An Epidemiologic Investigation of a Case of Acute Hepatitis E.
Hepatitis E virus (HEV) is considered a zoonotic infection in developed nations. A case of acute hepatitis E in a researcher following a scalpel injury while working on a pig prompted a seroepidemiologic study to identify potential modes of transmission and determine the seroprevalence of HEV among animal handlers at the institute. Sera from personnel (n = 64) in two animal facilities and age/sex-matched blood donors (n = 63) as controls were tested for IgG anti-HEV and, if positive, for IgM anti-HEV and HEV RNA. Sera and stool from pigs aged 6 to 12 weeks from the breeding farm and older pigs from animal facilities were tested similarly. The median age of personnel was 36 years, 74% were white, 56% were male, and 74% had direct exposure to pigs. The prevalence of anti-HEV was 3.1% among personnel compared to 3.2% among blood donors; none were positive for IgM anti-HEV or HEV RNA. IgG anti-HEV was detected in sera from 10% of pigs aged 6 to 8 weeks, 80% aged 10 weeks, 100% aged 12 weeks, and 76% aged >12 weeks. HEV RNA was detected in stool but not sera from three 12-week-old pigs. Sequencing revealed HEV genotype 3 with ∼10% difference between the patient and pig sequences. Parenteral transmission is a potential mode of acute HEV infection. The low and similar seroprevalence of anti-HEV between the at-risk group and age-matched blood donors suggests low transmission risk with universal precautions among animal handlers.
Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland, USA.
Souvik
http://orcid.org/0000-0002-9358-4257
S
Sarkar
Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland, USA.
Elenita M
EM
Rivera
Hepatitis Viruses Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA.
Ronald E
RE
Engle
Hepatitis Viruses Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA.
Hanh T
HT
Nguyen
Transfusion Transmitted Viruses Laboratory, Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland, USA.
Cathy A
CA
Schechterly
Transfusion Transmitted Viruses Laboratory, Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland, USA.
Harvey J
HJ
Alter
Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland, USA.
T Jake
TJ
Liang
Hepatitis Viruses Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA.
Robert H
RH
Purcell
Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, NIDDK, NIH, Bethesda, Maryland, USA.
Jay H
JH
Hoofnagle
Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland, USA marcg@intra.niddk.nih.gov.
Marc G
MG
Ghany
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood*; D001483:Base Sequence; D005243:Feces / Q000821:virology; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000175:diagnosis / Q000635:transmission* / Q000821:virology; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D012367:RNA, Viral / Q000097:blood / Q000235:genetics / Q000276:immunology; D016415:Sequence Alignment; D017423:Sequence Analysis, RNA; D016036:Seroepidemiologic Studies; D013552:Swine; D013553:Swine Diseases / Q000635:transmission* / Q000821:virology; D014951:Wounds, Stab; D015047:Zoonoses / Q000175:diagnosis / Q000635:transmission* / Q000821:virology
D000914:Antibodies, Viral; D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral; D000410:Alanine Transaminase