ABSTRACT
Hepatitis E virus (HEV) is the major cause of sporadic and epidemic acute viral hepatitis in adults. Mainly transmitted via fecal-oral route, hepatitis E (HE) represents an important public health concern in developing countries. 1–4 Worldwide, HEV is responsible for an estimated 20 million infections, 3.3 million symptomatic cases, and 56,600 deaths per annum (WHO fact sheet, July 2017). 5 In many countries, large outbreaks of HE are directly associated with contaminations of water and water bodies by sewage. 6–8 HE is endemic in Central and South Asia, North and West Africa, and Mexico, where inadequate sanitation and unhygienic drinking water supply prevail. HEV infection during pregnancy is characterized by high mortality rates of ∼15%–30%, especially in the third trimester, 9,10 whereas the fatality rates in young adults are between 0.5% and 3%. There is circulation of closely related HEV strains in pigs and humans. Zoonotic foodborne autochthonous infections have been reported from several developed countries. 1,11–13 HE is an acute liver disease that may self-recover; however, recent studies have identified HEV as an emerging cause of chronic hepatitis in immunocompromised patients from developed nations. 14,15 The differential clinical progression of HEV infection may be attributed to both host and viral factors.
