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Hepatitis E virus genotypes and subgenotypes causing acute hepatitis, Bulgaria, 2013-2015
Roberto Bruni1, Umbertina Villano1, Michele Equestre2
1Viral Hepatitis and Oncovirus and Retrovirus Diseases Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
Plos One
|June 8, 2018
Summary
Hepatitis E Virus genotype 3 (HEV-3) causes most acute hepatitis E cases in Bulgaria, with subtypes 3e, 3f, and 3c identified. HEV-3 subtype 3e shows distinct geographical distribution compared to subtypes 3f and 3c.
Area of Science:
- Virology
- Infectious Diseases
- Public Health
Background:
- Hepatitis E Virus (HEV) is an emerging pathogen in industrialized regions, with increasing autochthonous cases of HEV genotype 3 (HEV-3).
- Limited data exists on HEV strains causing acute hepatitis E in Eastern Europe/Balkans, specifically Bulgaria.
Purpose of the Study:
- To characterize the HEV strains responsible for acute hepatitis E in Bulgaria.
- To investigate the molecular and geographical distribution of circulating HEV-3 subtypes.
Main Methods:
- Analysis of 103 anti-HEV IgM positive serum samples from acute hepatitis cases (2013-2015) in Bulgaria.
- HEV RNA detection by Real-Time PCR, followed by nested PCR and sequencing of the ORF-2 region for genotyping and subtyping.
- Phylogenetic analysis of viral sequences to determine HEV genotype and subtype, and assess geographical distribution.
Main Results:
- HEV RNA was detected in 90/103 samples; 64 samples yielded sequence data.
- HEV genotype 3 (HEV-3) was identified in 63/64 cases, with HEV-1 in one case.
- Predominant HEV-3 subtypes were 3e (62%), 3f (24%), and 3c (13%). Subtype 3e sequences clustered distinctly and were geographically restricted to the South-West, while 3f and 3c were more widespread.
Conclusions:
- HEV-3, particularly subtypes 3e, 3f, and 3c, is the primary cause of acute hepatitis E in Bulgaria.
- HEV-3 subtype 3e exhibits a distinct geographical distribution in the South-West region, differing from the broader circulation of subtypes 3f and 3c.
- Further research is needed to understand the factors driving the observed molecular and geographical variations in HEV-3 subtypes.
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