江苏省东台市农村地区散发戊型病毒性肝炎流行病学特征分析

目的分析2008-2011年江苏省某农村地区戊型病毒性肝炎流行病学特征。方法利用已建立的疑似肝炎症状监测系统主动发现戊型病毒性肝炎患者,并对其流行病学特征进行分析。结果 2008-2011年戊型肝炎所占急性病毒性肝炎比例为27.29%,成为第2个主要病毒性肝炎。戊型肝炎年平均发病率2.2/万,戊肝发病全年散发,冬春季节高发;男性发病率高于女性,发病率随年龄增长逐渐升高,发病平均年龄(55.48±14.32)岁。戊型肝炎病毒株HEV1、4型并存,以HEV4型为主(95.6%)。结论本地戊肝呈散发,中老年高发,男性多于女性,以HEV4型为主。     

慢性HBV感染重叠HEV感染的临床研究

目的进一步了解慢性乙型肝炎病毒(HBV)感染重叠戊型肝炎病毒(HEV)感染的临床特点及转归。方法对慢性HBV感染重叠HEV感染与单纯戊型肝炎进行临床对照研究。结果167例戊型肝炎均为散发型,发病无明显季节性,以40岁以上成人发病为主,平均年龄为42.12±14.06岁,男女比例为2.71∶1。其中,慢性HBV感染重叠HEV感染(简称乙戊肝)79例(47.31%),单纯戊型肝炎88例(52.69%)。乙戊肝组重度黄疸(TB>280μmol/L)、严重凝血功能异常(PTA<40%)和低蛋白血症的发生率明显高于单纯戊型肝炎组(P<0.01)。结论重叠戊型肝炎病毒感染是导致慢性HBV感染者病情急性加重和重症化,甚至发展成致死性重型肝炎的重要原因之一。     

戊型肝炎人畜共患性的研究进展

戊型肝炎(Hepatitis E,以下简称戊肝)是由戊型肝炎病毒(Hepatitis E virus,HEV)引起的肠道传播为主的传染性疾病。戊肝的爆发流行主要累及发展中国家,常因饮用水源被污染所致,散发病例呈全球分布。HEV 主要侵犯青壮年,重型肝炎多,易感染孕妇并且病死率可高达15%～25%,严重     

肝移植术后戊型肝炎肝硬化1例

<正>戊型肝炎(戊肝)是由HEV感染引起的人兽共患病,全球每年发生人戊肝约2000万例,我国为戊肝的高流行区之一[1]。一直以来戊肝被认为是具有自限性的急性病毒性肝炎,然而近年发现接受器官移植、化疗及免疫抑制药物治疗的患者以及HIV阳性者或AIDS患者感染HEV后可发生慢性戊肝。本文将肝移植术后戊肝肝硬化1例报道如下。1病例报告患者,男,48岁,因"肝移植术后4年余,间断呕     

急性戊型肝炎诊治6例

戊型肝炎（戊肝）为戊型肝炎病毒（HEV）引起的急性自限性病毒性肝炎,在临床上远较乙型肝炎、丙型肝炎少见,多表现为散发病例,但其发病率在我国多数地区成人急性病毒性肝炎中仍占首位。由于在临床工作中相对少见、与药物性肝病等疾病临床表现类似以及对戊型肝炎的认识不够等原因导致其误诊、误治情况多见,为此我们对4年来我院诊治的戊型肝炎患者的临床特征、实验室检查及转归进行分析,以促进我们更好地认识、诊治急性戊型病毒性肝炎。     

戊型肝炎

以往认为戊型肝炎病毒(HEV)感染只限于发展中国家,近年来发现HEV有更广阔的地理分布和宿主范围.人和动物中HEV感染及在发达国家戊型肝炎(戊肝)的人数逐年增多,再次引起人们对HEV感染的研究兴趣.     

生猪屠宰销售职业人群戊型肝炎病毒感染的危险因素研究

目的　生猪屠宰销售职业人群戊型肝炎病毒的感染情况 ,流行特征及研究工作时间长短与戊型肝炎病毒感染的关系。方法　 2 0 0 3年在浙江省北部地区采用横断面调查方法 ,调查 2 1- 6 1岁生猪屠宰销售人员 189人 ,用ELISA法检测该人群中HEV -IgG和HEV -IgM抗体水平 ,同时调查相关的职业危险因素。 结果　在调查的 189名与生猪屠宰销售相关的职业人群中 ,抗HEV -IgG和抗HEV -IgM阳性者分别为 14 6例和 5例 ,人群总感染率分别为 77 2 5 %和 2 6 5 %。在 189例抗HEV -IgG阳性者中有男性 139例 ,女性为 7例 ,男女的感染率分别为 77 6 5 %和 70 0 0 % ,戊肝感染和性别没有关系。 5例HEV -IgM阳性者都为男性。戊肝感染可见于各个年龄段 ,但流行率分布不平衡 ,差异有显著性 (χ2 =11 2 2 ,P =0 0 11) ,随着年龄的增长感染率有上升的趋势 ,但是到 4 5岁以后戊肝感染率保持在一个相对稳定水平。戊肝感染随着职业人群和猪接触的年限增加而呈现上升趋势 (χ2 =9 5 74 ,P =0 0 0 2 )。结论　浙江省生猪屠宰销售人员的感染率高于当地人群。和密切猪接触是戊型肝炎感染的危险因素之一 ,同时与猪接触的工作年限也是戊肝感染的危险因素。戊肝感染随着年龄的增加而感染率上升 ,4 5岁以后维持一个相对稳定状态。     

戊型肝炎实验室诊断研究进展

戊型肝炎（戊肝,HE）是一种由戊型肝炎病毒（HEV）引起的主要经肠道传播的急性传染性肝炎,既往称肠道传播的非甲非乙型肝炎,常引起爆发或流行,病死率约0．5％～1．5％,稍高于甲肝,但孕妇戊肝的病死率可高达20％。我国是戊肝的高流行区之一,约占临床散发性肝炎病例的10％～20％。1986-1988年我国新疆南部地区曾发生世界上最大的一次戊型肝炎流行。近年来,发现在猪、牛、羊、鸡、鼠等多种与人类密切接触的动物可感染HEV,并且动物中分离的HEV与人体内分离的HEV的基因序列高度一致,使人们逐渐将戊肝视为一种人兽共患病。在美国、日本及欧洲等传统的非戊肝流行区普通人群中发现了较高的戊肝感染率,使国际上对戊肝的危害性予以了更大的关注。     

急性戊型肝炎临床分析221例

目的:观察和分析急性戊型肝炎的临床特点.方法:调查急性戊型肝炎患者221例的流行病学资料. 分别比较年龄18岁以下、18-60岁和60岁以上患者组, 单纯急性戊肝组和重叠慢乙型肝炎、酒精肝组以及单项抗-HEV-IgG阳性组与抗-HEV-IgM阳性组病例的病程、生化学指标、预后等方面的差异.结果:221例急性戊型肝炎患者中18岁以上者188例, 占84.8%; 男女之比3.92∶1; 职业分布特点是外出务工者108例, 占48.8%; 2-5月份发病患者数占当年发病患者数的67.8%, 随患病年龄增加, 表现出住院时间延长, 病死率增加, ALT、ALB水平呈下降趋势, 各组比较均有显著差异. 重叠乙型肝炎和酒精肝组的重肝发生率及死亡率分别为7.8%、1.9%和6.0%、3.0%, 明显高于单纯戊肝组的2.1%和0.7%. 抗-HEV-IgG阳性与抗-HEV-IgM阳性病例的临床表现和各项生化学指标比较无显著性差异.结论:急性戊型肝炎成年人多发, 外务工者高发, 有冬春发病高峰. 大多数患者预后良好, 老年戊型肝炎及在乙型肝炎、酒精肝基础上重叠戊肝病毒感染可能是影响患者预后的主要因素.     

武汉地区散发性戊型肝炎流行病学及病毒基因型

为了解武汉地区戊型肝炎病毒(HEV)流行病学特点及基因型。回顾性分析2000年至2004年同济医院就诊急性肝炎916例流行病学特点,应用逆转录-套式聚合酶链反应法(RT-nested-PCR),扩增HEV开放读码框架2(ORF2)的部分序列120份,用Clustal X和Treeview软件比较武汉地区HEV序列与4个HEV主要代表株序列。发现所扩增的HEV,核苷酸同源性为(82.61~98.55)%,与Ⅰ型(缅甸株)、Ⅱ型(墨西哥株)、Ⅲ型(美国株)、Ⅳ型(中国/台湾株)核苷酸同源性分别为(76.52~81.74)%、(70.43~73.04)%、(76.52~81.16)%和(84.35~88.70)%。故认为武汉地区散发性戊型肝炎患者以HEVⅣ型感染为主,其发病率呈上升趋势,发病年龄以30~59岁为主,全年均可发病,3~6月为高峰季节。     

Hepatitis E in new zealand

Background and Aim: Locally acquired hepatitis E virus (HEV) infection has been described in a number of developed countries and is thought to be zoonotic from pigs. Little is known about hepatitis E in humans in New Zealand (NZ) but 90% of NZ pigs show evidence of HEV infection. The aim of this study was to investigate the epidemiology of hepatitis E infection in NZ by documenting HEV immunoglobulin (Ig) G seroprevalence in NZ blood donors, testing patients with unexplained hepatitis for HEV, and comparing genetic sequences of human HEV with local porcine isolates. Methods: In total, 265 blood donors were tested for HEV IgG and 77 patients with unexplained hepatitis were tested for HEV. Viral sequences were compared with known HEV isolates including those from NZ pigs. Results: The HEV IgG seroprevalence was 4%. HEV genotype 3 was isolated in four patients with unexplained hepatitis. Clinical and sequencing data suggest that two cases were acquired in Europe and two in NZ. All cases were in elderly patients, one of whom was asymptomatic and initially misdiagnosed as a drug reaction. The NZ‐acquired cases were most similar to HEV from Japan, and bore little sequence homology to HEV isolated from NZ pigs. Conclusions: Hepatitis E does occur in NZ in patients who have not traveled to endemic areas and seems to affect the elderly. The seroprevalence data suggest that subclinical/unrecognized infection is common. Sequencing data suggest that some reservoir other than pigs could be the source of HEV in NZ. It is recommend that all patients with unexplained hepatitis, whatever their age or travel history, are tested for HEV.     

Autochthonous hepatitis E in southwest England

Although autochthonous hepatitis E has been reported in developed countries, its extent and nature in the United Kingdom are unclear. The aim of the present study was to report the natural history, lifestyle risk factors and molecular epidemiology of autochthonous hepatitis E infection in southwest England. Three hundred and thirty-three patients with unexplained hepatitis were tested for markers of hepatitis E virus (HEV) infection over a 7-year period. HEV RNA isolated from the cases was amplified and characterized. Of the 333 patients, 21 had autochthonous hepatitis E. Patients were middle-aged or elderly and males were more commonly affected. Clinical manifestations ranged from asymptomatic infection to severe hepatitis. Of the 21 patients, 20 recovered within 6 weeks. None of the cases had travelled to an area endemic for HEV. None of the patients were vegetarian and all ate pork. Of the 21 cases, 20 occurred in the spring, summer and autumn months. All polymerase-chain-reaction-confirmed cases carried HEV genotype 3, which bore close sequence homology to HEV circulating in UK pigs. In the United Kingdom, autochthonous hepatitis E may be more common than previously recognized. Although the mode of transmission remains to be determined, it may be a zoonosis with pigs as a reservoir. Hepatitis E should be considered a public health issue in the United Kingdom.     

High prevalence of hepatitis A and E viruses in environmental and clinical samples from West Argentina

Environmental surveillance of water sources is important to monitoring viral hepatitis transmission in clinical settings. This study investigated the circulation of hepatitis A (HAV) and E (HEV) viruses in sewage and clinical samples from Argentina. Between 2016 and 2017, 80 raw sewage samples and 86 clinical samples (stool and serum) from suspected cases of hepatitis A and hepatitis E were obtained. HAV and HEV were tested by both real-time and nested PCR. Positive samples were sequenced for genotype determination and phylogenetic analysis. Overall, HAV was recovered in 39% of sewage samples and 61.1% of clinical samples. HEV was detected in 22.5% of sewage samples and 15.9% of clinical samples. HAV was found more frequently in sewage during the winter and in clinical samples in spring; HEV was more prevalent in sewage during summer and in clinical samples in autumn. All HAV isolates belonged to genotype IA and HEV isolates belonged to genotype 3, the most prevalent genotypes in South America. High prevalence of HAV and HEV in environmental and clinical samples in Mendoza, Argentina was observed. These findings reinforce the importance of environmental surveillance and implementation of health strategies to control the spread of HAV and HEV in developing countries.     

新疆和田地区人群血清抗HEV水平调查

目的 调查新疆维吾尔族自治区(新疆)和田地区在1986-1989年戊型肝炎流行后,目前人群中血清抗戊型肝炎病毒(hepatitis E virus,HEV)特异性抗体水平及当地HEV感染的状态.方法 应用酶联免疫方法检测抗HEV IgG和抗HEVIgM,检测新疆和田地区1～90岁健康人血清3070例,对抗HEV IgM...     

Swine hepatitis E virus in rural southern China: genetic characterization and experimental infection in rhesus monkeys (Macaca mulatta)

BACKGROUND: In rural areas of southern China, where hepatitis E is endemic, residents generally rear pigs in pigsties near their houses. The study was conducted to assess the possibility that hepatitis E virus (HEV) infections in this region are acquired primarily through contact with swine. METHODS: One hundred twenty swine fecal samples collected from pigsties located in eight rural communities of southern China were tested for HEV RNA. The swine HEV isolates were analyzed genetically and were experimentally inoculated into rhesus monkeys to determine the potential risk of cross-species infection. RESULTS: Twenty-nine of the 120 swine fecal samples were positive for HEV RNA. The nucleotide sequences of these swine HEV strains shared 85%-99% identities with the local human genotype 4 isolates and belonged to two subgroups of genotype 4. Importantly, swine HEV strains representing both subgroups induced hepatitis in rhesus monkeys by inoculation with the virus, evidenced by elevated serum alanine transaminase (ALT), viremia, fecal viral shedding, anti-HEV seroconversion, and liver histopathological changes. CONCLUSIONS: Swine may be the principal reservoir for human HEV infection in rural southern China.     

一起敬老院戊肝暴发疫情的流行病学调查

目的 了解一起敬老院戊型肝炎(HE)暴发疫情的可能传染源,明确该起疫情的病原特点。方法 对疫点和相关人员进行现场访谈和病例对照研究,并采集116人份标本进行抗-HEV IgM和抗-HEV-IgG检测,通过RT-PCR对病毒感染者和可疑传染源进行HEV RNA检测和序列分析。结果 本次疫情共发病19例,亚临床感染11人。病例对照研究显示是否使用公共餐具P=0.062,自带餐具者无感染;人源、水源、猪源HEV毒株均为HEV-4d亚型,水源和人源毒株同源性100%,人源毒株与猪源同源性93.7%-95.5%。该敬老院自养生猪和自种菜地并施粪肥;食堂操作不规范,可能导致携带HEV的猪粪或污水污染餐具,是引起本起疫情的原因。 结论 该起暴发疫情与当地生猪HEV病毒携带率高,疫点食堂卫生管理欠规范有关。     

Sporadic cases of acute autochthonous hepatitis E in Spain

BACKGROUND/AIMS: In industrialized countries hepatitis E virus (HEV) infection is rare and its diagnosis is difficult because the utility of available tests is not well established. METHODS: We studied the presence of acute HEV infection markers in a cluster of 11 cases of acute hepatitis with IgG anti-HEV antibodies. RESULTS: Three cases were confirmed as acute hepatitis E and 8 as presumptive hepatitis E, two as a past HEV infection and one could not be determined. Three different HEV strains were identified in serum from 3 patients. Two strains belonged to genotype 3, the predominant genotype found in local urban sewage and the other strain belonged to genotype 1 and was considered an imported strain. CONCLUSIONS: Our findings demonstrate the presence of some autochthonous, sporadic acute hepatitis E cases as well as an imported case in our area and the transitory nature of virological and serological markers for HEV.     

Two cases of acute hepatitis E in patients with hyperthyroidism]

Acute hepatitis E occur commonly as outbreaks in endemic areas, but can occur sporadically in other part of the world. Acute hepatitis E has been reported rarely in Korea. A case of concurrent acute hepatitis E virus (HEV) infection and hyperthyroidism was reported in an inactive hepatitis B surface antigen carrier. We experienced two cases of concomitant acute HEV infection in patients with hyperthyroidism. The first case had acute HEV infection with subclinical hyperthyroidism while taking propylthiouracil. The second case suffered from acute HEV infection in a patient with Graves' disease intractable to propylthiouracil. Herein, we suggest the possible association between HEV infection and hyperthyroidism.     

Sporadic acute hepatitis E occurred constantly during the last decade in northeast Japan

Background  Recent studies have shown that indigenous hepatitis E virus (HEV) strains cause hepatitis E in industrialized countries. We aimed to clarify the characteristics of HEV infection in sporadic hepatitis patients during the last decade in Miyagi, northeast Japan. Methods  We analyzed 94 serum samples obtained from acute or fulminant hepatitis patients of non-A, non-B, and non-C etiology between 1999 and 2008. Antibody to HEV (anti-HEV) was assayed, and patients who were positive for IgM- and/or IgA-class anti-HEV were diagnosed with hepatitis E. HEV RNA was tested in these patients, and phylogenetic analysis was performed. The occurrence of hepatitis E was compared with that of hepatitis A. Results  Eight acute hepatitis patients (8.5%) were diagnosed with hepatitis E, and HEV RNA was detectable in seven patients. Five isolates of HEV were segregated into genotype 3 and the remaining two isolates into genotype 4. The year of the occurrence of hepatitis E was distributed almost equally from 1999 to 2008, whereas the cases of acute hepatitis A (n = 16) have decreased markedly in the last several years. In 2004–2008, the occurrence of hepatitis E was greater than that of hepatitis A (five cases vs. one case). As for seasonality, hepatitis E occurred more frequently from September to December than hepatitis A (five cases vs. four cases), although less frequently from January to April (one case vs. seven cases). Conclusion  The occurrence of hepatitis E has not decreased during the last decade in northeast Japan, in contrast to hepatitis A. The nucleotide sequence data reported in this study have been assigned GenBank/EMBL/DDBJ accession numbers AB206467 and AB453332–AB453337.