title: Prevalence of hepatitis viruses in patients with acute hepatitis and characterization of the detected genotype 4 hepatitis E virus sequences in Mongolia.
abstract: Hepatitis E is considered to be a worldwide public health problem. Although the prevalence of hepatitis E virus (HEV) antibodies in healthy individuals is noted to be 11%, no patients with acute hepatitis E have previously been identified in Mongolia. Three hundred two consecutive patients (183 males and 119 females; median age of 22.0 [Interquartile range: 18.3-25.0] years) who were clinically diagnosed with sporadic acute hepatitis during 2012-2013 in Ulaanbaatar, Mongolia, were studied. By serological and/or molecular approaches, 77 (25.5%), 93 (30.8%), 19 (6.3%), 48 (15.9%), and 12 (4.0%) of the patients were diagnosed with acute hepatitis of types A, B, C, D (superinfection of hepatitis delta virus on a background of chronic hepatitis B virus infection) and E, respectively, while the cause of hepatitis was unknown in the remaining 53 patients (17.5%). The 12 hepatitis E patients had no history of travel abroad in the 3 months before the onset of disease, and lived separately in fixed or movable houses with water supplied via pipe, tank or well, denying transmission from a common water supply. The 12 HEV isolates obtained from the patients showed high nucleotide identities of 99.7-100%, and a representative HEV isolate, MNE13-227, was closest to the Chinese isolates of genotype 4, with the highest identity of 97.3% in the 304-nt ORF2 sequence and 92.1% over the entire genome. The present study revealed the occurrence of autochthonous acute hepatitis E in Mongolia, caused by a monophyletic genotype 4 HEV strain.
authors.affiliation: National Institute of Medicine, Ministry of Health and Ministry of Science Education, Ulaanbaatar, Mongolia.|National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia.
authors.forename: Bira
authors.initials: B
authors.lastname: Tsatsralt-Od
authors.affiliation: National Institute of Medicine, Ministry of Health and Ministry of Science Education, Ulaanbaatar, Mongolia.
authors.forename: Nachin
authors.initials: N
authors.lastname: Baasanjav
authors.affiliation: National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia.
authors.forename: Dulmaa
authors.initials: D
authors.lastname: Nyamkhuu
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi-Ken, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohnishi
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi-Ken, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi-Ken, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005838:Genotype; D016752:Hepatitis E virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D006525:Hepatitis, Viral, Human / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D008297:Male; D008986:Mongolia / Q000453:epidemiology; D015995:Prevalence; D017422:Sequence Analysis, DNA; D055815:Young Adult
keywords: Mongolia; acute hepatitis; full genome; genotype 4; phylogenetic tree