title: First detection of hepatitis E virus in Central Argentina: environmental and serological survey.
abstract: BACKGROUND
  The hepatitis E virus (HEV) is an emergent causative agent of acute hepatitis worldwide, transmitted by fecal-oral route. In Argentina it is considered rare, so differential laboratory testing is not routinely performed. Besides, in Argentina's central area epidemiological and molecular characteristics of HEV are still unknown.
  
  
  OBJECTIVE
  Provide evidence of local circulation of HEV by molecular detection on environmental samples and by serological survey in healthy adult population of Córdoba city, Argentina.
  
  
  METHODS
  Environmental surveillance was conducted in river and sewage samples collected between 2007 and 2009-2011. Viral detection was performed by RT-Nested PCR of ORF-1 and ORF-2 partial regions. Anti-HEV IgG was determined by EIA in 433 serum samples collected between 2009 and 2010.
  
  
  RESULTS
  HEV was detected in 6.3% of raw sewage samples and in 3.2% of riverine samples. Nucleotide sequencing analyses revealed that all isolates belonged to genotype 3, subtypes a, b and c. The prevalence of IgG anti-HEV was 4.4%. Seroprevalence increased with the age of the individuals (OR: 3.50; 95% CI 1.39-8.87; p=0.0065) and, although the prevalence was higher in low income population, no statistical relation was found between anti-HEV and socioeconomic level.
  
  
  CONCLUSIONS
  The environmental findings added to serological results, demonstrate that HEV circulates in central Argentina. Contamination of water with HEV could represent a route of transmission for local populations, which have a high number of susceptible individuals. This fact alerts local health care systems in order to include detection of HEV in the diagnostic algorithm of viral hepatitis.
authors.affiliation: Department of Virology, School of Chemical Sciences, Catholic University of Córdoba, Argentina; Department of Virology and Molecular Biology, LACE Laboratories, Córdoba, Argentina. Electronic address: maribel.martinez@laboratoriolace.com.ar.
authors.forename: Maribel G
authors.initials: MG
authors.lastname: Martínez Wassaf
authors.affiliation: Department of Virology, School of Chemical Sciences, Catholic University of Córdoba, Argentina; Virology Institute "Dr. J.M. Vanella", School of Medical Sciences, National University of Córdoba, Argentina. Electronic address: mbelenpisano@gmail.com.
authors.forename: María B
authors.initials: MB
authors.lastname: Pisano
authors.affiliation: Virology Institute "Dr. J.M. Vanella", School of Medical Sciences, National University of Córdoba, Argentina. Electronic address: patricia_barril@fcm.unc.edu.ar.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Barril
authors.affiliation: Department of Virology, School of Chemical Sciences, Catholic University of Córdoba, Argentina; Department of Virology and Molecular Biology, LACE Laboratories, Córdoba, Argentina. Electronic address: osvaldo@laboratoriolace.com.ar.
authors.forename: Osvaldo C
authors.initials: OC
authors.lastname: Elbarcha
authors.affiliation: Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Electronic address: marcelop@ioc.fiocruz.br.
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Pinto
authors.affiliation: Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Electronic address: jackie@ioc.fiocruz.br.
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Mendes de Oliveira
authors.affiliation: Virology Institute "Dr. J.M. Vanella", School of Medical Sciences, National University of Córdoba, Argentina. Electronic address: pablodigiusto91@gmail.com.
authors.forename: Pablo
authors.initials: P
authors.lastname: DiGiusto
authors.affiliation: Virology Institute "Dr. J.M. Vanella", School of Medical Sciences, National University of Córdoba, Argentina. Electronic address: snates@fcm.unc.edu.ar.
authors.forename: Silvia V
authors.initials: SV
authors.lastname: Nates
authors.affiliation: Department of Virology, School of Chemical Sciences, Catholic University of Córdoba, Argentina; Virology Institute "Dr. J.M. Vanella", School of Medical Sciences, National University of Córdoba, Argentina. Electronic address: vivianare@fcm.unc.edu.ar.
authors.forename: Viviana E
authors.initials: VE
authors.lastname: Ré
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D062665:Epidemiological Monitoring; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood*; D016751:Hepatitis E / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012367:RNA, Viral / Q000302:isolation & purification*; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D044967:Serum / Q000821:virology*; D012722:Sewage / Q000821:virology*; D014871:Water Microbiology; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies; D012367:RNA, Viral; D012722:Sewage
keywords: Argentina; Environmental surveillance; Hepatitis E virus; Molecular epidemiology; Seroprevalence; Subtyping