Hepatitis E in South America: Analysis of the sero-epidemiology and clinical impact in the región

MARÍA BELÉN PISANO, ; MARIBEL MARTÍNEZ WASSAF; SANTIAGO MIRAZO, ; JAMES LEATHERS; ANABELLA FANTILLI,; JOSÉ D. DEBES,; VIVIANA E. RÉ

Congreso; XXV Congreso de la Asociación Latinoamericana para el estudio del hígado (ALEH); 2018

Asociación Latinoamericana para el estudio del hígado (ALEH)

Introduction: Hepatitis E virus (HEV) is a frequent cause of acute viral hepatitis of enteric transmission worldwide. IN non-endemic areas if can lead to chronic viral hepatitis. In South America the overall epidemiology and burden of disease remains largely unknown.Objectives: To evaluate available data about hepatitis E in South American, to understand the impact of the virus in the regionMethods: We searched published scientific articles regarding HEV in South America by assessment of Pubmed/NLM using the following keywords: HEV, South America, seroprevalence, genotypes, circulation. The search yielded 97 articles and these were evaluated to address the seroprevalence of HEV in human and animal samples, acute and chronic cases as well as associated risk factors in the region.Results: The overall prevalence of HEV IgG in South America among blood donors ranged from 1.8 to 9.8%. Reports from Brazil and Argentina exposed a much higher seroprevalence of HEV among HIV-infected individuals, transplant recipients and patients undergoing hemodialysis. HEV genotype 3 was the most frequently detected in the region, with HEV genotype 1 detected only in Venezuela and Uruguay. There multiple reports of small acute outbreaks as well as isolated cases of hepatitis across the region, most of them by HEV genotype 3, but no large outbreaks were identified during the study period. Extrahepatic manifestations of HEV were rare with one case of HEV-associated thyroiditis and aplastic anemia reported in Argentina. Chronic HEV was equally rare with only two cases reported in solid-organ transplant recipients. Interestingly, HEV was prevalent in the swine population with rates as high as 100% in slaughterhouses of certain Colombian regions. HEV positivity was also reported in animal species such as cows, dogs and chickens. Whether HEV represents a source of zoonotic transmission remains unclear. Conclusions: HEV is widely distributed throughout South America with variable prevalences in humans as well as animals. There are sporadic cases of acute hepatitis E but chronic infection does not represent a public health issue and exra-hepatic manifestations are unusual.