title: Detection and assessment of infectivity of hepatitis E virus in urine.
abstract: OBJECTIVE
  Hepatitis E virus (HEV) is known to be excreted in the stool but there has been no report of its presence in urine. This study investigated the presence of HEV RNA and antigen (HEV-Ag) in urine and its possible transmission.
  
  
  METHODS
  Serum and urine samples from patients with chronic or acute HEV infection and HEV infected monkeys were tested for viral and biochemical markers. Liver and kidney biopsies from the infected monkeys were analyzed by histopathology and immunohistochemistry. The infectivity of HEV from urine was assessed by inoculation into monkeys.
  
  
  RESULTS
  HEV RNA and HEV-Ag were detected persistently in the urine of a patient with chronic HEV infection. Subsequently, HEV RNA was detected in the urine of three of the eight (37.5%) acute patients, all of whom had detectable HEV-Ag in their urine. HEV RNA and HEV-Ag were also detectable in the urine of HEV infected monkeys. The ratio of HEV-Ag to RNA in the urine of the infected monkeys was significantly higher than in their sera and feces. The parameters of routine urinalysis remained within the normal ranges in the hepatitis E patients and infected monkeys, however, pathological changes and HEV-Ag were observed in the kidneys of the infected monkeys. Furthermore, one of two monkeys became infected with HEV after inoculation with urine from another infected monkey.
  
  
  CONCLUSIONS
  HEV infection may result in kidney injury and the urine may pose a risk of transmission. HEV-Ag detection in urine may be valuable for diagnosis of ongoing HEV infection.
authors.affiliation: Health Science Center, Hebei University, No. 342 Yuhuadonglu, Baoding 071000, China.
authors.forename: Yansheng
authors.initials: Y
authors.lastname: Geng
authors.affiliation: Division of HIV/AIDS and Sex-transmitted Virus Vaccines, National Institutes for Food and Drug Control, No. 2 Tiantanxili, Beijing 100050, China.
authors.forename: Chenyan
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Division of HIV/AIDS and Sex-transmitted Virus Vaccines, National Institutes for Food and Drug Control, No. 2 Tiantanxili, Beijing 100050, China.
authors.forename: Weijin
authors.initials: W
authors.lastname: Huang
authors.affiliation: Division of Medicine, University College London Medical School, Cruciform Building, 90 Gower Street, London WC1E 6BT, UK.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Harrison
authors.affiliation: Health Science Center, Hebei University, No. 342 Yuhuadonglu, Baoding 071000, China.
authors.forename: Hongxin
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Baoding Hospital for Infectious Disease, Baoding, China.
authors.forename: Kunjing
authors.initials: K
authors.lastname: Geng
authors.affiliation: Division of HIV/AIDS and Sex-transmitted Virus Vaccines, National Institutes for Food and Drug Control, No. 2 Tiantanxili, Beijing 100050, China. Electronic address: wangyc@nifdc.org.cn.
authors.forename: Youchun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000328:Adult; D000818:Animals; D005260:Female; D018963:Hepatitis Antigens / Q000652:urine*; D016751:Hepatitis E / Q000821:virology; D016752:Hepatitis E virus / Q000302:isolation & purification* / Q000472:pathogenicity; D006801:Humans; D007668:Kidney / Q000473:pathology; D008099:Liver / Q000473:pathology; D008252:Macaca fascicularis; D008297:Male; D012367:RNA, Viral / Q000652:urine*
chemical_list: D018963:Hepatitis Antigens; D012367:RNA, Viral
keywords: Enzyme immunoassay; HEV ORF2 protein; HEV antigen; Hepatitis E virus; Real-time RT-PCR; Urine