title: Hepatitis E in Singapore: A Case-Series and Viral Phylodynamics Study.
abstract: AbstractThe incidence of hepatitis E in Singapore appears to be increasing. A retrospective case-series study of patients diagnosed with hepatitis E in a tertiary hospital from 2009 to 2013 was conducted. Of 16 cases, eight (50%) were solid-organ transplant recipients (SOTRs), and 14 (88%) were found infected by genotype 3 hepatitis E virus (HEV-3). Bayesian inferences based on HEV subgenomic sequences from seven cases suggest that HEV-3 strains were introduced to Singapore as two principal lineages. Within limitations of the study, it can be inferred that one lineage, in the 3efg clade, emerged about 83 years ago, probably originating from Japan, whereas the other, in the 3abchij clade, emerged about 40 years ago, from the United States. Establishment and subsequent transmissions of strains from these two lineages likely contribute to the current endemicity of hepatitis E in Singapore.
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore.
authors.forename: Esmeralda Chi-Yuan
authors.initials: EC
authors.lastname: Teo
authors.affiliation: DSO National Laboratories, Singapore.
authors.forename: Boon-Huan
authors.initials: BH
authors.lastname: Tan
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Purdy
authors.affiliation: DSO National Laboratories, Singapore.
authors.forename: Pui-San
authors.initials: PS
authors.lastname: Wong
authors.affiliation: DSO National Laboratories, Singapore.
authors.forename: Pei-Jun
authors.initials: PJ
authors.lastname: Ting
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.|Duke-NUS Medical School, National University of Singapore, Singapore.
authors.forename: Pik-Eu Jason
authors.initials: PJ
authors.lastname: Chang
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore.
authors.forename: Lynette Lin-Ean
authors.initials: LL
authors.lastname: Oon
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sue
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Chong-Gee
authors.initials: CG
authors.lastname: Teo
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.|Duke-NUS Medical School, National University of Singapore, Singapore.
authors.forename: Chee-Kiat
authors.initials: CK
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D016751:Hepatitis E / Q000453:epidemiology* / Q000821:virology*; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects; D010802:Phylogeny; D012846:Singapore / Q000453:epidemiology