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Acute hepatitis E in south-west France over a 5-year period

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Abstract

Background

Hepatitis E was found in people living in industrialized countries who had not travelled to highly endemic areas.

Objectives

To study the cases of acute hepatitis E confirmed thanks to viral genomic detection over a 5 years period in south-west France.

Study Design

62 cases of hepatitis E were identified between 2003 and 2007. Their demographic, clinical, and virological features were analyzed.

Results

Cases of acute hepatitis E occurred regularly throughout this period. No seasonal variation was found. Patients, usually male (sex ratio = 1.95), were adults living in both urban and rural areas. Sixty (96.8%) patients had not travelled abroad during the 6 months before diagnosis. Clinical manifestations ranged from asymptomatic infection to severe hepatitis.

HEV was genotyped in 55 specimens. All the patients who had not travelled abroad were infected with genotype 3.

Conclusion

The incidence of hepatitis E in south-west France was stable from 2003 to 2007, 96.8% of the cases were autochthonous. There was an age-related increase in the disease and patients tended to be men. The predominant genotype and subtype was 3f. However, contaminations pathways involved in hepatitis E in our area remain to clarify.

Introduction

Hepatitis E virus (HEV) infections are recognized as an emerging autochthonous disease in industrialized countries.1 Such infections can evolve from a limited biological hepatitis to fulminant hepatitis.

HEV isolates have been classified into four genotypes.2 HEV genotypes 3 (USA, Europe, Japan, Argentina) are found in human and animals like swine, boar and deer.3 Phylogenetic and epidemiologic studies have revealed the relationships between the strains isolated from humans and pigs.4, 5 It is suggested that hepatitis E is a zoonosis transmitted directly as a food-borne disease,6, 7, 8 or indirectly from animals to humans. Moreover raw water might be a vector of HEV transmission as observed in developing areas.

We have studied the cases of acute hepatitis E in south-west France from 2003 to 2007 to learn more about it. Cases were diagnosed thanks to HEV genomic detection.

Section snippets

Setting

Midi Pyrénées counts for 4.4% of the french population while it represents 8.3% of the territory (45,348 km2). One third of the population lives in the main town Toulouse and its suburbs. Such inhabitants are considered as urban. The rest of the population lives in small towns or villages in a rural landscape. Rainfall was collected from MeteoFrance database.

Patients

We studied data from 62 patients who were positive for HEV RNA in a context of acute hepatitis between 2003 and 2007. Patients were from

Results

62 cases of acute hepatitis E confirmed thanks to RT-PCR between 2003 and 2007 were studied. The number of 10–16 cases per year (Fig. 1) was stable throughout this period without significant seasonal variation. They were 41 men and 21 women (sex ratio 1.95 (p = 0.06) all Caucasians. The mean age of the men (57.9, range: 20–82) was not statistically different (p = 0.1) than the women's one (47.9, range: 25–77). 36 patients lived in a rural area and 26 in a urban area (p = 0.6). The ages (mean, range)

Discussion

From 2003 to 2007 we recorded 62 patients suffering from acute hepatitis E diagnosed thanks to HEV genome detection. The cases remained stable during the period, and the number of autochthonous hepatitis E ranged from 8 in 2007 to 16 in 2004. There was no seasonal variation in the time of diagnosis and cases were not related to rainfall intensity (Fig. 1), in contrast to endemic areas where the incidence rate is higher during monsoon months. The risk of infection in our area seems to be small

Acknowledgement

Hepatologists from local hospitals in Midi Pyrénées.

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