Hepatitis E in Italy Site Institute of Virology

Hepatitis E in Italy Site: Institute of Virology, University of Milan Period: January 1994 – December 2001 Study population: 310 patients with acute n. An. C hepatitis (negativity for Ig. M anti-HAV, HBs. Ag, Ig. M anti-HBc, anti-HCV, HCV-RNA and exclusion of autoimmunity, alchol or hepatotoxic drugs) ALT at the hospitalization: mean 1451. 3 IU/ml median 1100 IU/ml range 101 -12290 IU/ml

SAMPLES AND METHODS Samples examined: at least two sera collected during the acute and convalescent phase of the illness and stools. Anti-HEV Ig. G: EIA (Abbott Labs) Anti-HEV Ig. M: in house EIA HEV RNA: nested RT-PCR ORF 3 ORF 1 nt 55 nt 320 ORF 2

Acute hepatitis E: definition • Hepatitis E was defined by the presence of HEV-RNA in sera and/or stools; positivity for Ig. M anti-HEV and/or seroconversion to Ig. G anti-HEV. • To identify the risk factors for hepatitis during the 6 m preceeding the onset of the illness, each patient was interviewed with a pre-coded questionnaire.

Hepatitis E in Italy: Results (1) 44/310 (14. 2%) patients with acute hepatits E mean age 29. 7, range 3 - 65 years 36 males, 8 females Risk factors: 2. 3% 20. 4% Unknown Contact with an infected person Travel to: 77. 3% India Marocco Somalia Angola Sri Lanka Pakistan Bangladesh

Hepatitis E in Italy: Results (2) PAKISTAN BANGLADESH INDIA BANGLADESH PAKISTAN Group I B 2 BANGLADESH B 1 PAKISTAN BANGLADESH Group III US 1 Italia 1 C 4 INDIA C 1 C 2 Pak 1 C 3 I 1 sw. US 1 Phylogenetic tree (unrooted) of 14 viral strains from patients with acute hepatitis E INDIA US 2 Group IV I 2 Group II Ct 1 Mx 1

Hepatitis E in Italy: conclusions • HEV is the aetiological cause in approx 14% of patients with acute n. An. C hepatitis, 95% exhibiting a benign course. Hepatitis E is generally diagnosed in travellers from endemic areas. The identification of a new variant in an individual who never indicated travel or contact with individuals associated with endemic areas, suggest that this virus may be native to Italy. • •