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BackgroundHepatitis-E virus (HEV), an etiologic agent of acute inflammatory liver disease, is a significant cause of morbidity and mortality in South Asia. HEV is considered endemic in Nepal; but data on population-level infection transmission is sparse.MethodsWe conducted a longitudinal serosurvey in central Nepal to assess HEV exposure. At each visit, capillary blood samples were collected and analyzed for the presence of anti-HEV IgG antibodies. The study took place between February 2019 and April 2021, with up to 4 visits per participant approximately 6 months apart.ResultsWe collected 2513 samples from 923 participants aged 0-25 years, finding a seroprevalence of 4.8% and a seroincidence rate of 10.9 per 1000 person-years. Young adults and individuals consuming surface water faced the highest incidence of infection. Geospatial analysis identified potential HEV clusters, suggesting a need for targeted interventions.SignificanceOur findings demonstrate that HEV is endemic in Nepal and that the risk of infection increases with age.

Background: Hepatitis E virus (HEV) causes acute jaundice and poses an important public health problem in low- and middle-income countries. Limited surveillance capacity and suboptimal access to diagnostics leads to under-reporting of HEV infections in affected countries, including Nepal. Serum antibodies against HEV are indicative of past infection. We analyzed existing samples from a nationally representative serosurvey to describe the geospatial distribution and factors associated with HEV seroprevalence in Nepal, as a proxy for infection. Methodology/Principle findings: A nationally representative cross-sectional serosurvey of 3,922 individuals ≥2 years old from 975 households spread across 65 wards throughout Nepal was conducted between November 2021 and January 2022. Bio-banked samples were tested for anti-HEV IgG. Seroprevalence and its 95% confidence interval were estimated by age, sex, ecological region, municipality type, and other waterborne-disease related risk factors. Bayesian geostatistical models were fitted to observed seroprevalence data and used to generate high-resolution maps of seroprevalence across Nepal. Available samples from 3,707 participants were tested for anti-HEV IgG, and 3,703 were used for final analysis. We found 20.8% (95% CI: 19.5–22.2) of participants had evidence of prior HEV infection. HEV seroprevalence increased with age, and was higher in males (23.5%, 95% CI: 21.5–25.5) than in females (18.6%, 95% CI: 16.9–20.3). Seroprevalence in hilly (28.9%, 95% CI: 26.6–31.2) and mountain (24.6%, 95% CI: 18.8–30.5) regions were significantly higher than in terai (14.2%, 95% CI: 12.7–15.8). While there was no significant difference between urban and rural populations, the predicted seroprevalence was highest in Kathmandu, the capital of Nepal, reaching seroprevalence of 50% in some selected area. No statistically significant differences were found for wealth quintile, water source, and toilet facility. Conclusions: This study provides population-based serologic evidence that HEV is endemic in Nepal, with the greatest risk of infection in Kathmandu. Author summary: Hepatitis E virus spreads through fecal to oral transmission, primarily via contaminated water. The virus can impair liver function and causes frequent outbreaks of acute jaundice in Nepal. Diagnostic tests are often not accessible, meaning many cases of hepatitis E go undetected and it is difficult to know how many people are affected or where to target interventions to protect those most at risk. However, infections can be detected retrospectively by looking for long-lasting antibodies produced by the body in response to the virus. We looked for these antibodies in blood specimens collected from a population representative sample of individuals across Nepal and found that, overall, around 1 in 5 people had likely been infected previously. Risk of past infection varied across the three ecological regions of Nepal and was higher in Hilly and Mountain regions than in the southern Terai. We fitted a geospatial model to our data to map the predicted risk across the country and found it to be highest in Kathmandu, with up to half the population previously infected. This research demonstrates the scale of hepatitis E virus infections in Nepal and identified parts of the Hilly region–particularly Kathmandu–as areas where people are most at risk. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) infection is a major cause of acute viral hepatitis worldwide. The efficacy and safety of the HEV239 vaccine have been validated, with protection lasting at least 10 years. This study extended the phase 3 trial of HEV239 (NCT01014845), presenting data on the durability of the anti-HEV IgG response elicited by one or two doses in the participants with different baseline serostatus. Over half of baseline seronegative individuals retained detectable antibodies at month 91 after two doses, with geometric mean concentration levels above the detection limit at month 67 (no available data for month 91). Seropositive individuals exhibited more prolonged and higher anti-HEV IgG response. After a single dose, individuals with pre-existing immunity achieved high and sustained antibody levels for over 103 months, comparable to the two-dose regimen. Both single-dose and two-dose HEV239 regimens demonstrated notable immunogenicity and persistence, potentially offering substantial protective benefits. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) is recognized as an emerging zoonosis. Pigs and wild boars are considered the main reservoirs of zoonotic HEV-3 and HEV-4 genotypes. In Europe, autochthonous human cases of hepatitis E, mainly associated with HEV-3 and consumption of raw or undercooked pig and wild boar liver/meat, have increased over the last decades. From 2016 to 2024, during several hunting seasons, we conducted a molecular and serological longitudinal survey on the circulation of HEV in Maremman wild boar (Italian subspecies/ecotype, Sus scrofa majori) and fallow deer (Dama dama) populations in a protected area in Central Italy. During the study period, 346 livers (256 from wild boar, 90 from fallow deer), 161 serum (127 from wild boar, 34 from fallow deer), and 23 meat juice (11 from wild boar, 12 from fallow deer) samples were collected. Serum and meat juice samples were tested using a commercial ELISA test for the detection of total anti-HEV antibodies. An estimated serological prevalence of 28.3% (39/138) in wild boar and 21.7% (10/46) in fallow deer was found. The 346 liver samples were tested using a HEV Real-Time RT-PCR for the detection of HEV-RNA. Thirty-one wild boar (12%) and four fallow deer (4.4%) livers were found positive. Phylogenetic analysis of 11 partial ORF2 sequences from wild boar confirmed the HEV3 heterogeneity in this species, revealing different strains (3f, 3c) circulating over the years. The detected subtypes are among the most commonly detected in Italy and our strains showed a high correlation with human and wild boar Italian strains. Although the studied area is a fenced natural reserve, the presence of different strains over time suggests the probable virus introduction from the external. Our results confirm fallow deer susceptibility to the infection, and that wild boar could be considered the main wild HEV reservoir. This is also the first study demonstrating the infection in the so-called Italian subspecies/ecotype Maremman wild boar. Moreover, our results corroborate that the consumption of undercooked or raw liver from both wild boar and fallow deer, or the direct contact with these animals, could represent a zoonotic risk. [ABSTRACT FROM AUTHOR]

Virus-like particles (VLP) have been the subject of intense research for the last 20 years. Virus-like particles-based vaccines have displayed encouraging results regarding safety and efficacy in preclinical and clinical studies. Vaccines for hepatitis B, human papillomavirus, and hepatitis E using virus-like particle platforms have elicited durable immune responses. VLP vaccines can be tailored to elicit therapeutic humoral, cell-mediated, or immune-modulating responses through various designs. The adherence of foreign antigens on the VLP surface generates an antibody response not derived from the parental virus. Different types of antigens, such as proteins, polypeptides, capsular polysaccharides, and tiny chemical compounds, have been coupled using this technique. Chimeric VLPs aim to improve the immune response to foreign peptides presented on virus-like particles. Virus-like particles from plants and bacterial viruses show promising therapeutic properties against various metabolic disorders. Four immunodrugs aimed at therapeutically significant polypeptides have undergone human trials. These vaccines target angiotensin II (ATII), tumor necrosis factora (TNFα), β-amyloid, ghrelin, and interleukin 1β (IL-1β) and are named AngQb, TNFQb, CAD106, GhrQb, and IL1bQb, respectively. The article provides an overview of the chimeric VLP platform and the successful applications of VLP to develop immune responses against various infectious diseases and metabolic disorders. The review ends by highlighting the benefits of VLP-based vaccinations compared to traditional vaccine methods. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) is a global health problem, causing an estimated 20 million infections annually. Thus, the management of HEV requires special consideration. In developed countries, hepatitis E is mainly recognized as a foodborne disease (mainly transmitted via undercooked meat consumption) that is generally caused by genotype 3 and 4 circulating in various animals, including pigs and wild boars. The current absence of officially recognized protocols for the analysis of HEV in foods and the lack of awareness of this disease among healthcare workers, together with the high percentage of asymptomatic cases, make HEV infection highly underestimated. Most HEV-3 infections in immunocompetent individuals are self-limited. Nevertheless, the possibility of serious forms of liver disease, especially in patients with co-morbidities, should be considered because it can lead to a fatal outcome. Here, we report a case of fatal hepatitis related to HEV-3 infection in a 67-year-old male patient with underlying chronic liver disease (CLD) and living in a region where a high prevalence and genetic heterogeneity of HEV-3 in wild boar has been recently demonstrated. Our case report describes the interdisciplinary approach used (from the diagnosis to the virus phylogenetic characterization) in order to improve epidemiologic HEV surveillance in central Italy. [ABSTRACT FROM AUTHOR]

Thalassemia is an inherited hematological disorder characterized by a decrease in the synthesis of or absence of one or more globin chains. Hepatitis E virus (HEV) is a major cause of acute viral hepatitis, constituting a major global health burden and emerging as a critical public health concern. HEV infection is mainly transmitted via the fecal–oral route; however, parenteral transmission through blood components has been reported in both developing and developed countries. Although HEV infection is typically self-limiting, immunocompromised individuals, patients with chronic liver disease, and thalassemic patients are at a heightened risk of contracting the infection and may develop chronic hepatitis and life-threatening complications that require treatment. The reported prevalence rates of HEV in thalassemia patients vary significantly by country. Age, gender, residential area, and the cumulative amount of blood transfusions received have been identified as associated risk factors for HEV infection. In order to enhance blood safety and ensure the protection of vulnerable patient populations, such as thalassemia patients, several countries have introduced universal or targeted HEV screening policies in blood donations. Other preventive measures include vigilant monitoring of thalassemic patients and screening for anti-HEV antibodies. The aim of this review is to explore the prevalence, risk factors, clinical impact and management of HEV infection in patients with thalassemia. [ABSTRACT FROM AUTHOR]

Introduction: Foodborne infections are caused by a wide spectrum of microbial pathogens, and they pose a significant global health threat, resulting in millions of cases and thousands of fatalities annually. Among these pathogens, human viruses, including Hepatitis A virus (HAV) and Hepatitis E virus (HEV), play a significant role in foodborne viral outbreaks, especially in Africa. This systematic review determined the prevalence of these viruses in livestock and produce in Africa. Method: A systematic search strategy was implemented following the PRISMA guidelines. Databases such as African Journal Online, Web of Science, Scopus, and PubMed were searched from their inception until November 30, 2023. Descriptive statistics and a proportional meta-analysis utilising a random-effects model with a 95% confidence interval were employed in the data analysis. The Cochrane risk-of-bias tool (ROB2) was utilised to evaluate the potential for bias in each study. Results: The search identified 27 articles that met the inclusion criteria, among which seven focused on HAV, comprising a total of 309 samples, whereas 20 studies focused on HEV, comprising a total of 4238 samples. Egypt had the highest number of studies, followed by Cameroon and Nigeria. The meta-analysis revealed an overall prevalence of 33.8% (95% CI: 17.0–50.6) for HAV in ducks and shellfish and 22.0% (95% CI: 12.1–31.8) for HEV in various livestock. Genotype 3 was identified as the predominant genotype, for both HAV and HEV. Conclusion: This review revealed a high prevalence of HAV and HEV in livestock populations in Africa, shedding light on the potential risks associated with zoonotic and/or food-related infections. There is a need for continued surveillance and monitoring of these viruses in both animals and food products to mitigate the risk of foodborne outbreaks and protect human health. [ABSTRACT FROM AUTHOR]

Background Establishing the safety and immunogenicity of a hepatitis E virus vaccine in multiple populations could facilitate broader access and prevent maternal and infant mortality. Methods We conducted a phase 1, randomized, double-blinded, placebo-controlled (4:1 vaccine to placebo) trial of 30 µg HEV-239 (Hecolin, Xiamen Innovax Biotech Company Limited, China) administered intramuscularly in healthy US adults aged 18–45 years. Participants were vaccinated on days 1, 29, and 180. Participants reported solicited local and systemic reactions for 7 days following vaccination and were followed through 12 months after enrollment for safety and immunogenicity (IgG, IgM). Results Solicited local and systemic reactions between treatment and placebo group were similar and overall mild. No participants experienced serious adverse events related to HEV-239. All participants receiving HEV-239 seroconverted at 1 month following the first dose and remained seropositive throughout the study. HEV-239 elicited a robust hepatitis E IgG response that peaked 1 month following the second dose (geometric mean concentration [GMC], 6.16; 95% confidence interval [CI], 4.40–8.63), was boosted with the third dose (GMC, 11.50; 95% CI, 7.90–16.75) and persisted through 6 months. Conclusions HEV-239 is safe and elicits a durable immune response through at least 6 months after the third dose in healthy US adults. Clinical Trials Registration NCT03827395. [ABSTRACT FROM AUTHOR]

The article discusses a case of chronic hepatitis E in a 47-year-old female patient following chimeric antigen receptor-T cell treatment for diffuse large B-cell lymphoma. The patient developed rapid progression towards decompensated liver cirrhosis, with a confirmed diagnosis of chronic hepatitis E caused by genotype 3 of the hepatitis E virus. Treatment with ribavirin and pegylated interferon led to viral clearance, but also resulted in adverse effects such as haemolysis and autoimmune flare-ups. The case highlights the challenges of diagnosing and treating chronic hepatitis E post-CAR T-cell therapy, emphasizing the importance of monitoring transaminases and raising awareness about preventive measures. [Extracted from the article]

This review synthesizes current knowledge on the risks posed by viral foodborne infections associated with pork, emphasizing their global prevalence and the complexity of managing such pathogens. It covers a range of significant viruses, including hepatitis A and E, norovirus, rotavirus, sapovirus, enterovirus, astrovirus, and enteric adenovirus. The role of pigs as reservoirs for diverse pathogens with zoonotic potential further complicates safety challenges, extending risks to individuals involved in pork production and processing. Various factors influencing viral contamination throughout the meat production chain are explored, from farm-level practices to processing and handling procedures. Emphasis is placed on the critical importance of implementing effective control measures at each stage, including enhanced biosecurity, rigorous hygiene practices, and appropriate thermal processing techniques. Additionally, the need for improved surveillance and detection methods to effectively identify and monitor viral presence in meat products is highlighted. In conclusion, the necessity of adopting a One Health approach that integrates efforts in animal health, food safety, and public health to mitigate the risks of viral foodborne infections associated with meat consumption is underscored. This holistic strategy is essential for safeguarding consumer health and ensuring the safety of the global food supply. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) is a foodborne zoonotic pathogen that is supposed to be one of the most common causes of acute viral hepatitis. However, HEV infection has been recently associated with a wide spectrum of extrahepatic manifestations, particularly neurological disorders. Previous studies have shown that HEV is able to cross the blood–brain barrier (BBB) and induce inflammatory response of the central nervous system. However, the pathogenesis of HEV‐induced neuroinflammation and tissue injury of the central nervous system have yet to be fully elucidated. In this study, activation of NLRP3 inflammasome following HEV infection were investigated. In a gerbil model infected by HEV, brain histopathological changes including gliosis, neuronophagia and neuron injury were observed and expression of NLRP3, caspase‐1, IL‐1β and IL‐18 were elevated. Brain microvascular endothelial cells (BMECs) are key components of the BBB that protects the brain from various challenges. Following HEV infection, virus‐like particles range from 30 to 40 nm in diameter were observed in human BMECs (hBMECs). Enhanced expression levels of NLRP3 and subsequent ASC, caspase‐1, IL‐1β and IL‐18 were detected in infected cells. Treatment with MCC950 alleviated HEV infection induced activation of NLRP3 inflammasome, mitochondrial damage and VE‐cadherin degradation. The findings provide new insights into HEV‐associated neuroinflammation. Moreover, targeting NLRP3 inflammasome signalling is a promising therapeutic in HEV‐induced neurological disorder. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) is typically asymptomatic in developed countries but can be more severe in certain populations. We aim to describe the epidemiology of HEV‐associated hospitalisations from 1998 to 2020 in the United States, investigate risk factors for inpatient mortality and describe outcomes in pregnant women. We utilised the National Inpatient Sample and extracted cases of HEV‐associated hospitalisations using ICD‐9/10 diagnostic codes. Demographic, clinical and pregnancy data were extracted and analysed by chi‐square and logistic regression. We identified 3354 cases of HEV‐associated hospitalisations; 1689 (50.4%) were female and 1425 (42.5%) were non‐Hispanic White. The median age was 50 (IQR: 37–59) years. Hospitalisation rates for HEV ranged from 2.5 per 10,000,000 in 2008 to a peak of 9.6 per 10,000,000 people in the general U.S. population in 2004. The mortality rate was 5.2%. Age ≥ 40 years (OR: 7.73; 95% CI: 1.57–38.09; p = 0.012), HIV infection (OR: 4.63; 95% CI: 1.26–16.97; p = 0.021), and coagulopathy (OR: 7.22; 95% CI: 2.81–18.57; p < 0.001) were associated with increased odds of mortality within the HEV cohort. There were 226 pregnant women with HEV. Rates of maternal death, stillbirth and preterm birth were similar between HEV and non‐HEV pregnant cohorts. Hepatitis B and hepatitis C co‐infection were significantly more common in the HEV pregnant cohort (p < 0.05). HEV‐associated hospitalisations are uncommon in the United States, but likely underdiagnosed. Certain risk factors can be used to predict prognosis of these hospitalised patients. Pregnant women with HEV appear to have favourable maternal and fetal outcomes despite hepatitis B and C co‐infection. [ABSTRACT FROM AUTHOR]

Aims: Hepatitis E caused by the hepatitis E virus (HEV) is prevalent worldwide. In China, considerable shifts in the epidemiology of hepatitis E have been observed over the last two decades, with ongoing changes in the prevalence of HEV. Method s : This study, in conjunction with the health examinations for students and workers, aims to estimate the seroprevalence and assess the risk factors of HEV infection in general population in Hebei province, China. Epidemiological information was collected using a specific questionnaire and blood samples were collected from each participant during the process of health examination. Anti‐HEV IgG and IgM in sera were tested using the Wantai ELISA assay kits. Logistic regression modelling was used to identify associated risk factors. Results: The average positive rate of anti‐HEV IgG in students (6–25 years) was 3.4%. One (0.2%) student was anti‐HEV IgM positive, while also testing positive for IgG. The HEV seroprevalence was not related to students' gender, school, or family residence. In occupational populations, the overall seropositivity rate was 13.3% for anti‐HEV IgG and 0.67% for IgM. HEV seropositivity increased significantly with age, ranging from 3.8% to 18.6% in age groups, and differed significantly among four occupation groups: farmers (17.6%), food supply workers (18.0%), other non‐farm workers (14.7%) and healthcare workers (5.9%) (p = 0.002). Multivariable logistic analysis confirmed the significant correlations of seroprevalence with age and occupation. Conclusions: The study found a low seroprevalence of HEV in children and young adults in Hebei Province, China. Advanced age correlates with higher seroprevalence in occupational populations, indicating an accumulation of HEV infection over time. Seroprevalence varied significantly among different occupation groups, suggesting the important role of occupational exposure for HEV infection. [ABSTRACT FROM AUTHOR]

The hepatitis E virus (HEV) is an important causative agent of acute hepatitis (AH). Despite reports of human infection in Brazil, the investigation is not routinely conducted, even in cases of elevated liver enzymes. This study evaluated two groups: group 1—patients with acute hepatitis A (n = 44); group 2—patients with nonA‐C AH (n = 47). They were tested by enzyme immunoassay for anti‐HEV IgM/IgG and real‐time PCR for HEV RNA detection. The positive sample for HEV RNA was submitted for sequencing. The seroprevalence of anti‐HEV IgM and IgG in group 1 was 4% (2/44) and 14.5% (7/44), respectively. Viral RNA was not detected in any sample. In group 2, the anti‐HEV IgM positivity was 4.3% (2/47), and IgG 14.9% (7/47). RNA was detectable in one case, which presented a viral load of 222.4 IU/μL and positive anti‐HEV IgM/IgG. In the phylogenetic analysis, the genotype identified was HEV‐3f. These results indicate that HEV infection should be considered a possible diagnosis in cases of non‐A–C AH. The patient identified with acute hepatitis E had recently traveled to the Northeast region of Brazil (Garanhuns city in Pernambuco state), where there are reports of high HEV seroprevalence among pigs. The close phylogenetic relationship observed between the sequence characterized in this study and strains isolated from pigs in nearby cities where the patient went suggested a possible zoonotic transmission in this region. This study highlights the importance of expanding studies and improving surveillance to understand better and manage HEV infections nationwide. [ABSTRACT FROM AUTHOR]

In this review, recent advances in the combination of CRISPR–Cas systems with graphene-based electrolyte-gated transistors are discussed in detail. In the first part, the functioning of CRISPR–Cas systems is briefly explained, as well as the most common ways to convert their molecular activity into measurable signals. Other than optical means, conventional electrochemical transducers are also developed. However, it seems that the incorporation of CRISPR/Cas systems into transistor devices could be extremely powerful, as the former provides molecular amplification, while the latter provides electrical amplification; combined, the two could help to advance in terms of sensitivity and compete with conventional PCR assays. Today, organic transistors suffer from poor stability in biological media, whereas graphene materials perform better by being extremely sensitive to their chemical environment and being stable. The need for fast and inexpensive sensors to detect viral RNA arose on the occasion of the COVID-19 crisis, but many other RNA viruses are of interest, such as dengue, hepatitis C, hepatitis E, West Nile fever, Ebola, and polio, for which detection means are needed. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) is a small non-enveloped virus that is transmitted via the fecal-oral route. It is a highly common cause of acute hepatitis, particularly in low to middle income regions of Asia, Africa, and Central America. Most cases are self-limited, and symptomatic patients usually present with acute icteric hepatitis. A subset of patients including pregnant women, older men, those with pre-existing liver disease and immunocompromised patients however, may develop severe disease and hepatic failure. Immunocompromised patients are also at risk for chronic infection, and their immunosuppression should be decreased in order to facilitate viral clearance. HEV can also present with a variety of extra-intestinal manifestations including neurological, renal, hematological, and pancreatic derangements. The gold standard of diagnosis is HEV ribonucleic acid detection via nucleic acid amplification testing. Currently, there are no approved treatments for Hepatitis E, though ribavirin is the most commonly used agent to reduce viral load. Studies assessing the safety and efficacy of other antiviral agents for HEV are currently underway. HEV vaccination has been approved in China, and is currently being investigated in other regions as well. This review article aims to discuss the epidemiology, pathogenesis, presentation, diagnosis, complications, and treatment of Hepatitis E infection.

Hepatitis E virus (HEV) is a significant global health issue, impacting both low- and middle-income countries and industrialized nations. HEV genotypes 1 and 2, primarily transmitted through contaminated water, are endemic in low- and middle-income countries, whereas genotypes 3 and 4 are zoonotically transmitted in industrialized regions. Acute HEV infection poses severe risks, particularly to pregnant women and immunocompromised individuals, whereas chronic HEV infection leads to serious complications in those with pre-existing liver disease and transplant recipients. The development of an HEV vaccine offers new prevention opportunities, though its availability and integration into global immunization programmes remain limited. This position paper was developed by the European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group through an extensive review of clinical data, safety profiles, efficacy, and immunogenicity of HEV vaccines. The study group focused particularly on high-risk and special populations, synthesizing global health insights and incorporating recommendations from the Strategic Advisory Group of Experts to formulate strategies for wider HEV vaccination use. The position paper evaluates the efficacy and safety of HEV vaccines in both general and special populations. It identifies key barriers to the integration of HEV vaccines into routine immunization programmes, including infrastructure limitations, costs, and vaccine accessibility. The paper also proposes strategies to overcome these challenges and improve vaccine distribution. Furthermore, it addresses ways to enhance public awareness and international cooperation to promote HEV vaccination efforts globally. European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group recommends HEV vaccination for high-risk groups, including women of childbearing age, patients with chronic liver diseases, and immunosuppressed individuals. Prioritizing investments in vaccine logistics, integrating diagnostics, and educational outreach can enhance uptake. [ABSTRACT FROM AUTHOR]

Abstract Background Infectious diseases are major medical and social challenges of the 21 st century. Accurately predicting incidence is of great significance for public health organizations to prevent the spread of diseases. Internet search engine data, like Baidu search index, may be useful for analyzing epidemics and improving prediction. Methods We collected data on hepatitis E incidence and cases in Shandong province from January 2009 to December 2022 are extracted. Baidu index is available from January 2009 to December 2022. Employing Pearson correlation analysis, we validated the relationship between the Baidu index and hepatitis E incidence. We utilized various LSTM architectures, including LSTM, stacked LSTM, attention-based LSTM, and attention-based stacked LSTM, to forecast hepatitis E incidence both with and without incorporating the Baidu index. Meanwhile, we introduce KAN to LSTM models for improving nonlinear learning capability. The performance of models are evaluated by three standard quality metrics, including root mean square error(RMSE), mean absolute percentage error(MAPE) and mean absolute error(MAE). Results Adjusting for the Baidu index altered the correlation between hepatitis E incidence and the Baidu index from -0.1654 to 0.1733. Without Baidu index, we obtained 17.04±0.13%, 17.19±0.57%, in terms of MAPE, by LSTM and attention based stacked LSTM, respectively. With the Baidu index, we obtained 15.36±0.16%, 15.15±0.07%, in term of MAPE, by the same methods. The prediction accuracy increased by 2%. The methods with KAN can improve the performance by 0.3%. More detailed results are shown in results section of this paper. Conclusions Our experiments reveal a weak correlation and similar trends between the Baidu index and hepatitis E incidence. Baidu index proves to be valuable for predicting hepatitis E incidence. Furthermore, stack layers and KAN can also improve the representational ability of LSTM models.

Abstract Guillain–Barré syndrome and neuralgic amyotrophy have been associated with hepatitis E virus (HEV) genotype 3 infections, while myasthenia gravis (MG) has been associated with HEV genotype 4 infections. However, whether chronic inflammatory demyelinating polyneuropathy (CIDP) is associated with HEV infections has not been conclusively clarified yet. 102 CIDP patients, 102 age- and sex-matched blood donors, 61 peripheral neuropathy patients (non-CIDP patients), and 26 MG patients were tested for HEV and anti-HEV IgM and IgG. Sixty-five of the 102 (64%) CIDP patients tested positive for anti-HEV IgG and one (1%) for anti-HEV IgM. No other patient tested positive for ati-HEV IgM. In the subgroup of CIDP patients with initial diagnosis (without previous IVIG treatment), 30/54 (56%) tested positive for anti-HEV IgG. Anti-HEV rates were significantly lower in blood donors (28%), non-CIDP peripheral neuropathy patients (20%), and MG patients (12%). No subject tested positive for HEV viremia. CSF tested negative for in 61 CIDP patients (54 patients with primary diagnosis). The development of CIDP but not non-CIDP polyneuropathy may be triggered by HEV exposure in an HEV genotype 3 endemic region. The increased anti-HEV seroprevalence in CIDP patients is not a consequence of IVIG therapy.

Background: Infectious diseases are major medical and social challenges of the 21st century. Accurately predicting incidence is of great significance for public health organizations to prevent the spread of diseases. Internet search engine data, like Baidu search index, may be useful for analyzing epidemics and improving prediction. Methods: We collected data on hepatitis E incidence and cases in Shandong province from January 2009 to December 2022 are extracted. Baidu index is available from January 2009 to December 2022. Employing Pearson correlation analysis, we validated the relationship between the Baidu index and hepatitis E incidence. We utilized various LSTM architectures, including LSTM, stacked LSTM, attention-based LSTM, and attention-based stacked LSTM, to forecast hepatitis E incidence both with and without incorporating the Baidu index. Meanwhile, we introduce KAN to LSTM models for improving nonlinear learning capability. The performance of models are evaluated by three standard quality metrics, including root mean square error(RMSE), mean absolute percentage error(MAPE) and mean absolute error(MAE). Results: Adjusting for the Baidu index altered the correlation between hepatitis E incidence and the Baidu index from -0.1654 to 0.1733. Without Baidu index, we obtained 17.04±0.13%, 17.19±0.57%, in terms of MAPE, by LSTM and attention based stacked LSTM, respectively. With the Baidu index, we obtained 15.36±0.16%, 15.15±0.07%, in term of MAPE, by the same methods. The prediction accuracy increased by 2%. The methods with KAN can improve the performance by 0.3%. More detailed results are shown in results section of this paper. Conclusions: Our experiments reveal a weak correlation and similar trends between the Baidu index and hepatitis E incidence. Baidu index proves to be valuable for predicting hepatitis E incidence. Furthermore, stack layers and KAN can also improve the representational ability of LSTM models. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) infection, one of the most common forms of hepatitis worldwide, is often associated with extrahepatic, particularly renal, manifestations. However, the underlying mechanisms are incompletely understood. Here, we report the development of a de novo immune complex-mediated glomerulonephritis (GN) in a kidney transplant recipient with chronic hepatitis E. Applying immunostaining, electron microscopy, and mass spectrometry after laser-capture microdissection, we show that GN develops in parallel with increasing glomerular deposition of a non-infectious, genome-free and non-glycosylated HEV open reading frame 2 (ORF2) capsid protein. No productive HEV infection of kidney cells is detected. Patients with acute hepatitis E display similar but less pronounced deposits. Our results establish a link between the production of HEV ORF2 protein and the development of hepatitis E-associated GN in the immunocompromised state. The formation of glomerular IgG-HEV ORF2 immune complexes discovered here provides a potential mechanistic explanation of how the hepatotropic HEV can cause variable renal manifestations. These findings directly provide a tool for etiology-based diagnosis of hepatitis E-associated GN as a distinct entity and suggest therapeutic implications. It's poorly understood how renal manifestations develop in HEV infection in patients. Here, the authors observe glomerular accumulation of the viral protein ORF2 in complex with host IgG in immunocompromised patients with chronic or acute HEV infection who developed glomerulonephritis. [ABSTRACT FROM AUTHOR]

ABSTRACT Acute hepatitis E virus infection is a serious global health problem, which a significant cause of morbidity and mortality. The aim of the present study was to characterise the clinical features and therapeutic response of patients with acute HEV infection and identify risk factors for poor prognosis. In a retrospective study from 01 January 2014 to 01 Januray 2022, we collected baseline data from all patients eligible for acute hepatitis E virus (HEV) infection and followed up with all patients via interviews and medical records. We explored the clinical feature of Chinese patients with acute HEV infection. The follow‐up data of patients were used to identify risk factors for poor prognosis. In total, 628 acute hepatitis E (AHE) patients fulfilled the inclusion criteria and did not meet the exclusion criteria. Among them, 452 were males and 176 were females (M:F = 2.57:1). The median age at diagnosis was 57.0 years (interquartile range: 46–64 years). The median baseline serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) were elevated in this cohort (642.3 U/L, 216.2 U/L, 104.1 μmol/L, respectively). The median hospitalisation duration was 16 days. Compared with patients without other liver diseases, patients with liver cirrhosis show lower baseline ALT and AST level, poorer coagulation indices and higher MELD scores. According to multivariate analysis, liver cirrhosis, high MELD score, low albumin concentration was found to be independent predictors of poor prognosis in patients with AHE. Our study used a lager sample size to validate that some demographic and serological features were quite different between patients with/without CLDs. Liver cirrhosis was a significant independent predictor of poor prognosis in acute HEV hepatitis. [ABSTRACT FROM AUTHOR]

Recent advances in studies exploring the roles of extracellular vesicles (EVs) in viral transmission and replication have illuminated hepatotropic viruses, such as hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV). While previous investigations have uncovered these viruses' ability to exploit cellular EV pathways for replication and transmission, most have focused on the impacts of exosomal pathways. With an improved understanding of EVs, four main subtypes, including exosomes, microvesicles, large oncosomes, and apoptotic bodies, have been categorized based on size and biogenic pathways. However, there remains a noticeable gap in comprehensive reviews summarizing recent findings and outlining future perspectives for EV studies related to hepatotropic viruses. This review aims to consolidate insights into EV pathways utilized by hepatotropic viruses, offering guidance for the future research direction in this field. By comprehending the diverse range of hepatotropic virus-associated EVs and their role in cellular communication during productive viral infections, this review may offer valuable insights for targeting therapeutics and devising strategies to combat virulent hepatotropic virus infections and the associated incidence of liver cancer. [ABSTRACT FROM AUTHOR]

Aim: This study investigated hepatitis E virus (HEV) prevalence among pregnant women in Siem Reap, Cambodia, by developing a cost‐effective, user‐friendly in‐house enzyme‐linked immunosorbent assay (ELISA) for detecting total anti‐HEV immunoglobulins (Ig). Methods: The in‐house ELISA was designed for large‐scale screening in resource‐limited settings. Its performance was benchmarked against two commercial tests: the Anti‐HEV IgG EIA (Institute of Immunology, Co. Ltd) and the Anti‐HEV IgG RecomLine LIA (Mikrogen). The in‐house ELISA demonstrated a sensitivity of 76% and 71.4%, and a specificity of 94.1% and 98.6%, against the two commercial tests, respectively, with overall agreement rates of 92.4% and 94.3%. Results: Among 1565 tested pregnant women, 11.6% were anti‐HEV positive. Prevalence increased with age, particularly in women aged 35–40 years and over 40 years. No significant associations were found with education, number of children, family size, or history of blood transfusion and surgery, except for the occupation of the family head as a public officer. Of the total anti‐HEV positive women, 22.7% had anti‐HEV IgM, indicating recent or ongoing infection. Conclusion: The study concluded that the in‐house ELISA is a viable option for HEV screening in regions with limited resources due to its high accuracy and cost‐effectiveness. It is particularly suitable for large‐scale studies and public health interventions in areas where HEV is endemic and poses a significant risk to pregnant women. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis worldwide, primarily transmitted through contaminated water and food. In patients with chronic liver disease (CLD), HEV infection might worsen the prognosis. This study aimed to evaluate the cost-effectiveness of hepatitis E vaccination strategies in CLD patients. A decision tree–Markov cohort model was used to assess the cost-effectiveness of universal-vaccination, vaccination-following-screening, and no-vaccination strategies in 100,000 CLD patients over their lifetimes, simulating cohorts aged ≥16 years, ≥40 years, and ≥60 years, based on the licensed vaccination ages and typical ages of CLD onset, from a societal perspective. Model parameters were retrieved and estimated from previous publications and government data. The outcomes included HEV-related cases, costs, and the incremental cost-effectiveness ratio (ICER). Compared to no-vaccination, universal-vaccination reduced HEV-related cases by 32.8% to 39.6%, while vaccination-following-screening reduced them by 38.1% to 49.3%. Furthermore, universal-vaccination showed ICERs of USD 6898.33, USD 6638.91, and USD 6582.69 per quality-adjusted life year (QALY) for cohorts aged ≥16, ≥40, and ≥60 years, respectively. Moreover, the vaccination-following-screening strategy significantly enhanced cost-effectiveness, with ICERs decreasing to USD 6201.55, USD 5199.46, and USD 4919.87 per QALY for the cohorts. Additionally, one-way sensitivity analysis identified the discount rate and utility for CLD patients as the key factors influencing ICER. Probabilistic sensitivity analysis indicated the vaccination-following-screening strategy was cost-effective with probabilities of 92.50%, 95.70%, and 95.90% for each cohort. Hepatitis E vaccination in CLD patients costs less than GDP per capita for each QALY gained in China. The vaccination-following-screening strategy may be the optimal option, especially in those over 60 years. [ABSTRACT FROM AUTHOR]

Hepatitis B e antigen (HBeAg) loss is a key event in the natural history of chronic hepatitis B virus infection. The rate and determinants of HBeAg loss depend upon cohort characteristics at baseline. Few studies have examined the age‐dependent rate, and none have examined the effect of patient sex and ethnicity on the age‐dependant rate. The study of age‐dependent rates requires the identification and long‐term follow‐up of a pediatric cohort. We have studied the age‐dependent rate of HBeAg loss, and the rate of HBeAg loss measured from baseline, in a multi‐ethnic cohort of 454 pediatric patients. During observation, HBeAg loss was observed in 121/303 (39.9%) HBeAg‐positive patients. The rate of HBeAg loss was greater in the second versus the first and third decades of life. The age‐related rate of HBeAg loss was clearly affected by patient sex and ethnicity, with earlier loss observed for males and for White versus both South Asian and Chinese ethnicities. When measured from baseline, Chinese patients had a slower rate of HBeAg loss in comparison with White patients. In multivariate analysis of HBeAg loss during prolonged follow‐up, male sex, older age, and White ethnicity were associated with HBeAg loss, but antiviral treatment was not. [ABSTRACT FROM AUTHOR]

Viral hepatitis (A–E) presents a major global health challenge. In 2015, the World Health Organization (WHO) launched an initiative to eliminate viral hepatitis, with the aim of reducing new infections by 90% and deaths by 65% by 2030. Mexico is one of 38 focus countries identified by the WHO, collectively accounting for 80% of global infections and deaths. While hepatitis B and C are commonly diagnosed in Mexico, routine diagnosis for hepatitis D and E is lacking, with no specific epidemiological data available. In 2020, Mexico implemented the National Hepatitis C Elimination Program, focusing on preventing new infections, reducing complications like cirrhosis and hepatocellular carcinoma, ensuring access to treatment, and improving patient care. However, this program has not been extended to hepatitis B and E. Addressing the challenges of viral hepatitis control in Mexico requires increased resource allocation, expanded diagnosis, vaccination for hepatitis A and B, and treatment coverage for hepatitis B and C, along with multisectoral engagement. This work provides an overview of Mexico's response to the global initiative, highlighting its progress, challenges, and areas of opportunity. [ABSTRACT FROM AUTHOR]

The hepatitis E virus (HEV) has become increasingly important in recent years in terms of risk for public health, as the main causative agent of acute viral hepatitis. It is a foodborne disease transmitted to humans through the consumption of contaminated water or contaminated food. Human-to-human transmission is sporadic and is linked to transfusions or transplants. The main reservoirs of the hepatitis E virus are domestic pigs and wild boars, although, compared to pigs, wild boars represent a lesser source of risk since their population is smaller and the consumption of derived products is more limited. These peculiarities often make the role of the wild boar reservoir in the spread of the disease underestimated. As a public health problem that involves several animal species and humans, the management of the disease requires an interdisciplinary approach, and the concept of "One Health" must be addressed. In this direction, the present review intends to analyze viral hepatitis E, with a particular focus on wild boar. For this purpose, literature data have been collected from different scientific search engines: PubMed, MEDLINE, and Google scholar, and several keywords such as "HEV epidemiology", "Extrahepatic manifestations of Hepatitis E", and "HEV infection control measures", among others, have been used. In the first part, the manuscript provides general information on the disease, such as epidemiology, transmission methods, clinical manifestations and implications on public health. In the second part, it addresses in more detail the role of wild boar as a reservoir and the implications related to the virus epidemiology. The document will be useful to all those who intend to analyze this infectious disease from a "One-Health" perspective. [ABSTRACT FROM AUTHOR]

Objectives: Hepatitis A virus (HAV) and Hepatitis E virus (HEV) both are spread through the fecal-oral route and cause acute viral hepatitis (AVH) and pose a major public health problem in India. This study was done to find out the proportion of positivity of HAV and HEV in patients with AVH and its seasonal trend. Materials and Methods: A retrospective study was carried out at Surat Municipal Institute of Medical Education and Research Medical College, Department of Microbiology, Surat, Gujarat. Result of 3615 blood samples of suspected AVH patients of the past 5 years (January 2018–December 2022) were taken from hospital data records. The enzyme-linked immunosorbent assay method was used to test serum samples for immunoglobulin M (IgM) HAV and IgM HEV antibodies for HAV and HEV, respectively. All samples were evaluated for liver function as well. Results: The positivity of HAV and HEV was 15.13% and 10.26%, respectively. The coinfection rate was 2.07%. HAV and HEV both affected males more than females. Among pregnant females, HEV infection had more positivity (6.77%) than HAV, which had 1.08% positivity. HAV and HEV infections had a seasonal trend, with the highest infection rate in the monsoon. Conclusion: The declining trend of cases of HAV and HEV was found in Surat city of south Gujarat which indicates increased awareness about hepatitis among people and better public health management by the civic authorities. [ABSTRACT FROM AUTHOR]

Background. In developing countries, acute hepatitis poses a serious threat in terms of mortality and morbidity. Objective: The aim of our study was to assess the etiology, clinical, and biochemical profile of acute hepatitis patients and study the predictors of mortality. Patient and Methods. A retrospective study was conducted from records over 3 years in an infectious disease facility. The data on etiology, clinical presentation, complications, severity, and outcomes were collected. Univariate followed by multivariate analysis was done to derive the predictors of mortality. Results. A total of 2488 patients were included. Hepatitis E was the most common etiology (52.65%), followed by hepatitis A (22.18%) and hepatitis B (10.56%). The majority of patients with hepatitis C (68.9%) had cirrhosis. The overall mortality rate was 1.43% among patients with viral hepatitis. Altered sensorium, gastrointestinal bleeding, anemia, elevated bilirubin, low albumin, and presentation as acute liver failure (ALF) or acute on chronic liver failure (ACLF) were independent predictors of mortality. Among patients of autoimmune hepatitis (AIH), one-third had age>60 years and the majority (83.9%) had cirrhosis. Drug-induced liver injury (DILI) was the most prevalent etiology among non-viral causes. The most common offending drug was complementary medications. Patients with non-A/non-E hepatitis were older and had higher mortality than hepatitis A/E patients. Conclusion. Hepatitis E is still the most prevalent cause of acute hepatitis. ALF/ACLF presentation and related comorbidities, such as altered sensorium and GI bleeding, predict death. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Complete viral suppression with nucleos(t)ide analogs (NAs) has led to a profound reduction in hepatocellular carcinoma and mortality among patients with chronic hepatitis B. Finite therapy yields higher rates of functional cure; however, initial hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) elevations are almost certain after treatment interruption. We aimed to analyze off-treatment outcomes beyond 12 months after NA cessation. METHODS: Patients with well-suppressed chronic hepatitis B who were hepatitis B e antigen-negative at NA cessation and remained off treatment without hepatitis B surface antigen (HBsAg) loss at 12 months were included (n = 945). HBV DNA and ALT fluctuations were allowed within the first 12 months. We used Kaplan-Meier methods to analyze outcomes beyond 12 months. Sustained remission was defined as HBV DNA <2,000 IU/mL and ALT <2x upper limit of normal (ULN) and an ALT flare as ALT ≥5x ULN. RESULTS: Cumulative probability of sustained remission was 29.7%, virological relapse was 65.2% with a mean peak HBV DNA of 5.0 ± 1.5 log10 IU/mL, an ALT flare was 15.6% with a median peak ALT x ULN of 8.3 (5.7-11.3), HBsAg loss was 9.9% and retreatment was 34.9% at 48 months after NA cessation. A single occurrence of virological relapse or an ALT flare within the first 12 months off-treatment were associated with significantly lower rates of sustained remission beyond 12 months. DISCUSSION: Despite allowing for HBV DNA and ALT fluctuations within the first 12 months off-treatment, most patients without HBsAg loss did not maintain a sustained response thereafter. The best candidates for NA withdrawal are patients with low HBsAg levels at NA cessation, and those without profound or recurrent virological and biochemical relapses in the first off-treatment year. [ABSTRACT FROM AUTHOR]

Climate change affects the spread of waterborne infectious diseases, yet research on vulnerability to outbreaks remains limited. This integrative review examines how climate variables (temperature and precipitation) relate to human vulnerability factors in Pakistan. By 2060, mean temperatures are projected to rise from 21.68°C (2021) to 30°C, with relatively stable precipitation. The epidemiological investigation in Pakistan identified Diarrhea (119,000 cases/year), Malaria (2.6 million cases/year), and Hepatitis (A and E) as the most prevalent infections. This research highlighted vulnerability factors, including poverty (52% of the population), illiteracy (59% of the population), limited healthcare accessibility (55% of the population), malnutrition (38% of the population), dietary challenges (48% of the population), as well as exposure to water pollution (80% of the population) and air pollution (55% of the population). The findings suggest that the coordinated strategies are vital across health, environmental, meteorological, and social sectors, considering climatic variability patterns and population vulnerability determinants. [ABSTRACT FROM AUTHOR]

HEV antibody detection constitutes the main screening test for HEV infection. The aim of this study is to compare the sensitivity and specificity of four techniques: LIAISON® MUREX DiaSorin anti-HEV IgG and anti-HEV IgM assays, Hepatitis E VIRCLIA® IgM and IgG monotests, WANTAI HEV-IgM and IgG ELISA and VIDAS® anti-HEV IgM and IgG tests in five panels of samples configurated according to the immunoblot (RecomLine, Mikrogen, Neuss, Germany). Anti-HEV IgM sensitivity in the acute phase was 100% in all techniques, while sensitivity, including the immediate convalescence phase, was 96.74% for LIAISON®, 83.14% for VIRCLIA®, 84.78% for WANTAI and 88.04% for VIDAS®. Anti-HEV IgM specificity was 100% for both LIAISON® and VIRCLIA®. Anti-HEV IgM WANTAI agreed with VIRCLIA® with a good Kappa coefficient (κ = 0.71). Anti-HEV IgG post-infection sensitivity was 100% for LIAISON®, VIDAS® and VIRCLIA® and 99% for WANTAI. Anti-HEV IgG specificity reached 97.17% for LIAISON and 88.68% for VIRCLIA®. Our results demonstrated a better capacity of LIAISON® MUREX anti-HEV IgM than that of competitors for detecting acute infections as well as accurate anti-HEV IgG results and in how to resolve them. [ABSTRACT FROM AUTHOR]

It is generally acknowledged that antiviral therapy can reduce the incidence of hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC), there remains a subset of patients with chronic HBV infection who develop HCC despite receiving antiviral treatment. This study aimed to develop a model capable of predicting the long‐term occurrence of HCC in patients with chronic HBV infection before initiating antiviral therapy. A total of 1450 patients with chronic HBV infection, who received initial antiviral therapy between April 2006 and March 2023 and completed long‐term follow‐ups, were nonselectively enrolled in this study. Least absolute shrinkage and selection operator (LASSO) and Cox regression analysis was used to construct the model. The results were validated in an external cohort (n = 210) and compared with existing models. The median follow‐up time for all patients was 60 months, with a maximum follow‐up time of 144 months, during which, 32 cases of HCC occurred. The nomogram model for predicting HCC based on GGT, AFP, cirrhosis, gender, age, and hepatitis B e antibody (TARGET‐HCC) was constructed, demonstrating a good predictive performance. In the derivation cohort, the C‐index was 0.906 (95% CI = 0.869–0.944), and in the validation cohort, it was 0.780 (95% CI = 0.673–0.886). Compared with existing models, TARGET‐HCC showed promising predictive performance. Additionally, the time‐dependent feature importance curve indicated that gender consistently remained the most stable predictor for HCC throughout the initial decade of antiviral therapy. This simple predictive model based on noninvasive clinical features can assist clinicians in identifying high‐risk patients with chronic HBV infection for HCC before the initiation of antiviral therapy. [ABSTRACT FROM AUTHOR]

Objective: Challenging differential diagnosis Background: Common causes of severely elevated transaminases, especially alanine transaminase, due to liver diseases include drug-induced liver injury and acute viral hepatitis, especially hepatitis E, which can present similarly in clinical practice. Broad differential diagnostic workup in patients with elevated transaminases is required to not overlook the possibility of hepatitis E infection. Case Report: We report on a 65-year-old asymptomatic man who was referred to the Emergency Department from the rehabilitation center due to markedly elevated liver transaminases. Physical examination revealed no jaundice or abdominal pain. Laboratory findings included severely elevated aspartate transaminase, alanine transaminase, and bilirubin levels. He was previously treated with imipenem/cilastatin and clindamycin for a surgical site infection of his jaw after the removal of a squamous cell carcinoma 2 weeks earlier. An ultrasound of the liver was unremarkable. Drug-induced liver injury was suspected, and all potentially hepatotoxic drugs, including antibiotics, were stopped. Due to the rapid and marked increase in liver transaminases, further tests were performed, including testing for hepatitis E. Serum anti-hepatitis E virus immunoglobulin M, immunoglobulin G antibodies, and hepatitis E virus-ribonucleic acid-polymerase chain reaction turned positive, and the diagnosis of hepatitis E was confirmed. Supportive care was applied. Liver transaminases decreased spontaneously. Conclusions: The diagnostic workup in patients with markedly elevated liver transaminases and suspected drug-induced liver injury should include the screening for hepatitis E. Making the correct diagnosis is crucial given the differing treatment approaches, the implications on further therapy, and the risk of contagion of hepatitis E. [ABSTRACT FROM AUTHOR]

Background and aims: Limited data have been reported on achieving functional cure using pegylated interferon (Peg-IFN) alpha-2b treatment for postpartum hepatitis B e antigen (HBeAg)-negative women with chronic hepatitis B virus (HBV) infection. This study was to assess the effectiveness and safety of Peg-IFN alpha-2b in HBV postpartum women without HBeAg and identify factors linked to the functional cure. Methods: A total of 150 HBeAg-negative postpartum women were retrospectively recruited.47 patients received Peg-IFN alpha-2b [Peg-IFN(+) group] and 103 patients did not [Peg-IFN(-) group]. Propensity score matching (PSM) was used to adjust the baseline imbalance between the two groups. The patients were followed for at least 48 weeks. The primary endpoints were hepatitis B surface antigen(HBsAg) loss and HBsAg seroconversion at 48 weeks. Logistic regression analysis was used to assess factors associated with HBsAg loss at 48 weeks. Results: At week 48, the HBsAg loss and seroconversion rate in Peg-IFN(+) group were 51.06%(24/47) and 40.43%(19/47), respectively. Even after PSM, Peg-IFN(+) group still showed higher HBsAg loss rate (50.00% vs 7.14%, p<0.001) and higher HBsAg seroconversion rate (38.10% vs 2.38%, p<0.001). Baseline HBsAg levels (Odds Ratio [OR]: 0.051, 95% Confidence Interval [CI]: 0.003-0.273, P=0.010), HBsAg at week 24 (OR:0.214, 95%CI:0.033-0.616, P=0.022), HBsAg decline at week 24 (OR:4.682, 95%CI: 1.624-30.198, P=0.022) and postpartum flare (OR:21.181, 95%CI:1.872-633.801, P=0.030) were significantly associated with HBsAg loss at week 48 after Peg-IFN alpha-2b therapy. Furthermore, the receiver operating characteristic curve (ROC) showed that the use of baseline HBsAg<182 IU/mL, HBsAg at week24 < 4 IU/mL and HBsAg decline at week24>12IU/mL were good predictors of HBsAg loss. No serious adverse events were reported. Conclusion: Peg-IFN alpha-2b treatment could achieve a high rate of HBsAg loss and seroconversion in HBeAg-negative postpartum women with reliable safety, particularly for patients experience postpartum flare and have low baseline HBsAg levels. [ABSTRACT FROM AUTHOR]

Introduction: Although pets provide several social-emotional benefits for children, the risk of zoonosis must be considered among immunocompromised individuals. Methods: A prospective study was conducted in a tertiary hospital including immunocompromised patients younger than 20 years owning dogs and/or cats. Colonization and/or infection was evaluated by stool studies, bacterial swabs, blood polymerase chain reaction and serological studies in both patients and their pets, to evaluate potential zoonotic transmission occurrence. Results: We included 74 patients and their 92 pets (63 dogs, 29 cats). Up to 44.6% of the patients and 31.5% of the pets had at least 1 positive result. Up to 18.4% of pets' fecal samples were positive (bacteria, parasites or hepatitis E virus). No helminths were observed despite the high frequency of incorrect intestinal deworming practices. Among children, gastrointestinal microorganisms were found in 37.3% (primarily Clostridium difficile). Colonization by Staphylococcus pseudintermedius was common among pets (8.0%) but not among children (0.0%). No shared colonization between owners and pets was observed, except in one case (Blastocystis in both patient and pet feces). Among patients, serologies were positive for Strongyloides stercoralis (14.8%), Toxocara canis (3.2%), Bartonella henselae (19.1%) and hepatitis E (5.6%). Serology was positive for Rickettsia spp. (22.6%) and Babesia spp. (6.5%) in dogs and for Leishmania spp. (14.3%) and Toxoplasma spp. (14.3%) in cats. Conclusion: Exposure to zoonotic agents was detected in both patients and pets; however, shared colonization events were almost nonexistent. In our cohort, dogs and cats do not appear to entail high zoonosis transmission risk for immunocompromised patients. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to compare bio chemical and clinical profile to outcome of acute febrile illness complications in patients of tertiary care hospital during prewinter season. Material and Methods: it’s an observational and prospective study done in a Teerthanker medical college Moradabad, India. During the period of august 2018 to Nov 2018, only patients admitted with complicated acute febrile illness were included. Patients were compared on the basis of demography, bio chemical profile and clinical profile of complications post-acute febrile illness. Results: Total of 275 patients was enrolled in which 186(66.8%) were males and larger proportion of the study comprises of cases with age group below 35yrs. On examination, mostly patients complained of generalized body ache (86.9%), headache (78.4%), nausea vomiting (72.4%), abdomen pain (52%), dark colored urine (36.2%), and dyspnoea (33.1%), loose stools (28.1%) and altered Sensorium (8.%). Significantly associated clinical sign were pedal edema 14.5% (P=0.001), icterus 20.7 % (P=0.0001) and tachypnea 19.4% (P=0.001). Commonest complication of dengue at presentation was shock(70.9%) later on by hepatic (67.5%) and hematology (65%) derangements, that of malaria was acute renal failure(3.4%), followed by respiratory distress(22.3%). Overall mortality in Dengue was 7(3.8%), malaria 15(32.6%), Hepatitis E 2(50%). Conclusion: Study shows similar spectrum clinical features, although there is diversity of etiology and causes that demonstrates the diagnosis complexity and thus treatment of acute febrile illness. So study of biochemical profile of complication in febrile illnesses will be a help to decrease morbidity and mortality because of post monsoon illnesses by early diagnosis and prompt treatment. Dengue and malaria emerges as the commonest causes and main killers because of respiratory and renal involvements. [ABSTRACT FROM AUTHOR]

Acute hepatitis E was considered rare until reports emerged affirming the existence of hepatitis E virus (HEV) genotypes 3 and 4 infections in Japan in the early 2000s. Extensive studies by Japanese researchers have highlighted the pivotal role of pigs and wild animals, such as wild boars and deer, as reservoirs for HEV, linking them to zoonotic infections in Japan. Currently, when hepatitis occurs subsequent to the consumption of undercooked or grilled pork, wild boar meat, or offal (including pig liver and intestines), HEV infection should be considered. Following the approval of anti‐HEV immunoglobulin A antibody as a diagnostic tool for hepatitis E by Japan's Health Insurance System in 2011, the annual number of diagnosed cases of HEV infection has surged. Notably, the occurrence of post‐transfusion hepatitis E promoted nationwide screening of blood products for HEV using nucleic acid amplification tests since 2020. Furthermore, chronic hepatitis E has been observed in immunosuppressed individuals. Considering the significance of hepatitis E, heightened preventive measures are essential. The Japan Agency for Medical Research and Development Hepatitis A and E viruses (HAV and HEV) Study Group, which includes special virologists and hepatologists, held a virtual meeting on February 17, 2024. Discussions encompassed pathogenesis, transmission routes, diagnosis, complications, severity factors, and ongoing and prospective vaccination or treatments for hepatitis E. Rigorous assessment of referenced studies culminated in the formulation of recommendations, which are detailed within this review. This comprehensive review presents recent advancements in HEV research and Japanese clinical practice guidelines for HEV infection. [ABSTRACT FROM AUTHOR]