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Association of hepatitis E virus with an outbreak of hepatitis in Pakistan: Serologic responses and pattern of virus excretion
Author(s) -
Ticehurst John,
Popkin Terry J.,
Bryan Joe P.,
Innis Bruce L.,
Duncan J. Fred,
Ahmed Aftab,
Iqbal Muhammad,
Malik Iftikhar,
Kapikian Albert Z.,
Legters Llewellyn J.,
Purcell Robert H.
Publication year - 1992
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.1890360205
Subject(s) - hepatitis e virus , virology , feces , caliciviridae , hepatitis e , serology , jaundice , hepatitis , outbreak , hepatitis a , virus , biology , antibody , viral disease , medicine , immunology , microbiology and biotechnology , genotype , biochemistry , gene
Hepatitis E virus (HEV), a positive‐strand RNA agent, has been associated with enterically transmitted non‐A, non‐B hepatitis in Asia, Africa, and Mexico. To evaluate the role of HEV in an outbreak of hepatitis in Pakistan, we used immune electron microscopy to detect 1) antibody to HEV, for evidence of infection, and 2) virus, to determine the pattern of HEV excretion. Paired sera from 2 patients were assayed for antibody by using reference HEV: one seroconverted, an atypical finding for HEV infections; the other had high levels of anti‐HEV in both sera. Virus particles with the size (29 × 31 nm) and morphology of HEV were detected in feces from 10 of 85 patients and serologically identified as HEV by using reference antibodies from an HEV‐infected chimpanzee. One of these HEV‐containing specimens was collected 9 days before the onset of jaundice; it was among feces from 38 outpatients with nonspecific symptoms and biochemical hepatitis, 12 of whom subsequently developed jaundice. The other 9 feces with HEV were among 36 collected within 7 days of the onset of acute icteric hepatitis; all 11 feces from days 8 to 15 were negative for HEV. Fecal concentrations of HEV appeared t o be lower than those of many enteric viruses: only one specimen contained as many as 5 particles per EM grid square. It is concluded that HEV was etiologically associated with the epidemic and was predominantly excreted at very low levels during the first week of jaundice.