title: Swine-like hepatitis E viruses are a cause of unexplained hepatitis in the Netherlands.
abstract: Hepatitis E virus (HEV) infections in developed countries are recognized as an imported disease related to travel to endemic regions. However, increasing evidence suggests that HEV infection may also occur in the developed countries and that swine may act as a possible reservoir. To investigate the indigenous transmission of HEV in the Netherlands, sera from 50 blood donors and 1027 sera from patients with acute hepatitis were screened with an ELISA for HEV-specific IgG and IgM. Because the Netherlands is considered a nonendemic region, all positive ELISA results were confirmed by immunoblot to exclude false-positive results. Evidence of recent HEV infection was detected in 0% of the blood donors and 4.4% of the cases, based on combined positive IgM and IgG responses. The serodiagnosis was confirmed by a positive polymerase chain reaction (PCR) in 24 patients with hepatitis (2.3% overall, 51% of confirmed IgM+/IgG+ cases). IgG antibodies alone were detected in 4.2% of patients. We found related sequences to virus strains detected in Dutch pigs (genotype 3, 91-97% homology) in 89% of PCR-confirmed HEV patients. The detection of unique swine-like HEV sequences in 16 indigenous hepatitis patients without a recent travel history suggests that HEV is endemic in the Netherlands. We recommend including HEV tests in unexplained acute hepatitis patients, despite their travel history.
authors.affiliation: National Institute for Public Health and the Environment, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, The Netheralnds. tineke.herremans@rivm.nl
authors.forename: M
authors.initials: M
authors.lastname: Herremans
authors.forename: H
authors.initials: H
authors.lastname: Vennema
authors.forename: J
authors.initials: J
authors.lastname: Bakker
authors.forename: B
authors.initials: B
authors.lastname: van der Veer
authors.forename: E
authors.initials: E
authors.lastname: Duizer
authors.forename: C A
authors.initials: CA
authors.lastname: Benne
authors.forename: K
authors.initials: K
authors.lastname: Waar
authors.forename: B
authors.initials: B
authors.lastname: Hendrixks
authors.forename: P
authors.initials: P
authors.lastname: Schneeberger
authors.forename: G
authors.initials: G
authors.lastname: Blaauw
authors.forename: M
authors.initials: M
authors.lastname: Kooiman
authors.forename: M P G
authors.initials: MP
authors.lastname: Koopmans
mesh_terms: D000818:Animals; D001483:Base Sequence; D001782:Blood Donors; D016751:Hepatitis E / Q000097:blood / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D009426:Netherlands / Q000453:epidemiology; D010802:Phylogeny; D016133:Polymerase Chain Reaction / Q000379:methods; D016036:Seroepidemiologic Studies; D013552:Swine
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M