title: Circulation of genotype 4 hepatitis E virus in Europe: first autochthonous hepatitis E infection in France.
abstract: BACKGROUND
  Human HEV infections reported in Europe without previous travel to endemic regions are linked to exposure to genotype 3 Hepatitis E virus (HEV).Genotype 3 is widely distributed through human cases and zoonotic reservoir. The geographical distribution of genotype 4 is limited to Asian countries.
  
  
  OBJECTIVE
  The first human case of autochthonous genotype 4 hepatitis E infection was reported in France.
  
  
  METHODS
  The HEV infection was described in an immunosuppressed patient, presenting an acute myeloblastic leukemia. Investigation of the case was performed on detection of HEV markers in the patient and in the environment.
  
  
  RESULTS
  Hepatitis E infection was diagnosed on the basis of HEV RNA viremia, and detection of anti-HEV IgM. The prognostic of leukemia was favorable and HEV was cleared without relapsing. HEV isolate was classified into genotype 4.
  
  
  CONCLUSIONS
  The recent characterization of genotype 4 HEV through swine surveillance in Europe and the description of the first human case in France open interesting questions about the circulation of this genotype: health risks in human population, transmission patterns, and zoonotic reservoir.
authors.affiliation: Unit of Virology, Hopital Val de Grace, National Reference Center of Hepatitis E, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Tessé
authors.forename: Bruno
authors.initials: B
authors.lastname: Lioure
authors.forename: Luc
authors.initials: L
authors.lastname: Fornecker
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Wendling
authors.forename: Françoise
authors.initials: F
authors.lastname: Stoll-Keller
authors.forename: Christine
authors.initials: C
authors.lastname: Bigaillon
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Nicand
mesh_terms: D000328:Adult; D000818:Animals; D016000:Cluster Analysis; D005260:Female; D005602:France; D005838:Genotype; D016751:Hepatitis E / Q000175:diagnosis* / Q000821:virology*; D016752:Hepatitis E virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D008969:Molecular Sequence Data; D010802:Phylogeny; D017422:Sequence Analysis, DNA