Hepatitis E Virus Species C Infection in Humans, Hong Kong . (27th October 2021)

• Record Type: Journal Article
• Authors: Sridhar, Siddharth; Yip, Cyril Chik Yan; Lo, Kelvin Hon Yin; Wu, Shusheng; Situ, Jianwen; Chew, Nicholas Foo Siong; Leung, Kit Hang; Chan, Helen Shuk Ying; Wong, Sally Cheuk Ying; Leung, Anthony Wai Shing; Tse, Cindy Wing Sze; Fung, Kitty S C; Tsang, Owen Tak Yin; Hon, Kam Lun; Cheng, Vincent Chi Chung; Ng, Ken Ho Leung; Yuen, Kwok Yung
• Is Part Of: Clinical infectious diseases. Volume 75:Number 2(2022)
• Page Start: 288
• Page End: 296
• Publication Date: 2021-10-27
• Subjects: rat hepatitis E virus -- HEV-C -- ribavirin -- chronic infection -- zoonosis; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab919
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Hepatitis E virus (HEV) variants belonging to Orthohepevirus species A (HEV-A) are the primary cause of human hepatitis E. However, we previously reported that Orthohepevirus species C genotype 1 (HEV-C1), a divergent HEV variant commonly found in rats, also causes hepatitis in humans. Here, we present a clinical-epidemiological investigation of human HEV-C1 infections detected in Hong Kong, with an emphasis on outcomes in immunocompromised individuals. Methods: A surveillance system for detecting human HEV-C1 infections was established in Hong Kong. Epidemiological and clinical characteristics of HEV-C1 cases identified via this system between 1 August 2019 and 31 December 2020 were retrieved. Phylogenetic analysis of HEV-C1 strain sequences was performed. Infection outcomes of immunocompromised individuals with HEV-A and HEV-C1 infections were analyzed. Results: HEV-C1 accounted for 8 of 53 (15.1%) reverse-transcription polymerase chain reaction (RT-PCR)–confirmed HEV infections in Hong Kong during the study period, raising the total number of HEV-C1 infections detected in the city to 16. Two distinct HEV-C1 strain groups caused human infections. Patients were elderly and/or immunocompromised; half tested negative for HEV immunoglobulin M. Cumulatively, HEV-C1 accounted for 9 of 21 (42.9%) cases of hepatitis E recorded in immunocompromised patients in Hong Kong. Immunocompromised HEV-C1 patients progressed to persistent hepatitis at similar rates (7/9 [77.8%]) as HEV-A patients (10/12 [75%]). HEV-C1 patients responded to oral ribavirin, although response to first course was sometimes poor or delayed. Conclusions: Dedicated RT-PCR–based surveillance detected human HEV-C1 cases that evade conventional hepatitis E diagnostic testing. Immunosuppressed HEV-C1–infected patients frequently progress to persistent HEV-C1 infection, for which ribavirin is a suitable treatment option. Abstract : Orthohepevirus species C (commonly known as rat hepatitis E virus) causes hepatitis in humans, with high rates of persistent infection in immunocompromised patients. Ribavirin is an effective antiviral for this condition, although suboptimal responses to the first course can occur.