Chapter 1 : Hepatitis E Virus Infection: an Enterically Transmitted Cause of Hepatitis

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Hepatitis E virus (HEV) is the most recently characterized of five viruses known to produce the majority of cases of hepatitis worldwide. Limited studies suggest that a substantial proportion of cases of acute viral hepatitis in Asia, the Indian subcontinent, and Africa is due to HEV infection. At the time of the epidemic, virus-specific diagnostic tests were not available and the disease was thought to be due to a variant of HAV that overwhelmed host immunity. Subsequent testing of stored specimens demonstrated that these patients did not have acute HAV or acute HBV infection. This newly identified disease was called enterically transmitted non-A, non-B hepatitis and suggested the presence of at least one other hepatitis virus. Prior to production of HEV antigens by recombinant DNA technology, anti-HEV was detected by immune electron microscopy with stool-derived virus or by blocking fluorescent microscopy with antigen from the liver of infected macaques. Subsequently, recombinant expressed proteins and synthetic peptides, primarily from open reading frame (ORF) 2, have been used to develop immunoblotting assays and enzyme immunoassays for the detection of anti-HEV activity. Amplification of RNA by reverse transcription-PCR (RT-PCR) has been used to detect HEV RNA in the stools of experimentally infected animals, as well as in humans with hepatitis E. Early studies indicated that active immunization with recombinant ORF2 proteins provided some protection from infection in the cynomolgus macaque model.

Citation: Favorov M, Margolis H. 1999. Hepatitis E Virus Infection: an Enterically Transmitted Cause of Hepatitis, p 1-16. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch1

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Hepatitis E virus
Hepatitis C virus
Hepatitis B virus
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Figure 1

Seasonal variation in acute hepatitis, Central Asian republics, 1984 to 1986. Tashauz, Turkmenistan; Iliali, Turkmenistan; and Suzak, Kyrgyzstan. The figure is adapted from reference .

Citation: Favorov M, Margolis H. 1999. Hepatitis E Virus Infection: an Enterically Transmitted Cause of Hepatitis, p 1-16. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch1
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Image of Figure 2
Figure 2

Detection of IgG anti-HEV following experimental intravenous inoculation of a chimpanzee with HEV ( ). Baculovirus antigen, enzyme immunoassay configured with a complete ORF2 antigen expressed in insect cells ( ); mosaic protein antigen, immunoassay configured with ORF2 and ORF3 immunogenic epitopes combined in a recombinant expressed mosaic protein ( ).

Citation: Favorov M, Margolis H. 1999. Hepatitis E Virus Infection: an Enterically Transmitted Cause of Hepatitis, p 1-16. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch1
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Table 1

Emerging and reemerging nature of diseases associated with hepatitis viruses, United States

Citation: Favorov M, Margolis H. 1999. Hepatitis E Virus Infection: an Enterically Transmitted Cause of Hepatitis, p 1-16. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch1
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Table 2

Epidemics of enterically transmitted non-A, non-B hepatitis (hepatitis E) worldwide

Citation: Favorov M, Margolis H. 1999. Hepatitis E Virus Infection: an Enterically Transmitted Cause of Hepatitis, p 1-16. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch1

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