title: Hepatitis E virus infection in a cohort of patients with acute non-A, non-B hepatitis.
abstract: OBJECTIVE
  The aim of this study was to determine the frequency of hepatitis E virus infection in a cohort of patients with acute non-A, non-B hepatitis in Greece.
  
  
  METHODS
  Serial serum samples of 198 patients with acute non-A, non-B hepatitis and a single serum specimen from 316 healthy subjects were tested for IgG and IgM antibodies to hepatitis E virus (anti-HEV).
  
  
  RESULTS
  Anti-HEV IgG was found in 15/198 (7.6%) of acute non-A, non-B hepatitis patients and 7/316 (2.2%) of healthy controls (p=0.007). Anti-HEV IgM was found in 2/198 (1.0%) acute non-A, non-B hepatitis patients and in none of the healthy subjects. Neither anti-HEV IgM (+) case reported any risk factor and neither had travelled in areas endemic for hepatitis E virus infection. HEV-RNA was detected by reverse transcription polymerase chain reaction in one patient. The prevalence of anti-HEV IgG was 7/45 (15.6%), 1/46 (2.2%), 5/30 (16.7%) and 2/77 (2.6%) in acute non-A, non-B hepatitis reporting transfusion, intravenous drug use, occupational/hospitalization, and unknown transmission, respectively (p=0.007). Anti-HEV IgG was found in 13/122 (10.7%) and 2/76 (2.6%) of acute non-A, non-B hepatitis patients positive and negative for anti-HCV, respectively (p=0.03). A similar association was found with anti-HBc (p=0.007). The prevalence of anti-HEV IgG was significantly higher in cases reporting transfusion [OR=7.3, 95% C.I. 1.4-37.7, p=0.017] and occupational/hospitalization [OR=6.8, 95% C.I. 1.2-38.2, p=0.029], as transmission category after controlling for age.
  
  
  CONCLUSIONS
  These findings indicate that: (a) hepatitis E virus may be a cause - although not a frequent one - of sporadic or community-acquired acute non-A, non-B hepatitis in Greece; (b) hepatitis E virus may share transmission routes with hepatitis B and C viruses; and (c) the hypothesis that hepatitis E virus may be transmitted by parenteral routes deserves careful consideration.
authors: Department of Hygiene and Epidemiology, Athens University Medical School, Greece.
authors: M A
authors: MA
authors: Psichogiou
authors: N C
authors: NC
authors: Tassopoulos
authors: G V
authors: GV
authors: Papatheodoridis
authors: E
authors: E
authors: Tzala
authors: R
authors: R
authors: Klarmann
authors: H
authors: H
authors: Witteler
authors: G G
authors: GG
authors: Schlauder
authors: H
authors: H
authors: Troonen
authors: A
authors: A
authors: Hatzakis
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D016751:Hepatitis E / Q000635:transmission / Q000821:virology*; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral