Hepatitis E virus infection in acute hepatitis in Spain

Area of Science:

• Hepatology
• Virology
• Epidemiology

Background:

• Hepatitis E virus (HEV) infection is a significant public health concern globally.
• Understanding HEV prevalence in developed countries is crucial for accurate diagnosis and management.
• Previous studies have primarily focused on HEV in endemic regions.

Purpose of the Study:

• To determine the prevalence of IgG and IgM anti-HEV antibodies in various patient cohorts in Spain.
• To assess the role of HEV as a cause of acute viral hepatitis in a developed country.
• To investigate potential transmission routes and epidemiological impact of HEV.

Main Methods:

• Serum samples from 382 patients with acute viral hepatitis (Hep A, B/D, non-A/B/C), 76 healthy subjects, 55 hemophiliacs, and 50 hemodialysis patients were tested.
• IgG and IgM anti-HEV antibodies were detected using a synthetic peptide-based enzyme immunoassay (EIA).
• Serial serum samples were analyzed for seroconversion in confirmed HEV cases.

Main Results:

• IgG anti-HEV antibodies were detected in low percentages across groups: 5.6% in non-A/B/C hepatitis, 6.5% in Hep B/D, 4% in Hep A, 5.5% in healthy adults, and 6% in hemodialysis patients. No HEV antibodies were found in hemophiliacs.
• IgM anti-HEV antibodies were found in only two cases of acute hepatitis B and/or D.
• Three cases of acute HEV infection were confirmed, all in adults with community-acquired infections (two were intravenous drug users) and self-limited courses. One of these also showed IgM positivity and IgG seroconversion.

Conclusions:

• HEV is a minor cause of acute hepatitis in Spain, with a low overall prevalence of anti-HEV antibodies.
• The study suggests a very low epidemiological impact of HEV in the studied population.
• An association between HEV and hepatitis B/D suggests a potential parenteral transmission route for HEV, typically considered an enteral pathogen.