Of organ meats and hepatitis E virus: one part of a larger puzzle is solved.
Of organ meats and hepatitis E virus: one part of a larger puzzle is solved.
复制标题
关于器官肉和戊型肝炎病毒：更大难题的一部分得到了解决。
DOI：
10.1086/593212
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Nelson,KenradE
中科院分区：
文献类型：
--
作者：
Kuniholm,MarkH;Nelson,KenradE
1980年，在对甲型肝炎和乙型肝炎病毒进行血清学检测后，戊型肝炎病毒（HEV）首次被假设存在，但没有发现任何一种病原体是印度水传播肝炎流行的原因[1,2]。随后的研究表明，HEV是导致水传播肝炎大流行和发展中国家相当一部分散发（非流行）肝炎的病原[3,4]。戊型肝炎通常有几个独特的流行病学特征。首先，戊型肝炎最常见于青壮年人群；对许多其他肠道病原体（如甲型肝炎病毒）的免疫力是在生命早期建立的，在流行环境中的成年人很少受到影响。其次，戊型肝炎病毒感染似乎在孕妇中引起更严重的疾病。尽管有一些初步的假设，但孕妇发病率和死亡率增加的发病机制仍然知之甚少。最后，与戊型肝炎病例相关的环境暴露通常在发展中国家与工业化国家有所不同。在工业化国家，戊型肝炎偶尔被认为是散发性急性肝炎的病因。其中一些病例可以追溯到到发展中国家的旅行，但其他病例发生在报告没有出国旅行或与旅行者接触的个人中[6-10]。工业化国家对本地戊型肝炎危险因素的早期调查提供的线索很少[9,10]；然而，在20世纪90年代中期，在猪体内检测到抗戊型肝炎抗体和戊型肝炎RNA后，对这种疾病的认识取得了重大进展[11,12]。这些发现表明，猪可能是戊肝病毒的天然宿主，并且该病毒可能通过接触猪或其他动物传播给工业化国家的人类。奇怪的是，在猪身上检测到的病毒与在发展中国家通常在人类身上检测到的病毒（HEV基因型1和2）有很大不同，而且，除了来自工业化国家本地戊型肝炎患者的毒株外，还被划分为不同的基因型（HEV基因型3和4）。虽然猪现在被认为是戊型肝炎基因3型和4型的人畜共患宿主，但据报道，猪对戊型肝炎基因1型和2型的实验性攻击具有抵抗力，这是发展中国家水传播戊型肝炎的主要原因。在这一期的杂志上，Wichmann等人描述了德国本土戊型肝炎危险因素病例对照研究的结果，德国是戊型肝炎报告的国家。在16个月期间报告的病例中，他们发现45人（68%）患有本地戊型肝炎，21人（32%）患有旅行相关戊型肝炎。与欧洲先前的研究一致，他们发现大多数基因型本地病例（15人中有14人）源于基因3型病毒感染[15,16]，而大多数旅行相关病例（9人中有8人）是由于基因1型感染。他们还注意到，据我们所知，这是第一次在欧洲发现由HEV基因型4引起的本地戊型肝炎病例，该毒株主要从亚洲的猪和本地病例患者身上恢复。他们发现，本地戊型肝炎患者近期食用野猪肉（优势比为4.3,95%可信区间为1.2-15.6）和/或内脏（优势比为2.7,95%可信区间为1.2-6.2）的几率高于匹配对照组。针对这些发现，他们提出了旨在改善公众健康的具体预防措施。威克曼的研究…
Hepatitis E virus (HEV) was first hypothesized to exist in 1980 after serologic tests for hepatitis A and hepatitis B viruses failed to implicate either pathogen as the cause of epidemics of water-borne hepatitis in India [1, 2]. Subsequent research has shown that HEV is the etiologic agent responsible for large epidemics of waterborne hepatitis and for a substantial fraction of sporadic (nonepidemic) hepatitis in developing countries [3, 4]. HEV is often noted for several unique epidemiologic characteristics. First, HEV causes clinical hepatitis most commonly in young and middle-aged adults; immunity to many other enteric pathogens, such as hepatitis A virus, is established early in life, and adults in settings of endemicity are rarely affected. Second, HEV infection appears to cause more-severe disease among pregnant women. Despite some preliminary hypotheses [5], the pathogenesis of this increased morbidity and mortality among pregnant women remains poorly understood. Finally, the environmental exposures associated with cases of hepatitis E are often observed to differ in developing versus industrialized countries. In industrialized countries, HEV is occasionally implicated as the cause of sporadic acute hepatitis. Some of these cases can be traced to travel to developing countries, but others have occurred among individuals reporting no foreign travel or contact with travelers [6–10]. Early investigations into the risk factors for autochthonous hepatitis E in industrialized countries provided few clues [9, 10]; however, a major advance in understanding occurred in the mid-1990s following detection of anti-HEV antibodies and HEV RNA in swine [11, 12]. These findings suggested that swine might be a natural reservoir for HEV and that the virus might be transmitted to humans in industrialized countries via exposure to swine or other animals. Curiously, the viruses detected in swine were significantly different from those generally detected in humans in developing countries (HEV genotypes 1 and 2) and, alongside strains derived from humans with autochthonous cases of hepatitis E in industrialized countries, have been assigned to different genotypes (HEV genotypes 3 and 4). Whereas swine are now thought to be a zoonotic reservoir for HEV genotypes 3 and 4, it has been reported that they are resistant to experimental challenge with HEV genotypes 1 and 2 [13], the principal causes of water-borne hepatitis E in developing countries.In this issue of the Journal, Wichmann et al.[14] describe the results of a casecontrol study of risk factors for autochthonous hepatitis E in Germany, a country in which hepatitis E is reportable. Among the cases reported over a 16-month period, they found 45 persons (68%) with autochthonous hepatitis E and 21 (32%) with travel-related hepatitis E. Consistent with previous studies from Europe, they found that the majority of the genotyped autochthonous cases (14 of 15) stemmed from infection with genotype 3 viruses [15, 16], whereas the majority of travel-associated cases (8 of 9) were due to genotype 1 infections. They also note, for the first time to our knowledge, a case of autochthonous hepatitis E in Europe caused by HEV genotype 4, a strain primarily recovered from swine and persons with autochthonous cases in Asia. They found that the odds of recent consumption of wild-boar meat (odds ratio, 4.3; 95% confidence interval, 1.2–15.6) and/or offal (odds ratio, 2.7; 95% confidence interval, 1.2–6.2) were higher among persons with autochthonous hepatitis E than among matched control subjects. In response to these findings, they suggest specific preventive measures aimed at improving public health. The study by Wichmann …
登录
查看更多内容
荷兰发生多起与戊型肝炎病毒感染相关的急性肝炎病例。
影响因子：
11.8
作者：
Marc;W. M. Jaspers;W. V. D. van der Poel;F. Verschoor;A. M. de Roda Husman;H. Winter;H. Zaaijer;M. Koopmans
通讯作者：
M. Koopmans
在加利福尼亚州获得的急性戊型肝炎感染。
影响因子：
11.8
作者：
Thomas Tsang;Edward K. Denison;Howard V. Williams;Linda Venczel;Michele M. Ginsberg;D. Vugia
通讯作者：
D. Vugia
DOI：
10.4269/ajtmh.1999.61.331
发表时间：
1999-08-01
影响因子：
3.3
作者：
Kabrane-Lazizi, Y;Fine, JB;Purcell, RH
通讯作者：
Purcell, RH
影响因子：
6.4
作者：
Emerson, SU;Arankalle, VA;Purcell, RH
通讯作者：
Purcell, RH