Chapter 3 : Enterically Transmitted Hepatitis

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase

Buy this Chapter
Digital (?) $15.00

Preview this chapter:
Zoom in

Enterically Transmitted Hepatitis, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555815738/9781555814649_Chap03-1.gif /docserver/preview/fulltext/10.1128/9781555815738/9781555814649_Chap03-2.gif


The genomic sequences of various hepatitis A virus (HAV) genotypes are, however, quite highly conserved in the 5' untranslated region, making it the most suitable genomic region for designing assays for detection and quantification of the virus in various clinical and other specimens. HAV infection induces the development of specific immunoglobulin M (IgM) and IgG antibodies. Immunization with HAV vaccines is associated with the development of IgG antibodies against the viral structural proteins. Humans are the only source of HAV. After excretion in human feces, the virus can contaminate food items though several possible routes. The detection of HAV in food material and environmental specimens is therefore based on specific methods such as reverse transcription-PCR (RT-PCR) for detecting small quantities of viral nucleic acids; these methods involve amplification of viral genomic sequences, making them highly sensitive. Adequate heating and proper handling of foods may be expected to reduce the risk of food-borne transmission of hepatitis E virus (HEV) infection, although direct evidence supporting the efficacy of these measures is lacking. Attempts at identifying novel viruses responsible for parenterally transmitted hepatitis led to the identification of genetic material of several putative viruses, such as hepatitis G virus/GB virus and TT virus. HAV and HEV are common causes of enterically transmitted viral hepatitis. Both these viruses have RNA genomes, are excreted in feces of the infected persons, and are transmitted by the fecal-oral route.

Citation: Aggarwal R, Naik S. 2008. Enterically Transmitted Hepatitis, p 65-85. In Koopmans M, Cliver D, Bosch A, Doyle M (ed), Food-Borne Viruses. ASM Press, Washington, DC. doi: 10.1128/9781555815738.ch3

Key Concept Ranking

Nucleic Acid Amplification Techniques
Hepatitis E virus
Hepatitis C virus
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


Image of Figure 1
Figure 1

Epidemiological patterns of HAV infection.

Citation: Aggarwal R, Naik S. 2008. Enterically Transmitted Hepatitis, p 65-85. In Koopmans M, Cliver D, Bosch A, Doyle M (ed), Food-Borne Viruses. ASM Press, Washington, DC. doi: 10.1128/9781555815738.ch3
Permissions and Reprints Request Permissions
Download as Powerpoint


1. Aggarwal, R., and, S. R. Naik. 1994. Hepatitis E: intrafamilial transmission versus water-borne spread. J. Hepatol. 21:718723.
2. Arankalle, V. A.,, M. S. Chadha,, S. A. Tsarev,, S. U. Emerson,, A. R. Risbud,, K. Banerjee, and, R. H. Purcell. 1994. Seroepidemiology of water-borne hepatitis in India and evidence for a third enterically-transmitted hepatitis agent. Proc. Natl. Acad. Sci. USA 91:34283432.
3. Arankalle, V. A.,, L. P. Chobe,, M. V. Joshi,, M. S. Chadha,, B. Kundu, and, A. M. Walimbe. 2002. Human and swine hepatitis E viruses from Western India belong to different genotypes. J.Hepatol. 36:417425.
4. Beller, M. 1992. Hepatitis A outbreak in Anchorage, Alaska, traced to ice slush beverages. West. J. Med. 156:624627.
5. Brack, K.,, W. Frings,, A. Dotzauer, and, A. Vallbracht. 1998. A cytopathogenic, apop-tosis-inducing variant of hepatitis A virus. J. Virol. 72:33703376.
6. Bradley, D.,, A. Andjaparidze,, E. H. Cook, Jr.,, K. McCaustland,, M. Balayan,, H. Stetler,, O. Velazquez,, B. Robertson,, C. Humphrey,, M. Kane, and, I. Weisfuse. 1988. Aetiological agent of enterically transmitted non-A, non-B hepatitis. J. Gen. Virol. 69:731738.
7. Calci, K. R.,, G. K. Meade,, R. C. Tezloff, and, D. H. Kingsley. 2005. High-pressure inac-tivation of hepatitis A virus within oysters. Appl. Environ. Microbiol. 71:339343.
8. Chen, H.Y.,, Y. Lu,, T. Howard,, D. Anderson,, P. Y. Fong,, W. P. Hu,, C. P. Chia, and, M. Guan. 2005. Enzyme-linked immunosorbent assay for rapid detection of immunoglobulin M antibodies to hepatitis E virus in human sera. Clin. Diagn. Lab. Immunol. 12:593598.
9. Cohen, J. I.,, J. R. Ticehurst,, R. H. Purcell,, A. BucklerWhite, and, B. M. Baroudy. 1987. Complete nucleotide sequence of wild-type hepatitis A virus: comparison with different strains of hepatitis A virus and other picornaviruses. J. Virol. 61:5059.
10. Conaty, S.,, P. Bird,, G. Bell,, E. Kraa,, G. Grohmann, and, J. M. McAnulty. 2000. Hepatitis A in New South Wales, Australia, from consumption of oysters: the first reported outbreak. Epidemiol. Infect. 124:121130.
11. Dawson, G. J.,, K. H. Chau,, C. M. Cabal,, P. O. Yarbough,, G. R. Reyes, and, I. K. Mushahwar. 1992. Solid-phase enzyme-linked immunosorbent assay for hepatitis E virus IgG and IgM antibodies utilizing recombinant antigens and synthetic peptides. J. Virol. Methods 38:175186.
12. DeMedici, D.,, M. Ciccozzi,, A. Fiore,, S. DiPasquale,, A. Parlato,, P. RicciBitti, and, L. Croci. 2001. Closed-circuit system for the depuration of mussels experimentally contaminated with hepatitis A virus. J. Food Prot. 64:877880.
13. Desenclos, J. C.,, K. C. Klontz,, M. H. Wilder,, O. V. Nainan,, H. S. Margolis, and, R. A. Gunn. 1991. A multistate outbreak of hepatitis A caused by the consumption of raw oysters. Am.J. Public Health 81:12681272.
14. Emerson, S. U.,, V. A. Arankalle, and, R. H. Purcell. 2005. Thermal stability of hepatitis E virus. J. Infect. Dis. 192:930933.
15. Emerson, S. U.,, P. Clemente-Casares,, N. Moiduddin,, V. A. Arankalle,, U. Torian, and, R. H. Purcell. 2006. Putative neutralization epitopes and broad cross-genotype neutralization of hepatitis E virus confirmed by a quantitative cell-culture assay. J. Gen. Virol. 87:697704.
16. Emerson, S. U.,, H. Nguyen,, J. Graff,, D. A. Stephany,, A. Brockington, and, R. H. Purcell. 2004. In vitro replication of hepatitis E virus (HEV) genomes and of an HEV replicon expressing green fluorescent protein. J. Virol. 78:48384846.
17. Enriquez, R.,, G. G. Frosner,, V. Hochstein-Mintzel,, S. Riedemann, and, G. Reinhardt. 1992. Accumulation and persistence of hepatitis A virus in mussels. J. Med. Virol. 37:174179.
18. Feagins, A. R.,, T. Opriessnig,, D. K. Guenette,, P. G. Halbur, and, X. J. Meng. 2007. Detection and characterization of infectious hepatitis E virus from commercial pig livers sold in local grocery stores in the USA. J. Gen. Virol. 88:912917.
19. Hadler, S. C.,, H. M. Webster,, J. J. Erben,, J. E. Swanson, and, J. E. Maynard.. Hepatitis A in day-care centers. A community-wide assessment. N. Engl. J. Med. 302:12221227.
20. Halbur, P. G.,, C. Kasorndorkbua,, C. Gilbert,, D. Guenette,, M. B. Potters,, R. H. Purcell,, S. U. Emerson,, T. E. Toth, and, X.J. Meng. 2001. Comparative pathogenesis of infection of pigs with hepatitis E viruses recovered from a pig and a human. J. Clin. Microbiol. 39:918923.
21. Halliday, M. L.,, L. Y. Kang,, T. K. Zhou,, M. D. Hu,, Q. C. Pan,, T. Y. Fu,, Y. S. Huang, and, S. L. Hu. 1991. An epidemic of hepatitis A attributable to the ingestion of raw clams in Shanghai, China. J. Infect. Dis. 164:852859.
22. Huang, F. F.,, Z. F. Sun,, S. U. Emerson,, R. H. Purcell,, H. L. Shivaprasad,, F. W. Pierson,, T. E. Toth, and, X. J. Meng. 2004. Determination and analysis of the complete genomic sequence of avian hepatitis E virus (avian HEV) and attempts to infect rhesus monkeys with avian HEV. J. Gen. Virol. 85:16091618.
23. Hutin, Y. J.,, V. Pool,, E. H. Cramer,, O. V. Nainan,, J. Weth,, I. T. Williams,, S. T. Goldstein,, K. F. Gensheimer,, B. P. Bell,, C. N. Shapiro,, M.J. Alter, and, H. S. Margolis for the National Hepatitis A Investigation Team. 1999. A multistate, foodborne outbreak of hepatitis A. N. Engl. J. Med. 340:595602.
24. Hutin, Y.J.,, K. M. Sabin,, L. C. Hutwagner,, L. Schaben,, G. M. Shipp,, D. M. Lord,, J. S. Conner,, M. P. Quinlisk,, C. N. Shapiro, and, B. P. Bell. 2000. Multiple modes of hepatitis A virus transmission among methamphetamine users. Am. J. Epidemiol. 152:186192.
25. Innis, B. L.,, R. Snitbhan,, P. Kunasol,, T. Laorakpongse,, W. Poopatanakool,, C. A. Kozik,, S. Suntayakorn,, T. Suknuntapong,, A. Safary,, D. B. Tang, et al., 1994. Protection against hepatitis A by an inactivated vaccine. JAMA 271:13281334.
26. Ishikawa, K.,, K. Matsui,, T. Madarame,, S. Sato,, K. Oikawa, and, T. Uchida. 1995. Hepatitis E probably contracted via a Chinese herbal medicine, demonstrated by nucleotide sequencing. J. Gastroenterol. Hepatol. 30:534538.
27. Khuroo, M. S. 1980. Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type. Am. J. Med. 68:818824.
28. Khuroo, M. S.,, S. Kamili,, M. Y. Dar,, R. Moecklii, and, S. Jameel. 1993. Hepatitis E and long-term antibody status. Lancet 341:1355.
29. Khuroo, M. S.,, S. Kamili, and, S. Jameel. 1995. Vertical transmission of hepatitis E virus. Lancet 345:10251026.
30. Khuroo, M. S.,, S. Kamili, and, G. N. Yattoo. 2004. Hepatitis E virus infection may be transmitted through blood transfusions in an endemic area. J. Gastroenterol. Hepatol. 19:778784.
31. Kumar, A.,, R. Aggarwal,, S. R. Naik,, V. Saraswat,, U. C. Ghoshal, and, S. Naik. 2004. Hepatitis E virus is responsible for decompensation ofchronic liver disease in an endemic region. Indian J. Gastroenterol. 23:5962.
32. Lednar, W. M.,, S. M. Lemon,, J. W. Kirkpatrick,, R. R. Redfield,, M. L. Fields, and, P. W. Kelley. 1985. Frequency of illness associated with epidemic hepatitis A virus infections in adults. Am. J. Epidemiol. 122:226233.
33. Lemon, S. M. 1993. Immunologic approaches to assessing the response to inactivated hepatitis A vaccine. J. Hepatol. 18(Suppl. 2):S15S19.
34. Li, T. C.,, T. Miyamura, and, N. Takeda. 2007. Detection of hepatitis E virus RNA from the bivalve Yamato-Shijimi (Corbicula japonica) in Japan. Am. J. Trop. Med. Hyg. 76:170172.
35. Lowry, P. W.,, R. Levine,, D. F. Stroup,, R. A. Gunn,, M. H. Wilder, and, C. Konigsberg, Jr. 1989. Hepatitis A outbreak on a floating restaurant in Florida, 1986. Am. J. Epidemiol. 129:155164.
36. Martin, A., and, S. M. Lemon. 2006. Hepatitis A virus: from discovery to vaccines. Hepatology43:S164S172.
37. Matsuda, H.,, K. Okada,, K. Takahashi, and, S. Mishiro. 2003. Severe hepatitis E virus infection after ingestion of uncooked liver from a wild boar. J. Infect. Dis. 188:944.
38. Mbithi,J. N.,, V. S. Springthorpe,, J. R. Boulet, and, S. A. Sattar. 1992. Survival of hepatitis A virus on human hands and its transfer on contact with animate and inanimate surfaces. J. Clin. Microbiol. 30:757763.
39. McCaustland, K. A.,, W. W. Bond,, D. W. Bradley,, J. W. Ebert, and, J. E. Maynard. 1982. Survival of hepatitis A virus in feces after drying and storage for 1 month. J. Clin. Microbiol. 16:957958.
40. Meng, X. J.,, P. G. Halbur,, M. S. Shapiro,, S. Govindarajan,, J. D. Bruna,, I. K. Mushahwar,, R. H. Purcell, and, S. U. Emerson. 1998. Genetic and experimental evidence for cross-species infection by swine hepatitis E virus. Am. Soc. Microbiol. 72:97149721.
41. Meng, X. J.,, R. H. Purcell,, P. G. Halbur,, J. R. Lehman,, D. M. Webb,, T. S. Tsareva,, J. S. Haynes,, B.J. Thacker, and, S. U. Emerson. 1997. A novel virus in swine is closely related to the human hepatitis E virus. Proc. Natl. Acad. Sci. USA 94:98609865.
42. Naik, S. R.,, R. Aggarwal,, P. N. Salunke, and, N. N. Mehrotra. 1992. A large waterborne viral hepatitis E epidemic in Kanpur, India. Bull. W.H. O. 70:597604.
43. Nainan, O. V.,, G. Xia,, G. Vaughan, and, H. S. Margolis. 2006. Diagnosis of hepatitis A virus infection: a molecular approach. Clin. Microbiol. Rev. 19:6379.
44. Nicand, E.,, G. L. Armstrong,, V. Enouf,, J. P. Guthmann,, J. P. Guerin,, M. Caron,, J. Y. Nizou, and, R. Andraghetti. 2005. Genetic heterogeneity of hepatitis E virus in Darfur, Sudan, and neighboring Chad. J. Med. Virol. 77:519521.
45. Nuanualsuwan, S.,, T. W. Mariam,, S. Himathongkham, and, D. O. Cliver. 2002. Ultraviolet inactivation of feline calicivirus, human enteric viruses and coliphages. Photo-chem. Photobiol. 76:406410.
46. Robertson, B. H.,, R. W. Jansen,, B. Khanna,, A. Totsuka,, O. V. Nainan,, G. Siegl,, A. Widell,, H. S. Margolis,, S. Isomura,, K. Ito,, T. Ishizu,, Y. Moritsugu, and, S. M. Lemon. 1992. Genetic relatedness of hepatitis A virus strains recovered from different geographic regions. J. Gen. Virol. 73:13651377.
47. Schlauder, G. G.,, B. Frider,, S. Sookoian,, G. C. Castano, and, I. K. Mushahwar. 2000. Identification of 2 novel isolates of hepatitis E virus in Argentina. J. Infect. Dis. 182:294297.
48. Shan, X. C.,, P. Wolffs, and, M. W. Griffiths. 2005. Rapid and quantitative detection of hepatitis A virus from green onion and strawberry rinses by use of real-time reverse transcription PCR. Appl. Environ. Microbiol. 71:56245626.
49. Shrestha, M. P.,, R. M. Scott,, D. M. Joshi,, M. P. Mammen, Jr.,, G. B. Thapa,, N. Thapa,, K. S. Myint,, M. Fourneau,, R. A. Kuschner,, S. K. Shrestha,, M. P. David,, J. Seriwatana,, D. W. Vaughn,, A. Safary,, T. P. Endy, and, B. L. Innis. 2007. Safety and efficacy of a recombinant hepatitis E vaccine. N. Engl. J. Med. 356:895903.
50. Somani, S. K.,, R. Aggarwal,, S. R. Naik,, S. Srivastava, and, S. Naik. 2003. A serological study of intrafamilial spread from patients with sporadic hepatitis E virus infection. J. Viral Hepat. 10:446449.
51. Staes, C.J.,, T. L. Schlenker,, I. Risk,, K. G. Cannon,, H. Harris,, A. T. Pavia,, C. N. Shapiro, and, B. P. Bell. 2000. Sources of infection among persons with acute hepatitis A and no identified risk factors during a sustained community-wide outbreak. Pediatrics 106:E54.
52. Tanaka, T.,, M. Takahashi,, E. Kusano, and, H. Okamoto. 2007. Development and evaluation of an efficient cell-culture system for hepatitis E virus. J. Gen. Virol. 88:903911.
53. Tei, S.,, N. Kitajima,, K. Takahashi, and, S. Mishiro. 2003. Zoonotic transmission of hepatitis E virus from deer to human beings. Lancet 362:371373.
54. Tsarev, S. A.,, S. U. Emerson,, G. R. Reyes,, T. S. Tsareva,, L. J. Legters,, I. A. Malik,, M. Iqbal, and, R. H. Purcell. 1992. Characterization of a prototype strain of hepatitis E virus. Proc. Natl. Acad. Sci. USA 89:559563.
55. Velazquez, O.,, H. C. Stetler,, C. Avila,, G. Ornelas,, C. Alvarez,, S. C. Hadler,, D. W. Bradley, and, J. Sepulveda. 1990. Epidemic transmission of enterically transmitted non-A, non-B hepatitis in Mexico, 1986–1987. JAMA 263:32813285.
56. Viswanathan, R. 1957. Infectious hepatitis in Delhi (1955–56). A critical study: epidemiology. Indian J. Med. Res. 45:129.
57. Waar, K.,, M. M. Herremans,, H. Vennema,, M. P. Koopmans, and, C. A. Benne. 2005. Hepatitis E is a cause of unexplained hepatitis in The Netherlands. J. Clin. Virol. 33:145149.
58. Werzberger, A.,, B. Mensch,, B. Kuter,, L. Brown,, J. Lewis,, R. Sitrin,, W. Miller,, D. Shouval,, B. Wiens,, G. Calandra,, J. Ryan,, P. Provost, and, D. Nalin. 1992. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N. Engl. J. Med. 13: 453457.
59. Wheeler, C.,, T. M. Vogt,, G. L. Armstrong,, G. Vaughan,, A. Weltman,, O. V. Nainan,, V. Dato,, G. Xia,, K. Waller,, J. Amon,, T. M. Lee,, A. Highbaugh-Battle,, C. Hembree,, S. Evenson,, M. A. Ruta,, I. T. Williams,, A. E. Fiore, and, B. P. Bell. 2005. An outbreak of hepatitis A associated with green onions. N. Engl. J. Med. 353:890897.
60. Willner, I. R.,, M. D. Uhl,, S. C. Howard,, E. Q. Williams,, C. A. Riely, and, B. Waters. 1998. Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann. Intern. Med. 128:111114.
61. Yazaki, Y.,, H. Mizuo,, M. Takahashi,, T. Nishizawa,, N. Sasaki,, Y. Gotanda, and, H. Okamoto. 2003. Sporadic acute or fulminant hepatitis E in Hokkaido, Japan, may be food-borne, as suggested by the presence of hepatitis E virus in pig liver as food. J. Gen. Virol. 84:23512357.
62. Yotsuyanagi, H.,, K. Koike,, K. Yasuda,, K. Moriya,, Y. Shintani,, H. Fujie,, K. Kurokawa, and, S. Iino. 1996. Prolonged fecal excretion of hepatitis A virus in adult patients with hepatitis A as determined by polymerase chain reaction. Hepatology24:1013.
63. Zhuang, H.,, X. -Y. Cao,, C.-B. Liu, and, G.-M. Wang. 1991. Enterically transmitted nonA, non-B hepatitis in China, p. 277285 In T. Shikata, R. H. Purcell, and, T. Uchida (ed.), Viral Hepatitis C, D and E. Excerpta Medica, Amsterdam, The Netherlands.


Generic image for table
Table 1

Characteristics of major hepatitis viruses

Citation: Aggarwal R, Naik S. 2008. Enterically Transmitted Hepatitis, p 65-85. In Koopmans M, Cliver D, Bosch A, Doyle M (ed), Food-Borne Viruses. ASM Press, Washington, DC. doi: 10.1128/9781555815738.ch3

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error