High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India
Background: There are only few reports about travel-associated, imported tropical hepatitis E virus (HEV) genotype 1 infections within Western travellers. We describe the clinical course of a single outbreak of hepatitis E in a German travellers group returning from India and compare the results of...
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doaj-d23aa1e087e9430e8523016827628e512021-06-09T05:51:04ZengElsevierAnnals of Hepatology1665-26812017-01-011615762High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from IndiaSven Pischke0Julian Schulze-zur-Wiesch1Marc Lütgehetmann2Benno Kreuels3Stefan Lueth4Petra Kapaun5Daniel Benten6Stefan Schmiedel7Martina Sterneck8Ansgar W. Lohse9Susanne Polywka10Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for I’nfection (DZIF), partner site HamburgMedical Practice, Hoheluftchausse, Hamburg, Germany; German Center for I’nfection (DZIF), partner site HamburgDepartment of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyInstitute for Microbiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for I’nfection (DZIF), partner site HamburgMedical Practice, Hoheluftchausse, Hamburg, Germany; Correspondence and reprint request:Background: There are only few reports about travel-associated, imported tropical hepatitis E virus (HEV) genotype 1 infections within Western travellers. We describe the clinical course of a single outbreak of hepatitis E in a German travellers group returning from India and compare the results of two commercial HEV-seroassays. Material and Methods: After identifying hepatitis E in an index patient returning from a journey to India all 24 members of this journey were tested for anti-HEV-IgG and IgM using two commercial seroassays (Wantai and Mikrogen), for HEV-RNA by PCR and HEV-Ag by an antigen-assay (Wantai). Results: 5/24 (21%) individuals were viraemic with viral loads between 580-4,800,000 IU/mL. Bilirubin and ALT levels in these patients ranged from 1.3-14.9 mg/dL (mean 7.3 mg/dL, SD 5.6 mg/dL) and 151-4,820 U/L (mean 1,832U/L, SD 1842U/L), respectively and showed significant correlations with viral loads (r = 0.863, p < 0.001; r = 0.890, p < 0.001). No risk factor for food-borne HEV-transmission was identified. All viraemic patients (5/5) tested positive for anti-HEV-IgG and IgM in the Wantai-assay but only 4/5 in the Mikrogen-as-say. Wantai-HEV-antigen-assay was negative in all patients. Six months later all previously viraemic patients tested positive for anti-HEV-IgG and negative for IgM in both assays. However, two non-viremic individuals who initially tested Wantai-IgM-positive stayed positive indicating false positive results. Conclusions: Despite the exact number of exposed individuals could not be determined HEV genotype 1 infections have a high manifestation rate of more than 20%.The Wantai-antigen-test failed, the Wantai-IgM-rapid-test and the Mikrogen-IgM-recomblot showed a better performance but still they cannot replace real-time PCR for diagnosing ongoing HEV-infections.http://www.sciencedirect.com/science/article/pii/S1665268119303618HEVAnti-HEVSerologyWantai-assayMikrogen-assay |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sven Pischke Julian Schulze-zur-Wiesch Marc Lütgehetmann Benno Kreuels Stefan Lueth Petra Kapaun Daniel Benten Stefan Schmiedel Martina Sterneck Ansgar W. Lohse Susanne Polywka |
spellingShingle |
Sven Pischke Julian Schulze-zur-Wiesch Marc Lütgehetmann Benno Kreuels Stefan Lueth Petra Kapaun Daniel Benten Stefan Schmiedel Martina Sterneck Ansgar W. Lohse Susanne Polywka High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India Annals of Hepatology HEV Anti-HEV Serology Wantai-assay Mikrogen-assay |
author_facet |
Sven Pischke Julian Schulze-zur-Wiesch Marc Lütgehetmann Benno Kreuels Stefan Lueth Petra Kapaun Daniel Benten Stefan Schmiedel Martina Sterneck Ansgar W. Lohse Susanne Polywka |
author_sort |
Sven Pischke |
title |
High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India |
title_short |
High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India |
title_full |
High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India |
title_fullStr |
High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India |
title_full_unstemmed |
High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India |
title_sort |
high clinical manifestation rate in an imported outbreak of hepatitis e genotype 1 infection in a german group of travellers returning from india |
publisher |
Elsevier |
series |
Annals of Hepatology |
issn |
1665-2681 |
publishDate |
2017-01-01 |
description |
Background: There are only few reports about travel-associated, imported tropical hepatitis E virus (HEV) genotype 1 infections within Western travellers. We describe the clinical course of a single outbreak of hepatitis E in a German travellers group returning from India and compare the results of two commercial HEV-seroassays. Material and Methods: After identifying hepatitis E in an index patient returning from a journey to India all 24 members of this journey were tested for anti-HEV-IgG and IgM using two commercial seroassays (Wantai and Mikrogen), for HEV-RNA by PCR and HEV-Ag by an antigen-assay (Wantai). Results: 5/24 (21%) individuals were viraemic with viral loads between 580-4,800,000 IU/mL. Bilirubin and ALT levels in these patients ranged from 1.3-14.9 mg/dL (mean 7.3 mg/dL, SD 5.6 mg/dL) and 151-4,820 U/L (mean 1,832U/L, SD 1842U/L), respectively and showed significant correlations with viral loads (r = 0.863, p < 0.001; r = 0.890, p < 0.001). No risk factor for food-borne HEV-transmission was identified. All viraemic patients (5/5) tested positive for anti-HEV-IgG and IgM in the Wantai-assay but only 4/5 in the Mikrogen-as-say. Wantai-HEV-antigen-assay was negative in all patients. Six months later all previously viraemic patients tested positive for anti-HEV-IgG and negative for IgM in both assays. However, two non-viremic individuals who initially tested Wantai-IgM-positive stayed positive indicating false positive results. Conclusions: Despite the exact number of exposed individuals could not be determined HEV genotype 1 infections have a high manifestation rate of more than 20%.The Wantai-antigen-test failed, the Wantai-IgM-rapid-test and the Mikrogen-IgM-recomblot showed a better performance but still they cannot replace real-time PCR for diagnosing ongoing HEV-infections. |
topic |
HEV Anti-HEV Serology Wantai-assay Mikrogen-assay |
url |
http://www.sciencedirect.com/science/article/pii/S1665268119303618 |
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