Hepatitis E virus in Cuba

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Abstract

The hepatitis E virus (HEV) has a global distribution and is known to have caused large waterborne epidemics of icteric hepatitis. The transmission is primarily fecal–oral. Some reports have suggested parenteral transmission of HEV from its association to hepatitis B or hepatitis C infection, or due to the development of hepatitis E after blood transfusion. Though most of the developing countries in Asia and Africa have been shown to be endemic for HEV infection, studies in the Latin American countries have been limited to Mexico, Brazil and Venezuela. We have developed an enzyme immunoassay (EIA) for IgM and IgG antibodies to a recombinant protein containing antigenic epitopes of the ORF3 region of the HEV. This system, as well as a commercial kit that includes ORF2 and ORF3 antigenic epitopes, were used to study the prevalence of anti-HEV antibodies in a sample of Cuban blood donors, acute hepatitis cases and individuals subjected to plasmapheresis. The incidence of anti-HEV IgM was compared with other viral hepatitis markers. Our findings suggest that infections due to HEV are an important viral cause of sporadic hepatitis in Cuba, and that HEV is endemic to this region of the world.

Introduction

The Hepatitis E virus (HEV) has a global distribution and is known to have caused large waterborne epidemics of icteric hepatitis (Bradley 1992, Krawczynski 1993). Epidemics as well as sporadic infections have been reported in Asia (Khuroo 1980, Khuroo et al., 1983, Jameel et al., 1992) and Africa (Goldsmith et al., 1992, Pillot et al., 1992). Studies in Latin America have been limited to Mexico (Bradley et al., 1991, Fields et al., 1993), Brazil (Focaccia et al., 1995) and Venezuela (Pujol et al., 1994). Sporadic cases have also been reported in some developed countries, the majority of these imported from endemic regions (Zaiijer et al., 1992, Buti et al., 1995). Transmission of the HEV is primarily fecal–oral (Balayan et al., 1983). Some authors have suggested the occurrence of a parenteral transmission of HEV from its association to hepatitis B or hepatitis C infection (Halfon et al., 1994, Pisanti et al., 1994), or due to the development of hepatitis E after blood transfusion (Wang et al., 1993, Psichogiou et al., 1994). However, other reports have denied the possibility of such transmission (Barzilai et al., 1995, Pohjanpelto et al., 1995). One curious feature of HEV infection is the high mortality rate (>20%) observed in pregnant women (Khuroo et al., 1981).

The cloning and expression of recombinant HEV proteins has made possible the development of laboratory and commercial diagnostic enzyme immunoassays (EIAs) (Dawson et al., 1991, Goldsmith et al., 1992). However, there is still little information about their sensitivity and specificity, and confirmatory tests are not yet available. Nonetheless, it is clear that in endemic areas only IgM anti-HEV is a measure of acute disease, while IgG anti-HEV measures the endemicity of infection (Panda et al., 1995).

We have developed an EIA using a recombinant protein containing antigenic epitopes of the ORF3 region of the HEV. This system, and a commercial kit that includes ORF2 and ORF3 antigenic epitopes, were used to study the prevalence of anti-HEV antibodies in a sample of Cuban blood donors, acute hepatitis cases, and individuals subjected to plasmapheresis. The results show that HEV infection is present in Cuba.

Section snippets

Study population

Healthy blood donor serum samples were obtained from several blood banks in Havana. All sera were tested and classified for HCV, HIV-1/2 and HBsAg markers. Other samples from apparently healthy blood donors with high serum alanine aminotransferase (ALT) were also included in the study, as well as sera from individuals subjected to plasmapheresis and negative for HBV, HCV and HIV-1/2 markers. Acute hepatitis sera were collected from symptomatic individuals aged 20 years and above, attending the

Results and discussion

The prevalence of antibodies to HEV in serum samples from healthy donors, voluntary blood donors positive to different hepatitis markers and in the group of individuals subjected to plasmapheresis are shown in Table 1. All samples positive in the anti-ORF3 IgM ELISA were confirmed as positive by the reference Genelabs test. The prevalence of antibodies reactive in the three ELISA systems was low in the healthy blood donor population negative for HBV, HCV and HIV-1/2. Of the 1149 samples tested,

Acknowledgements

The authors want to acknowledge the help of Genelabs Incorporated with the anti-HEV kits, and of Patrice Yarbough for the critical review of a previous version of this article.

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