Short communicationAcute hepatitis E in south-west France over a 5-year period
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.
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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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