title: Protective role of humoral immune responses during an outbreak of hepatitis E in Egypt.
abstract: Although the seroprevalence of hepatitis E virus (HEV) is approximately 80% in adult Egyptians living in rural areas, symptomatic HEV-caused acute viral hepatitis (AVH) is sporadic and relatively uncommon. To investigate the dichotomy between HEV infection and clinical AVH, HEV-specific immune responses in patients with symptomatic and asymptomatic HEV infection during a waterborne outbreak in Egypt were examined. Of 235 acute hepatitis patients in Assiut hospitals screened for HEV infection, 42 (17.9%) were acute hepatitis patients confirmed as HEV-caused AVH; 37 (88%) of the 42 patients were residents of rural areas, and 14 (33%) were from one village (Kom El-Mansoura). Another 200 contacts of AVH cases in this village were screened for HEV and 14 (7.0%), all of whom were family members of AVH cases, were asymptomatic HEV IgM-positive. HEV infections in this village peaked during the summer. Asymptomatic HEV seroconverters had significantly higher levels of epitope-specific neutralising (p=0.006) and high avidity (p=0.04) anti-HEV antibodies than the corresponding AVH cases. In conclusion, naturally acquired humoral immune responses appear to protect HEV-exposed subjects from AVH during an HEV outbreak in Egypt.
authors.affiliation: Digestive Diseases Division, University of Cincinnati College of Medicine, OH, USA. mohamed.shata@uc.edu
authors.forename: Mohamed T
authors.initials: MT
authors.lastname: Shata
authors.forename: Enas A
authors.initials: EA
authors.lastname: Daef
authors.forename: Maysaa E
authors.initials: ME
authors.lastname: Zaki
authors.forename: Sayed F
authors.initials: SF
authors.lastname: Abdelwahab
authors.forename: Naglaa M
authors.initials: NM
authors.lastname: Marzuuk
authors.forename: Maha
authors.initials: M
authors.lastname: Sobhy
authors.forename: Marwa
authors.initials: M
authors.lastname: Rafaat
authors.forename: Liala
authors.initials: L
authors.lastname: Abdelbaki
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Nafeh
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hashem
authors.forename: Samer S
authors.initials: SS
authors.lastname: El-Kamary
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Shardell
authors.forename: Nabiel N
authors.initials: NN
authors.lastname: Mikhail
authors.forename: George T
authors.initials: GT
authors.lastname: Strickland
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Sherman
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004534:Egypt / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood*; D016751:Hepatitis E / Q000453:epidemiology* / Q000276:immunology*; D016752:Hepatitis E virus / Q000276:immunology*; D006801:Humans; D056724:Immunity, Humoral / Q000276:immunology*; D008297:Male; D011446:Prospective Studies; D012367:RNA, Viral / Q000276:immunology; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies; D012367:RNA, Viral