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Hepatitis E Virus Genotype 4 Outbreak, Italy, 2011 - - Emerging Infectious Disease journal - CDC

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Hepatitis E Virus Genotype 4 Outbreak, Italy, 2011 - - Emerging Infectious Disease journal - CDC

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Volume 19, Number 1–January 2013

Dispatch

Hepatitis E Virus Genotype 4 Outbreak, Italy, 2011

Anna R. Garbuglia, Paola Scognamiglio, Nicola Petrosillo, Claudio Maria Mastroianni, Pasquale Sordillo, Daniele Gentile, Patrizia La Scala, Enrico Girardi, and Maria R. CapobianchiComments to Author 
Author affiliations: Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy (A.R. Garbuglia, P. Scognamiglio, N. Petrosillo, P. La Scala, E. Girardi, M.R. Capobianchi); Sapienza University, Rome (C.M. Mastroianni); Santa Maria Goretti Hospital, Latina, Italy (C.M. Mastroianni); Tor Vergata University Polyclinic, Rome (P. Sordillo); and Local Health Unit ASL Roma H, Rome (D. Gentile)
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Abstract

During 2011, 5 persons in the area of Lazio, Italy were infected with a monophyletic strain of hepatitis E virus that showed high sequence homology with isolates from swine in China. Detection of this genotype in Italy parallels findings in other countries in Europe, signaling the possible spread of strains new to Western countries.
Hepatitis E virus (HEV) represents the major etiologic agent of enterically transmitted, non-A, non-B hepatitis. One third of the world population is estimated to have been infected with HEV, although the global extent of infection is unknown (http://apps.who.int/gb/ebwha/pdf_files/A62/A62_22-en.pdf Adobe PDF fileExternal Web Site Icon). Recent evidence indicates that the family Hepeviridae may contain several genera and that viruses from some genera can be transmitted from animals to humans and vice versa (1). Gene sequence analysis demonstrates that HEV isolates are divided into 4 genotypes and >24 subgenotypes (2). Increasing evidence shows that genotypes 3 and 4 are zoonotic, with domestic pigs a likely reservoir of infection; these genotypes have also been found in boars and deer (3).
HEV genotype 4 is endemic among humans in China, Japan, India, and Indonesia (4) and was detected during 2008 from swine fecal samples in Belgium (5). Human infections with imported strains of this genotype that later became endemic have subsequently been described in Germany (6) and northern France (7). Recently, multiple cases of HEV infection have been described in southern France (8,9).
In different areas of Italy, HEV seroprevalence estimates range from 1% to 6% (10); prevalence is 2.9% in the Lazio region and 2.5% in the province of Rome (11). However, the number of acute hepatitis cases caused by HEV reported in Italy is relatively low compared with surrounding European countries and is probably underestimated; most cases are travel-related and caused by genotype 1, but sporadic cases spread within Italy have been caused by genotype 3 (12). We report an outbreak of HEV genotype 4 infection among persons living in Lazio, an administrative region of Italy that encompasses Rome.

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