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Background: Worldwide, hepatitis E virus (HEV) infection is considered a significant public health concern. In particular, HEV genotype 4 (HEV‐4) has spread to more areas and host species. In this study, we describe the global distribution of HEV‐4 and characterize HEV‐4 subtypes by host, country and year of isolation. Methods: We retrospectively collected HEV‐4 sequences available before December 31, 2019, in GenBank. HEV‐4 and its subtypes were determined using phylogenetic comparison with HEV reference sequences. Information on the isolation of the sequences was extracted from the GenBank or original publications. Temporal, spatial and host characteristics of the sequences were summarized and nucleotide similarity was calculated based on five amplified fragments within HEV genome, stratified by host, country and year. Results: A total of 2295 HEV‐4 complete and partial nucleotide sequences were studied. The majority (92.7%) was isolated in China's mainland, Japan, Hong Kong and France. A total of 20 animal hosts were documented, though swine remained predominant (71.7%). Globally, prevalent HEV‐4 subtypes changed remarkably over the last 18 years. Subtypes 4a, 4b, 4d and 4h were most commonly isolated (80.3%). Subtypes 4c, 4e, 4f, 4g and 4i remained limited in temporal distribution. High nucleotide similarities were observed between the sequences amplified in HEV ORF2, in the same and neighbouring countries, and in similar animal hosts. Conclusion: China and Japan are endemic for HEV‐4, and have all the subtypes. In Europe, France has a high prevalence of HEV‐4. Increases in affected areas and animal hosts imply consistent cross‐border and cross‐species transmission. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) infects both humans and animals. Swine has been confirmed to be the principal natural reservoir, which raises a concern that HEV infection would be substantially increasing among swine workers. The present study calculated the pooled prevalence of IgG antibodies against HEV among swine workers and the general population in previous cross‐sectional studies. We conducted a meta‐analysis comparing the prevalence of HEV infection between swine workers and the general population, including local residents, blood donors and non‐swine workers. Through searches in three databases (PubMed and OVID in English, and CNKI in Chinese) and after study selection, a total of 32 studies from 16 countries (from 1999 through 2018) were included in the meta‐analysis. A random‐effect model was employed in the study; an I2 statistic assessed heterogeneity, and the Egger's test detected publication bias. The comparative prevalence of anti‐HEV IgG was pooled from the studies. Compared to the general population, the prevalence ratio (PR) for swine workers was estimated to be 1.52 (95% CI 1.38–1.76) with the I2 being 71%. No publication bias was detected (p = 0.40). A subgroup analysis further indicated increased prevalence of anti‐HEV IgG in the swine workers in Asia (PR = 1.49, 95% CI: 1.35–1.64), in Europe (PR = 1.93, 95% CI: 1.49–2.50) and in all five swine‐related occupations, including swine farmers, butchers, meat processors, pork retailers and veterinarians (PR ranged between 1.19 and 1.75). In summary, swine workers have a relatively higher prevalence of past HEV infection, and this finding is true across swine‐related occupations, which confirms zoonotic transmission between swine and swine workers. [ABSTRACT FROM AUTHOR]

We used contact tracing to document how COVID‐19 was transmitted across 5 generations involving 10 cases, starting with an individual who became ill on January 27. We calculated the incubation period of the cases as the interval between infection and development of symptoms. The median incubation period was 6.0 days (interquartile range, 3.5‐9.5 days). The last two generations were infected in public places, 3 and 4 days prior to the onset of illness in their infectors. Both had certain underlying conditions and comorbidity. Further identification of how individuals transmit prior to being symptomatic will have important consequences. [ABSTRACT FROM AUTHOR]