Volume 19, Number 2—February 2013
CME ACTIVITY - Research
Laboratory-based Surveillance for Hepatitis E Virus Infection, United States, 2005–2012
Jan Drobeniuc
, Tracy Greene-Montfort, Ngoc-Thao Le, Tonya R. Mixson-Hayden, Lilia Ganova-Raeva, Chen Dong, Ryan T. Novak, Umid M. Sharapov, Rania A. Tohme, Eyasu Teshale, Saleem Kamili, and Chong-Gee Teo
, Tracy Greene-Montfort, Ngoc-Thao Le, Tonya R. Mixson-Hayden, Lilia Ganova-Raeva, Chen Dong, Ryan T. Novak, Umid M. Sharapov, Rania A. Tohme, Eyasu Teshale, Saleem Kamili, and Chong-Gee Teo
Table
Demographic, clinical, travel-related, and virologic characteristics for patients with hepatitis E, United States, 2005–2012*
| Travel history and case-patient no. | Age, y/sex | Race/ ethnicity | State of residence | Transplant (organ) | Jaundice | Countries visited | Anti-HEV SCR |
HEV genotype | HEV viral load† | |
|---|---|---|---|---|---|---|---|---|---|---|
| IgM | IgG | |||||||||
| No recent international travel‡ | ||||||||||
| NT1 | 61/M | White | FL | No | Yes | NA | 7.5 | 5.7 | 3 | NA |
| NT2 | 45/M | White | CA | No | Yes | NA | 3.7 | 4 | – | – |
| NT3 | 63/M | White | SD | Yes (kidney) | No | NA | 7.2 | 5.4 | 3 | NA |
| NT4 | 61/M | South Asian | IL | Yes (liver) | No | NA | 1.9 | 5.9 | 3 | NA |
| NT5 | 67/M | White | FL | No | Yes | NA | 6.3 | 1.3 | – | – |
| NT6 | 44/F | Hispanic | TX | No | Yes§ | NA | 3.1 | 3.7 | 3 | NA |
| NT7 | 21/F | Hispanic | TX | No | Yes¶ | NA | 2.2 | 1.6 | – | – |
| NT8 | 67/M | White | IL | Yes (heart and lungs) | Yes | NA | 3 | 3.3 | – | – |
| NT9 | 42/M | White | WI | No | Yes | NA | 6 | 6.6 | – | – |
| NT10 | 62/F | White | IL | Yes (kidney) | No | NA | 2.9 | 8.9 | – | – |
| NT11 | 26/M | White | PA | Yes (kidney) | No | NA | 5.3 | 8.3 | 3 | 7.8 × 102 |
| NT12 | 40/F | White | NY | Yes (kidney and pancreas) | No# | NA | 7.7 | 12.9 | 3 | 1.4 × 103 |
| NT13 | 64/M | White | CT | Yes (liver) | Yes | NA | 9.2 | 1.3 | 3 | 1.4 × 104 |
| NT14 | 29/F | White | MI | No | No** | NA | 6.6 | 9.8 | – | – |
| NT15 |
62/M |
White |
NY |
No |
No |
NA |
Neg |
9.6 |
3 |
1.5 × 103 |
| Recent international travel‡ | ||||||||||
| T1 | 35/M | South Asian | DE | No | Yes | India | 2.3 | 4.5 | 1 | 1.8 × 102 |
| T2 | 14/F | South Asian | TX | No | Yes | India | 7.3 | 5.8 | – | – |
| T3 | 32/F | South Asian | TX | No | Yes | India | 3.7 | 5.8 | – | – |
| T4 | 24/M | South Asian | TX | No | Yes | India | 2.3 | 2 | – | – |
| T5 | 35/M | White | IL | No | No | India and Indonesia | 2.9 | 8.9 | – | – |
| T6 | 24/M | White | MD | No | Yes | Afghanistan and Dubai | 6.9 | 9.4 | – | – |
| T7 | 63/M | White | AL | No | Yes | China | 7.9 | Neg | 4 | 2.4 × 102 |
| T8 | 23/M | South Asian | ME | No | Yes | Bangladesh | 7.6 | 10.8 | – | – |
| T9 | 53/M | South Asian | MD | No | Yes†† | India | 9.2 | 9.4 | – | – |
| T10 | 66/M | South Asian | TX | No | Yes | India | 5.5 | 11.7 | 1 | 1.8 × 102 |
| T11 | 22/M | South Asian | MD | No | Yes | India | 9.9 | 10.9 | 1 | 8.3 × 105 |
*HEV, hepatitis E virus; SCR, signal/cutoff ratio; NT, nontraveler; NA, not applicable (quantitative reverse transcription PCR not done); –, HEV not detected or genotype not tested; Neg, negative.
†In genome-equivalents/mL.
‡Within 2 mo before illness or visit to physician.
§Fulminant hepatic failure developed but resolved (14).
¶Fulminant hepatic failure developed; patient died at time of liver transplantation (14).
#Initial illness was meningitis.
**Asymptomatic; tested for HEV because of recent miscarriage.
††Fulminant hepatic failure developed, requiring liver transplantation; patient survived.
References
- Labrique A, Kuniholm MH, Nelson KE. The global impact of hepatitis E—new horizons for an emerging virus. In: Grayson L, editor. Emerging Infections 9. Washington (DC): American Society for Microbiology; 2010. p. 54–92.
- Teo CG. Much meat, much malady: changing perceptions of the epidemiology of hepatitis E. Clin Microbiol Infect. 2010;16:24–32. DOIPubMedGoogle Scholar
- Legrand-Abravanel F, Kamar N, Sandres-Saune K, Garrouste C, Dubois M, Mansuy JM, Characteristics of autochthonous hepatitis E virus infection in solid-organ transplant recipients in France. J Infect Dis. 2010;202:835–44. DOIPubMedGoogle Scholar
- Dong C, Meng J, Dai X, Liang JH, Feagins AR, Meng XJ, Restricted enzooticity of hepatitis E virus genotypes 1 to 4 in the United States. J Clin Microbiol. 2011;49:4164–72. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Hepatitis E among U.S. travelers, 1989–1992. MMWR Morb Mortal Wkly Rep. 1993;42:1–4 .PubMedGoogle Scholar
- Ooi WW, Gawoski JM, Yarbough PO, Pankey GA. Hepatitis E seroconversion in United States travelers abroad. Am J Trop Med Hyg. 1999;61:822–4 .PubMedGoogle Scholar
- Eick A, Ticehurst J, Tobler S, Nevin R, Lindler L, Hu Z, Hepatitis E seroprevalence and seroconversion among US military service members deployed to Afghanistan. J Infect Dis. 2010;202:1302–8. DOIPubMedGoogle Scholar
- Kuniholm MH, Purcell RH, McQuillan GM, Engle RE, Wasley A, Nelson KE. Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988–1994. J Infect Dis. 2009;200:48–56. DOIPubMedGoogle Scholar
- Kwo PY, Schlauder GG, Carpenter HA, Murphy PJ, Rosenblatt JE, Dawson GJ, Acute hepatitis E by a new isolate acquired in the United States. Mayo Clin Proc. 1997;72:1133–6. DOIPubMedGoogle Scholar
- Erker JC, Desai SM, Schlauder GG, Dawson GJ, Mushahwar IK. A hepatitis E virus variant from the United States: molecular characterization and transmission in cynomolgus macaques. J Gen Virol. 1999;80:681–90 .PubMedGoogle Scholar
- Tsang TH, Denison EK, Williams HV, Venczel LV, Ginsberg MM, Vugia DJ. Acute hepatitis E infection acquired in California. Clin Infect Dis. 2000;30:618–9. DOIPubMedGoogle Scholar
- Amon JJ, Drobeniuc J, Bower WA, Magaña JC, Escobedo MA, Williams IT, Locally acquired hepatitis E virus infection, El Paso, Texas. J Med Virol. 2006;78:741–6. DOIPubMedGoogle Scholar
- Curry JA, Adams N, Crum-Cianflone NF. Acute hepatitis E virus infection in an HIV-infected person in the United States. Ann Intern Med. 2009;150:226–7 .PubMedGoogle Scholar
- Tohme RA, Drobeniuc J, Sanches R, Heseltine G, Alsip B, Kamili S, Acute hepatitis associated with autochthonous hepatitis E virus infection — San Antonio, Texas, 2009. Clin Infect Dis. 2011;53:793–6. DOIPubMedGoogle Scholar
- Pas SD, de Man RA, Mulders C, Balk AH, van Hal PT, Weimar W, Hepatitis E virus infection among solid organ transplant recipients, the Netherlands. Emerg Infect Dis. 2012;18:869–72. DOIPubMedGoogle Scholar
- Drobeniuc J, Meng J, Reuter G, Greene-Montfort T, Khudyakova N, Dimitrova Z, Serologic assays specific to immunoglobulin M antibodies against hepatitis E virus: pangenotypic evaluation of performances. Clin Infect Dis. 2010;51:e24–7. DOIPubMedGoogle Scholar
- Baylis SA, Hanschmann KM, Blümel J, Nübling CM; HEV Collaborative Study Group. Standardization of hepatitis E virus (HEV) nucleic acid amplification technique–based assays: an initial study to evaluate a panel of HEV strains and investigate laboratory performance. J Clin Microbiol. 2011;49:1234–9. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Hepatitis E information for healthcare professionals [cited 2012 Sep 14]. http://www.cdc.gov/hepatitis/HEV/LabTestingRequests.htm
- Jothikumar N, Cromeans TL, Robertson BH, Meng XJ, Hill VR. A broadly reactive one-step real-time RT-PCR assay for rapid and sensitive detection of hepatitis E virus. J Virol Methods. 2006;131:65–71. DOIPubMedGoogle Scholar
- Chatterjee R, Tsarev S, Pillot J, Coursaget P, Emerson SU, Purcell RH. African strains of hepatitis E virus that are distinct from Asian strains. J Med Virol. 1997;53:139–44. DOIPubMedGoogle Scholar
- Davern TJ, Chalasani N, Fontana RJ, Hayashi PH, Protiva P, Kleiner DE, ; Drug-Induced Liver Injury Network (DILIN). Acute hepatitis E infection accounts for some cases of suspected drug-induced liver injury. Gastroenterology. 2011;141:1665–72.e1–9.
- Romanò L, Paladini S, Tagliacarne C, Canuti M, Bianchi S, Zanetti AR. Hepatitis E in Italy: a long-term prospective study. J Hepatol. 2011;54:34–40. DOIPubMedGoogle Scholar
- Colson P, Borentain P, Queyriaux B, Kaba M, Moal V, Gallian P, Pig liver sausage as a source of hepatitis E virus transmission to humans. J Infect Dis. 2010;202:825–34. DOIPubMedGoogle Scholar
- Wilhelm BJ, Rajić A, Greig J, Waddell L, Trottier G, Houde A, A systematic review/meta-analysis of primary research investigating swine, pork or pork products as a source of zoonotic hepatitis E virus. Epidemiol Infect. 2011;139:1127–44. DOIPubMedGoogle Scholar
- Crum-Cianflone N, Curry J, Drobeniuc J, Weintrob A, Landrum M, Ganesan A, ; Infectious Disease Clinical Research Program HIV Working Group. Hepatitis E virus infection in HIV-infected persons. Emerg Infect Dis. 2012;18:502–6. DOIPubMedGoogle Scholar
Page created: January 22, 2013
Page updated: January 22, 2013
Page reviewed: January 22, 2013
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.