title: Hepatitis E in Italy: a long-term prospective study.
abstract: OBJECTIVE
  In developed countries, hepatitis E is usually associated with travelling to endemic areas, but a growing number of sporadic cases are also seen in patients with no travel history. The aim of this study was to assess the impact and the molecular epidemiology of hepatitis E in Italy.
  
  
  METHODS
  Between January 1994 and October 2009, we analyzed 651 patients with acute non-A-C hepatitis. Diagnosis of hepatitis E was based on the presence of IgM anti-HEV and/or the detection of HEV RNA by RT-PCR. Viral isolates were sequenced and phylogenetically characterized.
  
  
  RESULTS
  A total of 134 out of 651 (20.6%) patients tested had acute hepatitis E. All were anti-HEV IgM and IgG positive and 96 (71.6%) were also positive for HEV RNA. Moreover, 39 (6%) patients were anti-HEV IgG positive but negative for both IgM anti-HEV and HEV RNA. A total of 109 (81.3%) patients developed hepatitis E travelling to endemic areas, 3 (2.3%) acquired intra-familial infection from relatives who developed travel-related disease, while 22 (16.4%) patients denied having travelled abroad. In all patients, acute disease had a self-limited course with ALT normalization within 3-6 weeks. Phylogenetic analysis of 39 isolates from patients with a travel-related disease showed that they belonged to genotype 1, while sequences from five patients with autochthonous hepatitis E belonged to genotype 3.
  
  
  CONCLUSIONS
  In Italy, most cases of hepatitis E are travel related, caused by viral genotype 1, while autochthonous cases are caused by genotype 3. The prevalence of genotype 3 among pigs and boars suggests that HEV infection may have zoonotic origins in non-endemic countries.
authors.affiliation: Dipartimento di Sanità Pubblica-Microbiologia-Virologia, Università degli Studi di Milano, Via C. Pascal 36, 20133 Milan, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Romanò
authors.forename: Sara
authors.initials: S
authors.lastname: Paladini
authors.forename: Catia
authors.initials: C
authors.lastname: Tagliacarne
authors.forename: Marta
authors.initials: M
authors.lastname: Canuti
authors.forename: Silvia
authors.initials: S
authors.lastname: Bianchi
authors.forename: Alessandro Remo
authors.initials: AR
authors.lastname: Zanetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004197:Disease Reservoirs / Q000821:virology; D005260:Female; D005838:Genotype; D016751:Hepatitis E / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics; D012307:Risk Factors; D013552:Swine / Q000821:virology; D014195:Travel; D055815:Young Adult
chemical_list: D012367:RNA, Viral