[Autochthonous hepatitis E: an emerging and still unrecognized disease]

Area of Science:

• Hepatology
• Infectious Diseases
• Public Health

Context:

• Hepatitis E virus (HEV) was historically considered rare and imported in developed countries.
• It is now recognized as an autochthonous (locally acquired) disease in these regions.
• Transmission routes, including foodborne and bloodborne, are increasingly identified.

Purpose:

• To highlight the changing epidemiology of Hepatitis E virus in developed countries.
• To discuss the clinical implications and transmission of HEV in non-endemic settings.
• To compare HEV outcomes in developed versus developing countries.

Summary:

• HEV is now endemic in developed countries, with autochthonous cases supplanting imported ones.
• Zoonotic (foodborne) and bloodborne transmissions are emerging concerns.
• Chronic hepatitis and cirrhosis can develop in immunocompromised patients (e.g., transplant recipients, HIV+).
• Mortality rates appear higher in industrialized nations compared to endemic areas.
• Unlike in developing countries, HEV has not been associated with maternal mortality in developed nations.

Impact:

• Increased awareness of HEV as a domestic public health issue in developed nations.
• Need for revised diagnostic and management strategies for HEV, particularly in immunocompromised populations.
• Potential for HEV to pose a significant burden on healthcare systems in industrialized countries.