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
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- Centers for Disease Control and Prevention. Hepatitis E among U.S. travelers, 1989–1992. MMWR Morb Mortal Wkly Rep. 1993;42:1–4 .PubMed
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- Centers for Disease Control and Prevention. Hepatitis E information for healthcare professionals [cited 2012 Sep 14]. http://www.cdc.gov/hepatitis/HEV/LabTestingRequests.htm
- 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.
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