Chibber, Rachana M et al. “ Should HEV infected mothers breast feed?” Archives of Gynecology and Obstetrics 270.1 (2004): 15-20. |
Given the heightened morbidity and mortality of hepatitis E infection among pregnant women and the effects of perinatal transmission, Chibber et al. studied the presence of anti-HEV antibodies and HEV-RNA in colostrum of seropositive mothers as well as the risk of transmission from mother to infant by breastfeeding. The authors followed ninety-three infected women from their third trimester of pregnancy to nine months postpartum. All infants were seronegative at birth. Six mothers developed acute infections, so their infants were formula fed. Of these, four babies were in close contact—fondled and kissed on the mouth—with their sickly mothers and developed symptomatic hepatitis within the first two months of life. Although all colostrum samples contained anti-HEV antibodies and RNA, the risk of HEV infection did not increase among the 86 infants of asymptomatic, positive women. These preliminary findings are of great significance in third world countries where HEV is endemic and breastfeeding provides an uncontaminated source of nutrition, free from water-borne pathogens that often cause diarrhea and death in young children. Thus, it appears that in the absence of HEV symptoms, breastfeeding is advisable and safe. Further studies are necessary to determine the risk of transmission through close contact .
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Fukuda, Satoko et al. “Prevalence of Antibodies to Hepatitis E Virus among Japanese Blood Donors: Identification of Three Blood Donors Infected With a Genotype Three Hepatitis E Virus.” Journal of Medical Virology 73.4 (2004): 554-561.
Hepatitis E is known to be endemic in many developing nations, but recent studies indicate low levels of endemicity in some industrialized nations including the United States and Japan. The risk of infection in these regions remains unclear, but blood transfusion may be a mechanism for transmission. Individuals from two blood donation centers in Japan were tested for anti-HEV IgG, anti-HEV IgM, and HEV RNA. The two centers averaged 5.5% and 2.1% of donors with anti-HEV IgG. Sequencing of HEV RNA showed that the viruses were all closely related to genotype 3, one of two thought to be found in industrialized nations. These findings confirm that the disease is indeed endemic in Japan and not only with travelers returning from abroad. The study supported the theory that blood transfusion plays a role in HEV transmission, as several patients tested positive for HEV RNA. The researchers used alanine aminotransferase (ALT) levels to classify blood samples and identify HEV contamination in the blood supply, but the correlation was weak. A greater percentage of donors with normal ALT levels had anti-HEV IgG than did donors with elevated ALT levels. Therefore, a specific test for HEV is necessary to prevent transmission through blood donations.
Myint, Khins A. et al. “EVALUATION OF A NEW RAPID IMMUNOGRAPHIC ASSAY FOR SERODIAGNOSIS OF ACUTE HEPATITIS E INFECTION.” The American Journal of Tropical Medicine and Hygiene 73.5 (2005): 942 -946.
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RT-PCR is expensive and time-consuming; EIA requires skilled technicians and the appropriate facilities. Neither technique is conducive to diagnosis in rural, field, or outbreak settings. Personnel from the US Army Medical Component, Asian biomedical engineers, and Australian public health officials collaborated to evaluate the performance of a rapid immunochromatographic assay for IgM antibodies (ASSURETM HEV IgM Rapid Test). They used 200 confirmed HEV-positive samples from patients in Nepal and Indonesia as well as 300 seronegative control specimens. The controls included serum from healthy donors and from individuals with other forms of clinical hepatitis (HAV, HBV, HCV, EBV, and blood-borne rheumatoid factor). The assay showed 93% sensitivity to HEV with 99.7% specificity among the negative samples. Furthermore, stained color bands proved easy to read—65.4% of positive tests developed “distinct” to “strong” line intensities. Because the immunochromatographic assay provides accurate, user friendly results and does not require laboratory equipment or skilled personnel, the authors recommend its use in developing nations and during outbreak investigations.
Mansuy, Jean Michel et al. “Hepatitis E in the South West of France in Individuals who Have Never Visited an Endemic Area.” Journal of Medical Virology 74.3 (2004): 419-424.
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Originally thought to be endemic only in developing nations with poor sanitation, more and more evidence is emerging to show that HEV is found in industrialized nations as well. This study investigated HEV as a possible etiological agent in 431 patients with acute hepatitis in the Midi Pyrenees area of France. Serological tests were positive for anti-HEV IgG in 10.7% of the cases. All the analyzed sequences belonged to genotype 3, commonly found in industrialized nations. Most of those for whom travel history was known had not left the region for several months prior to infection, thereby supporting the idea that HEV is endemic in France. Water contamination is an unlikely source of infection in this industrialized nation, so other possible modes of transmission should be investigated, particularly the role of swines as a zoonotic reservoir.
Nicand, Elisabeth et al. “Genetic Heterogeneity of Hepatitis E Virus in Darfur , Sudan and neighboring Chad .” Journal of Medical Virology 77.4 (2005): 519-521. |
Nicand and associates classified within-outbreak heterogeneity of specimens collected during the 2004 Sudan/Chad Hepatitis E outbreak. Sera samples came from the Sudanese Moray refugee camp in West Darfur and from two camps in neighboring Chad, Iriba and Goz Amer Camps. Using an automatic DNA sequencer to align RT-PCR products, the researchers compared forty isolates to known HEV genomic sequences. Thirty-six of the forty were Genotype 1 with 88% homology to the prototype Burmese strain. These samples came from all three camps. The remaining four specimens collected at Goz Amer Camp in Chad were phylogenetically similar to Genotype 2. Unlike previous HEV outbreaks demonstrating over 98% homogeneity, the results propose that multiple sources of infection may be responsible for the two divergent strains circulating in 2004 and reiterate the need for better hygiene and safer water supplies within refugee camps.
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