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Molecular investigation of hepatitis E virus infection in patients with acute hepatitis in Kathmandu, Nepal
Author(s) -
Shrestha Santosh Man,
Shrestha Shobhana,
Tsuda Fumio,
Nishizawa Tsutomu,
Gotanda Yuhko,
Takeda Naokazu,
Okamoto Hiroaki
Publication year - 2003
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.10276
Subject(s) - virology , hepatitis e virus , hepatitis , hepatitis e , antibody , virus , medicine , hepatitis a , biology , genotype , immunology , gene , biochemistry
One hundred fifty‐four consecutive patients with sporadic acute hepatitis, who were seen at a city hospital in the Kathmandu valley of Nepal in 1997, were studied. IgM antibodies to hepatitis A virus were detected in four patients (3%), IgM antibodies to hepatitis B core in four patients (3%), hepatitis B surface antigen in 20 (13%), and hepatitis C virus RNA in four patients (3%). IgM antibodies to hepatitis E virus (HEV) (anti‐HEV IgM) and HEV RNA were detected in 77 (50%) and 48 (31%), respectively. Consequently, 86 patients (56%) including nine HEV‐viremic patients without anti‐HEV IgM, were diagnosed with hepatitis E. The cause of hepatitis was not known in 53 patients (34%). All 48 HEV RNA‐positive samples were genotyped as 1, and subtyped further as 1a in 17 (35%), 1c in 29 (60%), and mixed infection of 1a and 1c in 2 (4%). A seasonal difference in the prevalence of HEV subtypes was recognized. Before the rainy season (January to July), both 1a and 1c isolates were found: the intrasubtypic difference was up to 9.0% and 1.7%, respectively, in the 412‐nucleotide sequence of open reading frame 2. During the rainy season (August), only 1c isolates (n = 17) with 99.5–100% identity were found; 13 of 17 isolates had the same sequence, being identical to the 3 isolates that emerged at the end of July. These results suggest that a particular HEV 1c strain spread widely during the rainy season and was implicated in a small epidemic in the Kathmandu valley in August 1997. J. Med. Virol. 69:207–214, 2003. © 2003 Wiley‐Liss, Inc.