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2015 ; 3
(2
): 117-26
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Current Knowledge on Hepatitis E
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Pérez-Gracia MT
; García M
; Suay B
; Mateos-Lindemann ML
J Clin Transl Hepatol
2015[Jun]; 3
(2
): 117-26
PMID26355220
show ga
Although only a single serotype of hepatitis E virus (HEV), the causative agent
of hepatitis E, has been identified, there is great genetic variation among the
different HEV isolates reported. There are at least four major recognized
genotypes of HEV: genotypes 1 and 2 are mainly restricted to humans and linked to
epidemic outbreaks in nonindustrialized countries, whereas genotypes 3 and 4 are
zoonotic in both developing and industrialized countries. Besides human strains,
genotype 3 and 4 strains of HEV have been genetically characterized from swine,
sika deer, mongooses, sheep, and rabbits. Currently, there are approximately
11,000 human and animal sequences of HEV available at the International
Nucleotide Sequence Database Collaboration. HEV is the major cause of waterborne
outbreaks of hepatitis in areas of poor sanitation. Additionally, it is
responsible for sporadic cases of viral hepatitis in not only endemic but
industrialized countries as well. Transmission of HEV occurs predominantly by the
fecal-oral route, although parenteral and perinatal routes have been reported.
HEV infection develops in most individuals as a self-limiting, acute, icteric
hepatitis; with mortality rates around 1%. However, some affected individuals
will develop fulminant hepatic failure, a serious condition that is frequently
fatal without a liver transplant. This complication is particularly common when
the infection occurs in pregnant women, where mortality rates rise dramatically
to up to 25%. Among the preventive measures available to avoid HEV infection, two
separate subunit vaccines containing recombinant truncated capsid proteins of HEV
have been shown to be highly effective in the prevention of disease. One of them,
HEV 239, was approved in China, and its commercialization by Innovax began in
November 2012 under the name Hecolin(®).