Analysis of the sero-­epidemiology and clinical manifestations of hepatitis E virus in South America

M. B. PISANO; M. MARTINEZ WASSAF; S. MIRAZO; A. FANTILLI; J. D. DEBES; V. RÉ

Toronto

Encuentro; Global hepatitis summit 2018; 2018

Introduction: Hepatitis E virus (HEV) is a frequent cause of acute viral hepatitis of enteric transmission worldwide. In high prevalence areas such as Asia HEV produces large outbreaks of hepatitis, while low-prevalence o areas such as Europe it can lead to chronic disease in immune-compromised individuals. In South America the overall epidemiology and burden of disease remainslargely unknown.Methods: 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 showed a much higher seroprevalence of IgG among HIV-infected individuals, transplant recipients and patients on hemodialysis. HEV genotype 3 was the most frequently detected inthe region, with HEV genotype 1 detected only in Venezuela and Uruguay. Although no large HEV outbreaks were been described there are numerous reports of small acute outbreaks as well as isolated cases of hepatitis across the region, most of them by HEV genotype 3. Extrahepatic manifestations of HEV, which arewidely reported around the globe, were rare in the region with only Argentina reporting HEV-associated thyroiditis and aplastic anemia. Chronic HEV was equally rare with only two cases reported in solid-organ transplant recipients. Detection of HEV in the swine population is widely prevalent in the region with detections as high as 100% in slaughterhouses of specific Colombian regions.In addition to pigs, anti-HEV antibodies have been detected in other animal species such as cows, dogs and chickens. However, the potential role of these animals as zoonotic sources of infection remains unknown.Conclusions: HEV is widely distributed throughout South America, inducing sporadic cases of acute hepatitis. The extent of extrahepatic manifestations or progression to chronicity does not seem to represent a public health concern as in other regions of the world.