, Uhart MM, Parreño V, Vizoso-Pinto MG, Ibañez LI. A multispecies competitive nanobody-based ELISA for the detection of antibodies against hepatitis E virus. Sci Rep 2023; 13:15448. [PMID: 37723180 PMCID: PMC10507121 DOI: 10.1038/s41598-023-41955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
The hepatitis E virus (HEV) is an emergent zoonotic virus causing viral hepatitis worldwide. Clinically, hepatitis E is not easily distinguished from other types of acute viral hepatitis. There is a need for HEV diagnostic assays to detect and prevent interspecies transmission among susceptible populations. Nanobodies (Nbs) are expressed recombinantly in different systems, produced with high yields, and have superior physicochemical properties compared with conventional antibodies (Ab). Several Nbs against ORF2, the capsid protein and main antigen, were selected and produced in E. coli. Nb39 and Nb74 specifically recognized HEV ORF2 (genotypes 3 and 4). A competitive ELISA (cELISA) was developed and validated using a reference panel of human (n = 86) and swine sera (n = 116) tested in comparison with a commercial kit. The optimal cutoff values determined by ROC analysis were 69.16% (human) and 58.76% (swine); the sensitivity and specificity were high: 97.4% (95% CI 86.5-99.5%) and 95.8% (95% CI 86.0-98.8%) for human vs. 100% (95% CI 93.5-100%) and 98.3% (95% CI 91.0-99.7%) for swine. Further, the cELISA detected total anti-HEV antibodies in wild boar, deer, and mice. To our knowledge, this is the first report of production of Nbs against HEV-3 ORF2 for diagnostic purposes.
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Affiliation(s)
- Lorena Paola Arce
- Infection Biology Laboratory, Faculty of Medicine and Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET-UNT, T4000ILI, Tucumán, Argentina
- Laboratorio de Ingeniería de Anticuerpos, Instituto de Química, Física de los Materiales, Medio ambiente y Energía (INQUIMAE-CONICET), C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Florencia Pavan
- Laboratorio de Ingeniería de Anticuerpos, Instituto de Química, Física de los Materiales, Medio ambiente y Energía (INQUIMAE-CONICET), C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marina Bok
- IncuINTA, Instituto de Virología, Instituto Nacional de Tecnología Agropecuaria (INTA), 1686, Husrlingham, Argentina
| | - Silvina Elena Gutiérrez
- Universidad Nacional del Centro de la Provincia de Buenos Aires, Facultad de Ciencias Veterinarias, Núcleo SAMP, Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), B7000GHG, Tandil, Buenos Aires, Argentina
| | - Silvia Marcela Estein
- Universidad Nacional del Centro de la Provincia de Buenos Aires, Facultad de Ciencias Veterinarias, Núcleo SAMP, Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), B7000GHG, Tandil, Buenos Aires, Argentina
| | - Agostina Tammone Santos
- Universidad Nacional del Centro de la Provincia de Buenos Aires, Facultad de Ciencias Veterinarias, Núcleo SAMP, Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), B7000GHG, Tandil, Buenos Aires, Argentina
| | - Walter Ezequiel Condorí
- Universidad Nacional del Centro de la Provincia de Buenos Aires, Facultad de Ciencias Veterinarias, Núcleo SAMP, Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), B7000GHG, Tandil, Buenos Aires, Argentina
| | - Marcela María Uhart
- One Health Institute, School of Veterinary Medicine, University of California Davis, Davis, CA, 95616, USA
| | - Viviana Parreño
- IncuINTA, Instituto de Virología, Instituto Nacional de Tecnología Agropecuaria (INTA), 1686, Husrlingham, Argentina
| | - María Guadalupe Vizoso-Pinto
- Infection Biology Laboratory, Faculty of Medicine and Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET-UNT, T4000ILI, Tucumán, Argentina.
| | - Lorena Itatí Ibañez
- Laboratorio de Ingeniería de Anticuerpos, Instituto de Química, Física de los Materiales, Medio ambiente y Energía (INQUIMAE-CONICET), C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina.
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Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis. Pathogens 2023; 12:pathogens12030425. [PMID: 36986347 PMCID: PMC10059948 DOI: 10.3390/pathogens12030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
Background and aims: The increasing number of diagnosed hepatitis E virus (HEV) infections in Europe has led to the implementation of the testing of blood products in various countries. Many nations have not yet implemented such screening. To assess the need for HEV screening in blood products worldwide, we conducted a systematic review and meta-analysis assessing HEV RNA positivity and anti-HEV seroprevalence in blood donors. Methods: Studies reporting anti-HEV IgG/IgM or HEV RNA positivity rates among blood donors worldwide were identified via predefined search terms in PubMed and Scopus. Estimates were calculated by pooling study data with multivariable linear mixed-effects metaregression analysis. Results: A total of 157 (14%) of 1144 studies were included in the final analysis. The estimated HEV PCR positivity rate ranged from 0.01 to 0.14% worldwide, with strikingly higher rates in Asia (0.14%) and Europe (0.10%) in comparison to North America (0.01%). In line with this, anti-HEV IgG seroprevalence in North America (13%) was lower than that in Europe (19%). Conclusions: Our data demonstrate large regional differences regarding the risk of HEV exposure and blood-borne HEV transmission. Considering the cost–benefit ratio, this supports blood product screening in high endemic areas, such as Europe and Asia, in contrast to low endemic regions, such as the U.S.
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de Oliveira JM, dos Santos DRL, Pinto MA. Hepatitis E Virus Research in Brazil: Looking Back and Forwards. Viruses 2023; 15:548. [PMID: 36851763 PMCID: PMC9965705 DOI: 10.3390/v15020548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
Hepatitis E virus (HEV) has emerged as a public health concern in Brazil. From the first identification and characterization of porcine and human HEV-3 strains in the 2000s, new HEV subtypes have been identified from animal, human, and environmental isolates. As new potential animal reservoirs have emerged, there is a need to compile evidence on the zoonotic dissemination of the virus in animal hosts and the environment. The increasing amount of seroprevalence data on sampled and randomly selected populations must be systematically retrieved, interpreted, and considered under the One Health concept. This review focused on HEV seroprevalence data in distinct animal reservoirs and human populations reported in the last two decades. Furthermore, the expertise with experimental infection models using non-human primates may provide new insights into HEV pathogenesis, prevention, and environmental surveillance.
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Affiliation(s)
- Jaqueline Mendes de Oliveira
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro 21040-360, Brazil
| | | | - Marcelo Alves Pinto
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro 21040-360, Brazil
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Cunha GG, Bezerra LA, Silva Júnior JVJ, Gonçales JP, Montreuil ACB, Côelho MRCD. Analysis of seroprevalence and risk factors for hepatitis E virus (HEV) in donation candidates and blood donors in Northeast Brazil. Braz J Microbiol 2022; 53:1995-2001. [PMID: 36100808 PMCID: PMC9679076 DOI: 10.1007/s42770-022-00816-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/20/2022] [Indexed: 01/13/2023] Open
Abstract
Oral transmission is the main route of hepatitis E virus (HEV) infection; however, genotypes 3 and 4 may also be transmitted by blood transfusion. Individuals who need blood products are often immunosuppressed, which increase the risk of severe disease and death by HEV. Despite this, blood banks in Brazil do not screen for HEV and epidemiological studies in this population are rare; this is an important issue as HEV-3 is frequently identified in the country. Herein, we analyzed the seroprevalence and risk factors for HEV seropositivity in donor candidates/blood donors from Northeast Brazil. Nine hundred and ninety-six donor candidates/blood donors from Foundation of Hematology and Hemotherapy of Pernambuco (HEMOPE) were interviewed regarding socioeconomic, sociodemographic, and behavioral data and analyzed for anti-HEV IgG. Anti-HEV IgG was detected using the HEV IgG (EUROIMMUN) kit. Associations between seropositivity and potential risk factors were analyzed by the χ2 test and Fisher's exact test. Seroprevalence was 0.9% (9/996), 77.77% (7/9) and 22.22% (2/9) in blood donors and donor candidates, respectively. HEV seropositivity was associated with male (OR: 11.65; CI: 0.6755-200.9; p = 0.0163), income higher than BRL 20,000/month (p = 0.0002), and lake bathing (OR: 4.553; CI: 1.391-15.25; p = 0.0258). Importantly, about 43% (3/7) of anti-HEV positive donors made their first donation more than 20 years ago, which must be taken as a warning sign, given the possibility that these individuals may have been infected after registration as donors. Finally, the report of HEV seropositivity, especially in regular blood donors, as well as the identification of potential risk factors, reinforces the need for viral screening in Brazilian blood banks.
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Affiliation(s)
- Gabriel Galindo Cunha
- Programa de Pós-Graduação Em Medicina Tropical, Universidade Federal de Pernambuco, Pernambuco, Brazil
- Setor de Virologia, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, S/N. Cidade Universitária, 50, Recife, Pernambuco, 670-901, Brazil
| | - Luan Araújo Bezerra
- Programa de Pós-Graduação Em Medicina Tropical, Universidade Federal de Pernambuco, Pernambuco, Brazil
- Setor de Virologia, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, S/N. Cidade Universitária, 50, Recife, Pernambuco, 670-901, Brazil
| | - José Valter Joaquim Silva Júnior
- Setor de Virologia, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, S/N. Cidade Universitária, 50, Recife, Pernambuco, 670-901, Brazil
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Rio Grande do Sul, Brazil
| | - Juliana Prado Gonçales
- Setor de Virologia, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, S/N. Cidade Universitária, 50, Recife, Pernambuco, 670-901, Brazil
- Grupo SER Educacional, Recife, Pernambuco, Brazil
| | | | - Maria Rosângela Cunha Duarte Côelho
- Setor de Virologia, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, S/N. Cidade Universitária, 50, Recife, Pernambuco, 670-901, Brazil.
- Departamento de Fisiologia E Farmacologia, Centro de Biociências, Universidade Federal de Pernambuco, Pernambuco, Brazil.
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Pedersen J, Moukandja IP, Ndidi S, Sørensen AL, Koumakpayi IH, Lekana-Douki JB, Vachon ML, Weis N, Kobinger G, Fausther-Bovendo H. An adaptable platform for in-house hepatitis C serology. J Virol Methods 2022; 308:114586. [PMID: 35850366 DOI: 10.1016/j.jviromet.2022.114586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 12/09/2022]
Abstract
Serology-based diagnosis remains one of the major tools for diagnosis and surveillance of infectious diseases. However, for many neglected diseases no or only few commercial assays are available and often with prices prohibiting large scale testing in low and middle-income countries (LMICs). We developed an adaptable enzyme-linked immunoassay (ELISA) using hepatitis C virus (HCV) as a proof-of-concept application. By combining the maltose-binding-protein with a multiepitope HCV protein, we were able to obtain a high concentration of protein suitable for downstream applications. Following optimization, the assay was verified using previously tested human samples from Canada, Denmark and Gabon in parallel with the use of a commercial protein. Sensitivity and specificity were calculated to 98 % and 97 % respectively, after accounting for non-specific binding and assay optimization. This study provides a thorough description of the development, and validation of a multiepitope ELISA-based diagnostic assay against HCV, which could be implemented at low cost. The described methodology can be readily adapted to develop novel ELISA-based diagnostic assays for other infectious pathogens with well-described immunogenic epitopes. This method could improve the diagnosis of neglected diseases for which affordable diagnostic assays are lacking.
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Affiliation(s)
- Jannie Pedersen
- Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Canada
| | | | - Stella Ndidi
- Centre Hospitalier Universitaire de Libreville, Libreville BP2228, Gabon
| | - Anna-Louise Sørensen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jean-Bernard Lekana-Douki
- Unité d'Evolution Epidémiologie et Résistances Parasitaires, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
| | - Marie-Louise Vachon
- Axe des Maladies Infectieuses et Immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec G1V 4G2, Canada
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gary Kobinger
- Galveston National Laboratory, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Hugues Fausther-Bovendo
- Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Canada; Global Urgent and Advanced Research and Development - GUARD, 911 Rue Principale, unit 100, Batiscan, Quebec G0X 1A0, Canada.
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10
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Hepatitis E virus genotype 3 in bovine livers slaughtered in the state of Rio Grande do Sul, Brazil. Braz J Microbiol 2022; 53:1115-1120. [PMID: 35355235 PMCID: PMC9433617 DOI: 10.1007/s42770-022-00741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/25/2022] [Indexed: 11/02/2022] Open
Abstract
Foodborne viruses are becoming a global concern as they overwhelm the health system and have the potential to spread globally. Among them, some genotypes of hepatitis E virus (HEV), which is one of the main causes of acute hepatitis in humans, have a zoonotic potential and can be found in foods of animal origin. Infected farm animals are a possible source of the virus, either by direct contact with animal excreta or meat. In the present study, 240 bovine liver samples from slaughter carried out in Rio Grande do Sul (RS), Brazil, were analyzed and tested for the presence of HEV. After performing PCR, 5.4% of positive samples were observed. One of the samples could be identified by molecular phylogenetic analysis as belonging to genotype 3, for which pigs are natural reservoirs, but has not been reported in bovine meat and products so far.
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11
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Development and Optimization of an Enzyme Immunoassay to Detect Serum Antibodies against the Hepatitis E Virus in Pigs, Using Plant-Derived ORF2 Recombinant Protein. Vaccines (Basel) 2021; 9:vaccines9090991. [PMID: 34579228 PMCID: PMC8473109 DOI: 10.3390/vaccines9090991] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
Hepatitis E is an emerging global disease, mainly transmitted via the fecal-oral route in developing countries, and in a zoonotic manner in the developed world. Pigs and wild boar constitute the primary Hepatitis E virus (HEV) zoonotic reservoir. Consumption of undercooked animal meat or direct contact with infected animals is the most common source of HEV infection in European countries. The purpose of this study is to develop an enzyme immunoassay (EIA) for the detection of anti-hepatitis E virus IgG in pig serum, using plant-produced recombinant HEV-3 ORF2 as an antigenic coating protein, and also to evaluate the sensitivity and specificity of this assay. A recombinant HEV-3 ORF2 110-610_6his capsid protein, transiently expressed by pEff vector in Nicotiana benthamiana plants was used to develop an in-house HEV EIA. The plant-derived HEV-3 ORF2 110-610_6his protein proved to be antigenically similar to the HEV ORF2 capsid protein and it can self-assemble into heterogeneous particulate structures. The optimal conditions for the in-house EIA (iEIA) were determined as follows: HEV-3 ORF2 110-610_6his antigen concentration (4 µg/mL), serum dilution (1:50), 3% BSA as a blocking agent, and secondary antibody dilution (1:20 000). The iEIA developed for this study showed a sensitivity of 97.1% (95% Cl: 89.9-99.65) and a specificity of 98.6% (95% Cl: 92.5-99.96) with a Youden index of 0.9571. A comparison between our iEIA and a commercial assay (PrioCHECK™ Porcine HEV Ab ELISA Kit, ThermoFisher Scientific, MA, USA) showed 97.8% agreement with a kappa index of 0.9399. The plant-based HEV-3 ORF2 iEIA assay was able to detect anti-HEV IgG in pig serum with a very good agreement compared to the commercially available kit.
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12
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Moraes DFDSD, Mesquita JR, Dutra V, Nascimento MSJ. Systematic Review of Hepatitis E Virus in Brazil: A One-Health Approach of the Human-Animal-Environment Triad. Animals (Basel) 2021; 11:ani11082290. [PMID: 34438747 PMCID: PMC8388429 DOI: 10.3390/ani11082290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Hepatitis E virus (HEV) is an important causative agent of acute and chronic hepatitis worldwide. Originally identified in epidemics associated with flooding in Asia, it nowadays shows very distinct genetic and epidemiological patterns. While HEV genotypes (HEV-) 1 and 2 are associated with the original outbreaks (waterborne diseases), HEV-3 and HEV-4 present a zoonotic pattern (associated with consumption of meat from infected animals), HEV-5 and 6 have been found only in wild boar in Japan, and HEV-7 and 8 have been detected in camels and dromedary seldom affecting humans. Brazil, with a precarious sanitary structure and being an important world meat producer, was the focus of this study in order to identify patterns of occurrence of HEV. After reviewing scientific studies, it was identified that the only genotype found in Brazil is HEV-3 and the area where there were more reports was the South region of the country. This is the region that produces more pork. These results indicate that HEV-3 is widespread in the country and sanitary surveillance is essential in the national production of pigs, as well as the implementation of monitoring protocols in hospitals. Abstract Brazil is the fifth largest country in the world with diverse socioeconomic and sanitary conditions, also being the fourth largest pig producer in the world. The aim of the present systematic review was to collect and summarize all HEV published data from Brazil (from 1995 to October 2020) performed in humans, animals, and the environment, in a One Health perspective. A total of 2173 papers were retrieved from five search databases (LILACs, Mendeley, PubMed, Scopus, and Web of Science) resulting in 71 eligible papers after application of exclusion/inclusion criteria. Data shows that HEV genotype 3 (HEV-3) was the only retrieved genotype in humans, animals, and environment in Brazil. The South region showed the highest human seroprevalence and also the highest pig density and industry, suggesting a zoonotic link. HEV-1 and 2 were not detected in Brazil, despite the low sanitary conditions of some regions. From the present review we infer that HEV epidemiology in Brazil is similar to that of industrialized countries (only HEV-3, swine reservoirs, no waterborne transmission, no association with low sanitary conditions). Hence, we alert for the implementation of HEV surveillance systems in swine and for the consideration of HEV in the diagnostic routine of acute and chronic hepatitis in humans.
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Affiliation(s)
- Danny Franciele da Silva Dias Moraes
- Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá 78060-900, Brazil; (D.F.d.S.D.M.); (V.D.)
- Secretaria de Estado do Meio Ambiente de Mato Grosso (SEMA), Cuiabá 78050-970, Brazil
- Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal
| | - João R. Mesquita
- Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal
- Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, 4050-600 Porto, Portugal
- Correspondence:
| | - Valéria Dutra
- Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá 78060-900, Brazil; (D.F.d.S.D.M.); (V.D.)
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13
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Caetano KAA, Bergamaschi FPR, Carneiro MAS, Pinheiro RS, Araújo LA, Matos MA, Carvalho PMRS, de Souza MM, de Matos MAD, Del-Rios NHA, Martins RMB, Motta-Castro ARC, Soares CC, Cook RL, Teles SA. Hepatotropic viruses (hepatitis A, B, C, D and E) in a rural Brazilian population: prevalence, genotypes, risk factors and vaccination. Trans R Soc Trop Med Hyg 2021; 114:91-98. [PMID: 31608957 DOI: 10.1093/trstmh/trz080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People living in settlement projects represent an emergent rural population in Brazil. Data on their health is scarce and there are no data on viral hepatitis in this population. This study investigated the epidemiology of viral hepatitis A-E in residents of settlement projects in central Brazil. METHODS During 2011 and 2012, 923 people living in rural settlements in central Brazil were interviewed and tested to estimate the prevalence of exposure to viral hepatitis A-E, to identify the circulating hepatitis B virus (HBV)/hepatitis C virus (HCV) genotypes and risk factors for HBV exposure and to evaluate adherence to the hepatitis B vaccination series. RESULTS Overall, 85.9, 3.9, 0.4 and 17.3% of individuals showed evidence of exposure to hepatitis A virus (HAV), hepatitis E virus, HCV and HBV, respectively. Among HBV-DNA positive samples (n=8), subgenotypes A1 (n=3) and A2 (n=1) and genotype D/subgenotype D3 (n=4) were identified. Hepatitis D virus superinfection was detected in 0/16 HBsAg-positive participants. A total of 229 individuals showed serological evidence of HBV vaccination. In total, 442 settlers were eligible for vaccination, but only 150 individuals completed the vaccine series. All anti-HCV-positive samples (n=4) were also HCV-RNA positive and identified as subtype 1a. CONCLUSIONS The intermediate endemicity of HAV, the higher prevalence of HBV exposure compared with urban areas and the low compliance with HBV vaccination requires preventive measures focused on rural populations, emphasizing the need for HAV and HBV vaccination.
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Affiliation(s)
- Karlla A A Caetano
- Faculty of Nursing, Federal University of Goias, Goiânia, GO, 74605080, Brazil
| | | | - Megmar A S Carneiro
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, GO, 74605050, Brazil
| | - Raquel S Pinheiro
- Federal Institute of Education, Science, and Technology of Goias, Goiânia, GO, 74130012, Brazil
| | - Lyriane A Araújo
- Federal Institute of Education, Science, and Technology of Goias, Goiânia, GO, 74130012, Brazil
| | - Marcos A Matos
- Faculty of Nursing, Federal University of Goias, Goiânia, GO, 74605080, Brazil
| | | | - Márcia M de Souza
- Faculty of Nursing, Federal University of Goias, Goiânia, GO, 74605080, Brazil
| | - Márcia A D de Matos
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, GO, 74605050, Brazil
| | - Nativa Helena A Del-Rios
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, GO, 74605050, Brazil
| | - Regina M B Martins
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, GO, 74605050, Brazil
| | - Ana Rita C Motta-Castro
- Center for Biological and Health Sciences, Federal University of Mato Grosso do Sul, Campo Grande, MS, 79080190, Brazil
| | - Caroline C Soares
- Laboratory of Molecular Virology, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040900, Brazil
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, 100231, USA
| | - Sheila A Teles
- Faculty of Nursing, Federal University of Goias, Goiânia, GO, 74605080, Brazil
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Seroprevalence of hepatitis E virus in risk populations and blood donors in a referral hospital in the south of Brazil. Sci Rep 2021; 11:6011. [PMID: 33727656 PMCID: PMC7966736 DOI: 10.1038/s41598-021-85365-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/12/2021] [Indexed: 12/21/2022] Open
Abstract
The prevalence of anti-hepatitis E virus (HEV) antibodies has a high heterogeneity worldwide. South American data are still scarce. The aim of this study was to evaluate the prevalence of HEV in populations at risk in comparison to blood donors (BD). A cross-sectional study was carried out in adults of different risk populations including crack users (CK), residents in a low income area (LIA), cirrhotic (CIR) and liver transplant patients (LT) compared with BD. The WANTAI HEV ELISA test was used and real-time PCR (in-house for screening and ALTONA as confirmatory test) for HEV RNA screening. A total of 400 participants were included. Anti-HEV IgG was positive in 19.5% of the total sample, reaching the highest rate in the CIR group, 22.5%, followed by CK, LT, and LIA (20%, 18.7%, and 17.5%, respectively). The prevalence found in BD individuals was of 18.7% (p = NS). Anti-HEV IgM was positive in only 1.5% of the sample (6/400). No blood or stools samples were positive for HEV RNA. The seroprevalence reported is among the highest rates ever found in Brazil. Considering the intense diagnostic investigation, data show that HEV circulation is more common that might be expected in our country.
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15
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Remondegui C, Ceballos S, Arce LP, Pintado E, Vidaurre R, Nitschko H, Osterman A, Vizoso Pinto MG. Serologic evidence of the circulation of the hepatitis E virus and the prevalence of antibodies against hepatitis A in an indigenous population in northern Argentina. Rev Argent Microbiol 2021; 53:314-324. [PMID: 33648797 DOI: 10.1016/j.ram.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/31/2020] [Accepted: 10/02/2020] [Indexed: 11/29/2022] Open
Abstract
In 2005 a universal vaccination program against hepatitis A was introduced in Argentina. Nevertheless, there are still some unvaccinated marginal population groups. There are no data about the seroprevalence of hepatitis E in the northern region of Argentina mainly because of lack of awareness of this emergent pathogen. We aimed to determine the seroprevalence of hepatitis A, and hepatitis E in an indigenous population in northern Argentina. One hundred and twenty six (126) donor serum samples collected near San Salvador de Jujuy were analyzed for anti-HAV IgG and HEV IgG and IgM, alkaline phosphatase and transaminase values. Volunteers were interviewed about their living conditions, animal farming, consumption of tap water or river water, and level of education. Seroprevalence of specific anti-HAV antibodies was high (80.2%, 95% confidence interval, 72.1-86.7%) in children under 5 years of age, indicating early infection in life. Seroprevalence of anti-HEV antibodies was 5.6% (95% CI: 2.3-11.2%), being slightly higher than the values found in healthy patients from other regions of the country. Although we could not characterize the genotype of the circulating HEV strain, the clear epidemiological difference between seroprevalence of HAV and HEV in a community with poor sanitary conditions suggest that the circulating HEV strains spread through a different transmission route than HAV. Furthermore a significant correlation between anti-HEV IgG and swine farming was found (p<0.05), which supports a zoonotic transmission path. We reassessed the epidemiological pattern of HAV infection and reported evidence of HEV infection for the first-time in a community belonging to the Guarani ethnic group, highlighting the need to include hepatitis E testing in routine diagnostics in the region.
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Affiliation(s)
| | | | - Lorena Paola Arce
- Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET-UNT, San Miguel de Tucumán, Argentina; Laboratorio de Ciencias Básicas, OR. Genética, Facultad de Medicina, INSIBIO (CONICET-UNT), Universidad Nacional de Tucumán, Argentina
| | | | - Rene Vidaurre
- Hospital Paterson de San Pedro de Jujuy, Jujuy, Argentina
| | - Hans Nitschko
- Max von Pettenkofer Institute, Virology, National Reference Center for Retroviruses, Faculty of Medicine, LMU München, Munich, Germany; German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - Andreas Osterman
- Max von Pettenkofer Institute, Virology, National Reference Center for Retroviruses, Faculty of Medicine, LMU München, Munich, Germany; German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - María Guadalupe Vizoso Pinto
- Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET-UNT, San Miguel de Tucumán, Argentina; Laboratorio de Ciencias Básicas, OR. Genética, Facultad de Medicina, INSIBIO (CONICET-UNT), Universidad Nacional de Tucumán, Argentina.
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de Almeida e Araújo DC, de Oliveira JM, Haddad SK, da Roza DL, Bottino FDO, Faria SBSC, Bellíssimo-Rodrigues F, Passos ADC. Declining prevalence of hepatitis A and silent circulation of hepatitis E virus infection in southeastern Brazil. Int J Infect Dis 2020; 101:17-23. [DOI: 10.1016/j.ijid.2020.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/05/2020] [Accepted: 09/11/2020] [Indexed: 12/29/2022] Open
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17
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Arce LP, Müller MF, Martinez A, Baiker A, Marranzino G, Agote F, Vizoso-Pinto MG. A Novel In-House Enzyme-Linked Immunosorbent Assay for Genotype 3 Hepatitis E Virus Reveals High Seroprevalence in Blood Donors in Northern Argentina. Front Microbiol 2019; 10:2481. [PMID: 31736916 PMCID: PMC6838658 DOI: 10.3389/fmicb.2019.02481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022] Open
Abstract
The Hepatitis E virus (HEV) is an emergent virus that causes acute hepatitis in immunocompetent hosts and chronic hepatitis in immunocompromised hosts. In Latin America, the main circulating genotype HEV-3 is usually of zoonotic origin. Diagnosis and seroprevalence studies mainly rely on the detection of specific antibodies. There are scarce data on the seroprevalence of HEV infection in Latin America mainly due to the lack of awareness of HEV circulation. Furthermore, in some countries, like Argentina, HEV testing is not included in routine assays. In order to provide tools to deepen the knowledge on HEV epidemiology in South America, we designed a new in-house ELISA based on the native recombinant protein ORF2 aa112–608 and demonstrated its potential for detecting anti-HEV immunoglobulin G (IgG) in human serum samples. The following conditions were determined: an optimal antigen concentration of 0.25 μg/ml, a serum dilution of 1:80, gelatin as a blocking agent, and a secondary antibody dilution of 1:2000. A relative sensitivity of 93.33% (95% CI: 77.9–99.2%) and a relative specificity of 99.4% (95% CI: 96.7–100%) were determined using a panel of previously characterized sera and a gold standard (HEV IgG ELISA, DIA.PRO, Italy). Further, we obtained a very good agreement (κ index = 0.94, 95% CI: 0.87–1.00) with the gold standard. We screened 813 blood donor samples with this newly developed ELISA and found a seroprevalence of 9.23% (95% confidence interval, 7.33–11.43%). We show for the first time evidence of past HEV infection in Tucuman, the most populated city in northern Argentina. We expect that this study will raise the interest of health decision makers who should intercede to include indirect testing of HEV in regular diagnostic protocols. In conclusion, the in-house ELISA developed in this work shows a very good agreement with an already licensed commercial HEV IgG ELISA (DIA.PRO, ITALY), which can be used as an epidemiologic tool for HEV surveillance.
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Affiliation(s)
- Lorena Paola Arce
- Infection Biology Laboratory, Instituto de Investigaciones en Medicina Molecular y Celular Aplicada (IMMCA), SIPROSA, CONICET, UNT, San Miguel de Tucumán, Argentina.,Laboratorio de Ciencias Básicas and Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Melisa Florencia Müller
- Infection Biology Laboratory, Instituto de Investigaciones en Medicina Molecular y Celular Aplicada (IMMCA), SIPROSA, CONICET, UNT, San Miguel de Tucumán, Argentina.,Laboratorio de Ciencias Básicas and Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Alfredo Martinez
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Armin Baiker
- Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany
| | - Gabriela Marranzino
- Banco Central de Sangre de Tucumán "Dr. César Guerra," PRIS-Si.PRO.SA, San Miguel de Tucumán, Argentina
| | - Felicitas Agote
- Banco Central de Sangre de Tucumán "Dr. César Guerra," PRIS-Si.PRO.SA, San Miguel de Tucumán, Argentina
| | - Maria Guadalupe Vizoso-Pinto
- Infection Biology Laboratory, Instituto de Investigaciones en Medicina Molecular y Celular Aplicada (IMMCA), SIPROSA, CONICET, UNT, San Miguel de Tucumán, Argentina.,Laboratorio de Ciencias Básicas and Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
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da Silva MS, Silveira S, Caron VS, Mósena ACS, Weber MN, Cibulski SP, Medeiros AAR, Silva GS, Corbellini LG, Klein R, Kreutz LC, Frandoloso R, Canal CW. Backyard pigs are a reservoir of zoonotic hepatitis E virus in southern Brazil. Trans R Soc Trop Med Hyg 2019; 112:14-21. [PMID: 29554365 DOI: 10.1093/trstmh/try017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/08/2018] [Indexed: 12/27/2022] Open
Abstract
Background Hepatitis E virus (HEV) is the causative agent of acute hepatitis worldwide. There is no seroprevalence study in backyard farms, which are characterized by suboptimal hygienic conditions in Brazil. We aimed to determine the seroprevalence and genetic diversity of HEV in backyard pigs in Brazil. Methods Swine serum samples collected in 2012 (n=731) and 2014 (n=713) were analysed. The presence of anti-HEV immunoglobulin G in pig serum was evaluated by indirect enzyme-linked immunosorbent assay. Reverse transcription polymerase chain reaction was performed and phylogenetic analyses were carried out based on the partial ORF1 and ORF2 coding regions. Results Anti-HEV antibodies were detected in 77.6% (567/731; 95% confidence interval [CI] 74.5 to 90.6%) of serum samples in 2012 and 65.5% (467/713; 95% CI 62.0 to 69.0%) in 2014. The herd seroprevalence was 91.7% (187/204; 95% CI 91% to 99%) in 2012 and 83.7% (164/196; 95% CI 78% to 89%) in 2014. Further, HEV RNA was detected in 0.8% (6/713) of samples from 2014. Phylogenetic analysis showed three different genotype 3 subtypes with high similarity to human HEV strains. Conclusions This study showed that backyard pigs are a reservoir of HEV and alerts us to the need to control infection and spillover from backyard farms. GenBank accession numbers MF438128-MF438135.
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Affiliation(s)
- M S da Silva
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, CEP 91-540-000, Porto Alegre, Rio Grande do Sul, Brazil
| | - S Silveira
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, CEP 91-540-000, Porto Alegre, Rio Grande do Sul, Brazil
| | - V S Caron
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, CEP 91-540-000, Porto Alegre, Rio Grande do Sul, Brazil
| | - A C S Mósena
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, CEP 91-540-000, Porto Alegre, Rio Grande do Sul, Brazil
| | - M N Weber
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, CEP 91-540-000, Porto Alegre, Rio Grande do Sul, Brazil
| | - S P Cibulski
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, CEP 91-540-000, Porto Alegre, Rio Grande do Sul, Brazil
| | - A A R Medeiros
- Laboratório de Epidemiologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - G S Silva
- Laboratório de Epidemiologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - L G Corbellini
- Laboratório de Epidemiologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - R Klein
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo (UPF), Passo Fundo, Rio Grande do Sul, Brazil
| | - L C Kreutz
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo (UPF), Passo Fundo, Rio Grande do Sul, Brazil
| | - R Frandoloso
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo (UPF), Passo Fundo, Rio Grande do Sul, Brazil
| | - C W Canal
- Laboratório de Virologia, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, CEP 91-540-000, Porto Alegre, Rio Grande do Sul, Brazil
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19
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Molina CV, Heinemann MB, Kierulff C, Pissinatti A, da Silva TF, de Freitas DG, de Souza GO, Miotto BA, Cortez A, Semensato BDP, Moreno LZ, Catão-Dias JL, Bueno MG. Leptospira spp., rotavirus, norovirus, and hepatitis E virus surveillance in a wild invasive golden-headed lion tamarin (Leontopithecus chrysomelas; Kuhl, 1820) population from an urban park in Niterói, Rio de Janeiro, Brazil. Am J Primatol 2019; 81:e22961. [PMID: 30828830 DOI: 10.1002/ajp.22961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 01/18/2019] [Accepted: 02/03/2019] [Indexed: 01/13/2023]
Abstract
The world currently faces severe biodiversity losses caused by anthropogenic activities such as deforestation, pollution, the introduction of exotic species, habitat fragmentation, and climate changes. Disease ecology in altered environments is still poorly understood. The golden-headed lion tamarin (GHLT, Leontopithecus chrysomelas) is an endangered species that became invasive in an urban park in Niterói, Rio de Janeiro, Brazil. The initially few invasive GHLT individuals became hundreds, adapted to living in proximity to humans and domestic animals. These GHLTs were captured as part of a conservation project; some animals were translocated to Bahia and some were kept in captivity. This study tested 593 GHLT for Leptospira serology; 100 and 95 GHLT for polymerase chain reaction (PCR) toLeptospira and hepatitis E virus genotype 3 (HEV-3), respectively, and 101 familiar groups for PCR to viruses (rotavirus A, norovirus GI and GII, and HEV-3). One animal had antibodies for Leptospira serovar Shermani and another for serovar Hebdomadis. One saprophyticLeptospira was found by the 16S PCR and sequencing. Viruses were not detected in samples tested. Findings suggest that the epidemiological importance of such pathogens in this GHLT population is either low or nonexistent. These data are important to understand the local disease ecology, as well as monitoring a translocation project, and to contribute data for species conservation.
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Affiliation(s)
- Camila V Molina
- Laboratório de Patologia Comparada de Animais Selvagens (LAPCOM), Departamento de Patologia (VPT), Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Instituto Pri-Matas para a Conservação da Biodiversidade, Belo Horizonte, MG, Brazil
| | - Marcos B Heinemann
- Laboratório de Zoonoses Bacterianas, Departamento de Medicina Veterinária Preventiva e Saúde Animal (VPS), Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Cecilia Kierulff
- Instituto Pri-Matas para a Conservação da Biodiversidade, Belo Horizonte, MG, Brazil.,Programa de Pós-graduação em Biodiversidade Tropical, Universidade Federal do Espírito Santo (UFES), São Mateus, ES, Brazil
| | - Alcides Pissinatti
- Centro de Primatologia do Rio de Janeiro (CPRJ), Instituto Estadual do Ambiente (INEA), Guapimirim, RJ, Brazil.,Centro Universitário Serra dos Órgãos, Teresópolis, RJ, Brazil
| | - Tiago F da Silva
- Instituto Pri-Matas para a Conservação da Biodiversidade, Belo Horizonte, MG, Brazil
| | - Danilo G de Freitas
- Instituto Pri-Matas para a Conservação da Biodiversidade, Belo Horizonte, MG, Brazil
| | - Gisele O de Souza
- Laboratório de Zoonoses Bacterianas, Departamento de Medicina Veterinária Preventiva e Saúde Animal (VPS), Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Bruno A Miotto
- Departamento de Clínica Médica (VCM), Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Adriana Cortez
- Curso de Medicina Veterinária, Universidade Santo Amaro (UNISA), São Paulo, SP, Brazil
| | | | - Luisa Z Moreno
- Laboratório de Sanidade Suína, Departamento de Medicina Veterinária Preventiva e Saúde Animal (VPS), Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - José L Catão-Dias
- Laboratório de Patologia Comparada de Animais Selvagens (LAPCOM), Departamento de Patologia (VPT), Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Marina G Bueno
- Instituto Pri-Matas para a Conservação da Biodiversidade, Belo Horizonte, MG, Brazil.,Presidência, Plataforma Institucional Biodiversidade e Saúde Silvestre, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
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20
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Schwingel D, Andreolla AP, Erpen LMS, Frandoloso R, Kreutz LC. Bovine leukemia virus DNA associated with breast cancer in women from South Brazil. Sci Rep 2019; 9:2949. [PMID: 30814631 PMCID: PMC6393560 DOI: 10.1038/s41598-019-39834-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/23/2019] [Indexed: 01/23/2023] Open
Abstract
Breast cancer is a neoplastic condition with a high morbidity and mortality amongst women worldwide. Recent data linking bovine leukemia virus (BLV) with breast cancer has been contested already. Our study investigated the presence of BLV genome in healthy (n = 72) and cancerous (n = 72) paraffin-embedded samples of breast tissues from women in south Brazil. BLV DNA was found most frequently (30.5%) in breast cancer tissue than in healthy breast (13.9%) (Odds ratio = 2.73; confidence interval = 1.18-6.29; p = 0.027). In contrast, antibodies to BLV were found in a very small percentage of healthy blood donors. There was no association between BLV DNA and other tumor prognostic biological markers such as hormonal receptors, HER2 oncoprotein, proliferation index, metastasis in sentinels lymph nodes, and tumor grade and size. Our findings suggest that BLV should be considered a potential predisposing factor to breast cancer in women.
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Affiliation(s)
- Daniela Schwingel
- Universidade de Passo Fundo, Laboratório de Microbiologia e Imunologia Avançada, Prédio G3. Campus I, Bairro São José, BR 285, Km 292, 99052-900, Passo Fundo, RS, Brazil
| | - Ana P Andreolla
- Universidade de Passo Fundo, Laboratório de Microbiologia e Imunologia Avançada, Prédio G3. Campus I, Bairro São José, BR 285, Km 292, 99052-900, Passo Fundo, RS, Brazil
| | - Luana M S Erpen
- Universidade de Passo Fundo, Laboratório de Microbiologia e Imunologia Avançada, Prédio G3. Campus I, Bairro São José, BR 285, Km 292, 99052-900, Passo Fundo, RS, Brazil
| | - Rafael Frandoloso
- Universidade de Passo Fundo, Laboratório de Microbiologia e Imunologia Avançada, Prédio G3. Campus I, Bairro São José, BR 285, Km 292, 99052-900, Passo Fundo, RS, Brazil
| | - Luiz C Kreutz
- Universidade de Passo Fundo, Laboratório de Microbiologia e Imunologia Avançada, Prédio G3. Campus I, Bairro São José, BR 285, Km 292, 99052-900, Passo Fundo, RS, Brazil.
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21
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Andreolla AP, Erpen LMS, Frandoloso R, Kreutz LC. Development of an indirect ELISA based on recombinant capsid protein to detect antibodies to bovine leukemia virus. Braz J Microbiol 2018; 49 Suppl 1:68-75. [PMID: 29866609 PMCID: PMC6328717 DOI: 10.1016/j.bjm.2018.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/15/2018] [Accepted: 05/03/2018] [Indexed: 01/22/2023] Open
Abstract
Serological testing and culling infected animals are key management practices aiming eradication of bovine leukemia virus infection. Here, we report the development of an indirect ELISA based on BLV recombinant capsid protein (BLVp24r) to detect anti-BLV antibodies in cattle serum. The BLVp24r was expressed in Escherichia coli and purified by affinity chromatography, and then used to set up the ELISA parameters. The Polysorp® plate coated with 50ng of antigen/well and bovine serum diluted 1:100 gave the best results during standardization. Using sera from infected and non-infected cattle we set up the cutoff point at 0.320 (OD450nm) with a sensitivity of 98.5% and specificity of 100.0%. Then, we tested 1.187 serum samples from dairy (736 samples) and beef cattle (451 samples) with unknown status to BLV. We found that 31.1% (229/736) and 9.5% (43/451) of samples amongst dairy and beef cattle, respectively, had IgGs to BLV. The rate of agreement with a commercial competitive ELISA was 84.3% with a κ value of 0.68. Thus, our BLVp24r iELISA is suitable to detect BLV infected animals and should be a useful tool to control BLV infection in cattle.
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Affiliation(s)
- Ana Paula Andreolla
- Universidade de Passo Fundo (UPF), Faculdade de Agronomia e Medicina Veterinária (FAMV), Laboratório de Microbiologia e Imunologia Avançada, Passo Fundo, RS, Brazil
| | - Luana Marina Scheer Erpen
- Universidade de Passo Fundo (UPF), Faculdade de Agronomia e Medicina Veterinária (FAMV), Laboratório de Microbiologia e Imunologia Avançada, Passo Fundo, RS, Brazil
| | - Rafael Frandoloso
- Universidade de Passo Fundo (UPF), Faculdade de Agronomia e Medicina Veterinária (FAMV), Laboratório de Microbiologia e Imunologia Avançada, Passo Fundo, RS, Brazil
| | - Luiz Carlos Kreutz
- Universidade de Passo Fundo (UPF), Faculdade de Agronomia e Medicina Veterinária (FAMV), Laboratório de Microbiologia e Imunologia Avançada, Passo Fundo, RS, Brazil.
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22
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Pisano MB, Martinez-Wassaf MG, Mirazo S, Fantilli A, Arbiza J, Debes JD, Ré VE. Hepatitis E virus in South America: The current scenario. Liver Int 2018; 38:1536-1546. [PMID: 29788538 DOI: 10.1111/liv.13881] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
Hepatitis E virus (HEV) is one of the most frequent causes of acute viral hepatitis of enteric transmission worldwide. In South America the overall epidemiology has been little studied, and the burden of the disease remains largely unknown. A research of all scientific articles about HEV circulation in South America until November 2017 was carried out. Human seroprevalences of HEV varied according to the studied population: blood donors presented prevalence rates ranging from 1.8% to 9.8%, while reports from HIV-infected individuals, transplant recipients and patients on hemodialysis showed higher prevalence rates. Only 2 cases of chronic hepatitis in solid-organ transplant patients from Argentina and Brazil have been described. Detection of HEV in the swine population is widely prevalent in the region. Anti-HEV antibodies have also been recently documented in wild boars from Uruguay. Although scarce, studies focused on environmental and food HEV detection have shown viral presence in these kind of samples, highlighting possible transmission sources of HEV in the continent. HEV genotype 3 was the most frequently detected in the region, with HEV genotype 1 detected only in Venezuela and Uruguay. HEV is widely distributed throughout South America, producing sporadic cases of acute hepatitis, but as a possible agent of chronic hepatitis. Finding the virus in humans, animals, environmental samples and food, show that it can be transmitted through many sources, alerting local governments and health systems to improve diagnosis and for the implementation of preventive measures.
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Affiliation(s)
- María B Pisano
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | | | - Santiago Mirazo
- Sección Virología, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Anabella Fantilli
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Juan Arbiza
- Sección Virología, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - José D Debes
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Viviana E Ré
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
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