Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 22, Number 12—December 2016

New Hepatitis E Virus Genotype in Bactrian Camels, Xinjiang, China, 2013

Cite This Article

To the Editor: Hepatitis E virus (HEV) is a member of the family Hepeviridae, genus Orthohepevirus, which comprises 4 species, Orthohepevirus A–D. Orthohepevirus A contains 7 genotypes (HEV1–7) (1,2). HEV1 and HEV2 infect humans only; HEV3, HEV4, and HEV7 can infect humans and other mammals; and HEV5 and HEV6 have been detected in animals only.

Worldwide, HEV is the most common cause of acute viral hepatitis in humans. The disease is generally self-limiting, but high death rates have been observed among HEV-infected pregnant women. Chronic HEV infection is a problem in immunocompromised patients, such as solid organ transplant recipients (3). Human HEV3 and HEV4 infections have been associated with consumption of undercooked pork or game meat (4).

In 2014, we described the discovery of a novel genotype of HEV in dromedaries (Camelus dromedarius or 1-humped camels), suggesting another possible source of human HEV infection (5). This dromedary HEV was subsequently classified as a novel Orthohepevirus A genotype, HEV7 (1,2). Recently, this HEV7 genotype was also isolated from a liver transplant recipient from the Middle East with chronic HEV infection (6). The patient regularly consumed dromedary camel meat and milk, implying camel-to-human transmission of the virus (6).

Like the dromedary, the Bactrian camel (Camelus bactrianus or 2-humped camels) is an Old World camelid species. Thus, we hypothesize that Bactrian camels may also be reservoirs of HEV. To test this hypothesis and increase our understanding of the epidemiology of HEV in camels, we performed a molecular epidemiology study using feces samples from camels in China.


Thumbnail of Phylogenetic analyses of the proteins of concatenated ORF1/ORF2, excluding the hypervariable region, of Bactrian camel hepatitis E virus (HEV) and other HEV genotypes (HEV1–HEV7) within the species Orthohepevirus A (family Hepeviridae). The tree was constructed using the maximum-likelihood method using the Jones–Taylor–Thornton substitution model with invariant sites and gamma distributed rate variation. The analysis included 2,282 amino acid positions (aa residues 1–706 and 789–240

Figure. Phylogenetic analyses of the proteins of concatenated ORF1/ORF2, excluding the hypervariable region, of Bactrian camel hepatitis E virus (HEV) and other HEV genotypes (HEV1–HEV7) within the species Orthohepevirus A (family Hepeviridae)....

During November 2012–May 2013, we collected and tested 1 feces sample each from 205 Bactrian camels on a farm in Xinjiang, China. We performed RNA extraction and reverse transcription PCR (RT-PCR) as previously described (7). We screened for HEV by PCR amplification of a 251-bp fragment of open-reading frame (ORF) 2, using primers 5′-GTTGTCTCAGCCAATGGCGA-3′ and 5′-GTAGTTTGGTCATACTCAGCAGC-3′. PCR was performed, using previously described conditions (7), with the annealing temperature set at 50°C. DNA sequencing and quantitative real-time RT-PCR were performed as previously described (7). Three samples were positive for HEV; we performed complete genome sequencing of these samples as described (Technical Appendix) (5,7). We also performed comparative genomic analysis as previously described (1,2,8). We constructed a phylogenetic tree using the maximum-likelihood method and MEGA7 (9); bootstrap values were calculated from 1,000 trees. The optimal substitution model for each ORF was selected by MEGA7 (Figure).

RT-PCR for a 251-bp fragment in ORF2 of HEV was positive for 3 (1.5%) of the 205 fecal samples; virus loads were 1.6 × 103, 2.1 × 103, and 1.8 × 104 copies/mg, respectively. Whole-genome sequencing of the 3 Bactrian camel HEV (BcHEV) strains (GenBank accession nos. KX387865–7) showed genome sizes of 7,212–7,223 bp and a G + C content of 52.7%–53.1%. Overall, nucleotides in the BcHEV genome differed by >20% compared with those in all other HEVs. Genomes of the 3 BcHEV isolates contained 3 major ORFs; genome organization was typical of and characteristics were similar to those of HEVs from other Orthohepevirus A species. Phylogenetic trees constructed using ORF1, ORF2, ORF3, and concatenated ORF1/ORF2, excluding the hypervariable region, showed that these 3 BcHEV isolates clustered with the 2 dromedary camel HEV7 strains and the HEV7 strain from the liver-transplant recipient with chronic hepatitis (Figure; Technical Appendix Figure 1) (5,6). However, amino acid distances based on the concatenated ORF1/ORF2, excluding the hypervariable region of the 3 BcHEV isolates and the existing genotypes, ranged from 0.095 to 0.148, which was greater than the threshold (p-distance = 0.088) to demarcate intergenotype distance (1,2). Using this criterion, we propose that the 3 BcHEV isolates should constitute a new HEV genotype, HEV8.

A recent study in Dubai, United Arab Emirates, showed that HEV accounted for 40% of acute hepatitis cases (10). Even though HEV is an emerging pathogen in the Middle East, limited sequence data exist regarding the virus on the Arabian Peninsula. Recently, we discovered the HEV7 genotype in 1.5% of 203 feces samples from dromedaries in Dubai (5). In the current study, we detected a new HEV genotype in 1.5% of 205 Bactrian camels on a farm in Xinjiang. Comparative genomic and phylogenetic analyses showed that BcHEV represents a previously unrecognized HEV genotype. It has been shown that HEV7 from dromedaries can be transmitted to humans; thus, meat and milk from Bactrian camels might pose a similar risk to humans. The increasing discoveries of camel viruses and of their transmission to humans highlight the need for caution when handling these mammals and processing food products derived from them.



This work was partly supported by the Theme-based Research Scheme (project no. T11/707/15), Research Grant Council Grant, University Grant Committee; the Hong Kong Special Administrative Region Health and Medical Research Fund; and the Strategic Research Theme Fund, The University of Hong Kong.


Patrick C.Y. Woo1Comments to Author , Susanna K.P. Lau1, Jade L.L. Teng1, Kai-Yuan Cao, Ulrich Wernery, Tony Schountz, Tsz Ho Chiu, Alan K.L. Tsang, Po-Chun Wong, Emily Y.M. Wong, and Kwok-Yung YuenComments to Author 
Author affiliations: The University of Hong Kong, Hong Kong, China (P.C.Y. Woo, S.K.P. Lau, J.L.L. Teng, T.H. Chiu, A.K.L. Tsang, P.-C. Wong, E.Y.M Wong, K.-Y. Yuen); Sun Yat-sen University, Guangzhou, China (K.-Y. Cao); Central Veterinary Research Laboratory, Dubai, United Arab Emirates (U. Wernery); Colorado State University, Fort Collins, Colorado, USA (T. Schountz)



  1. Smith  DB, Simmonds  P, Izopet  J, Oliveira-Filho  EF, Ulrich  RG, Johne  R, et al. Proposed reference sequences for hepatitis E virus subtypes. J Gen Virol. 2016;97:53742.DOIPubMedGoogle Scholar
  2. Smith  DB, Simmonds  P, Jameel  S, Emerson  SU, Harrison  TJ, Meng  XJ, et al.; International Committee on Taxonomy of Viruses Hepeviridae Study Group. Consensus proposals for classification of the family Hepeviridae. J Gen Virol. 2014;95:222332.DOIPubMedGoogle Scholar
  3. Kamar  N, Selves  J, Mansuy  JM, Ouezzani  L, Péron  JM, Guitard  J, et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med. 2008;358:8117.DOIPubMedGoogle Scholar
  4. Debing  Y, Moradpour  D, Neyts  J, Gouttenoire  J. Update on hepatitis E virology: Implications for clinical practice. J Hepatol. 2016;65:20012.DOIPubMedGoogle Scholar
  5. Woo  PC, Lau  SK, Teng  JL, Tsang  AK, Joseph  M, Wong  EY, et al. New hepatitis E virus genotype in camels, the Middle East. Emerg Infect Dis. 2014;20:10448.DOIPubMedGoogle Scholar
  6. Lee  GH, Tan  BH, Teo  EC, Lim  SG, Dan  YY, Wee  A, et al. Chronic infection with camelid hepatitis E virus in a liver transplant recipient who regularly consumes camel meat and milk. Gastroenterology. 2016;150:3557.e3.DOIPubMedGoogle Scholar
  7. Woo  PC, Lau  SK, Lam  CS, Tsang  AK, Hui  SW, Fan  RY, et al. Discovery of a novel bottlenose dolphin coronavirus reveals a distinct species of marine mammal coronavirus in Gammacoronavirus. J Virol. 2014;88:131831.DOIPubMedGoogle Scholar
  8. Smith  DB, Purdy  MA, Simmonds  P. Genetic variability and the classification of hepatitis E virus. J Virol. 2013;87:41619.DOIPubMedGoogle Scholar
  9. Kumar  S, Stecher  G, Tamura  K. MEGA7: Molecular Evolutionary Genetics Analysis version 7.0 for bigger datasets. Mol Biol Evol. 2016;33:18704.DOIPubMedGoogle Scholar
  10. Abro  AH, Abdou  AM, Saleh  AA, Ustadi  AM, Hussaini  HS. Hepatitis E: a common cause of acute viral hepatitis. J Pak Med Assoc. 2009;59:924.PubMedGoogle Scholar




Cite This Article

DOI: 10.3201/eid2212.160979

1These authors contributed equally to this article.

Related Links


Table of Contents – Volume 22, Number 12—December 2016


Please use the form below to submit correspondence to the authors or contact them at the following address:

Patrick C.Y. Woo, State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong; ; Kwok-Yung Yuen, State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, The University of Hong Kong, University Pathology Bldg., Queen Mary Hospital, Hong Kong

Send To

10000 character(s) remaining.


Page created: November 18, 2016
Page updated: November 18, 2016
Page reviewed: November 18, 2016
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.