Webb Glynn W, Dalton Harry R
University of Manchester NHS Foundation Trust, 7 Radnor Rd London NW6 6TT Manchester, UK.
Truro, Cornwall, UK.
Ther Adv Infect Dis. 2019 Apr 3;6:2049936119837162. doi: 10.1177/2049936119837162. eCollection 2019 Jan-Dec.
Hepatitis E virus (HEV) is the most common cause of viral hepatitis in the world. It is estimated that millions of people are infected every year, resulting in tens of thousands of deaths. However, these estimates do not include industrialized regions and are based on studies which employ assays now known to have inferior sensitivity. As such, this is likely to represent a massive underestimate of the true global burden of disease. In the developing world, HEV causes large outbreaks and presents a significant public-health problem. Until recently HEV was thought to be uncommon in industrialized countries, and of little relevance to clinicians in these settings. We now know that this is incorrect, and that HEV is actually very common in developed regions. HEV has proved difficult to study , with reliable models only recently becoming available. Our understanding of the lifecycle of HEV is therefore incomplete. Routes of transmission vary by genotype and location: endemic regions experience large waterborne epidemics, while sporadic cases in industrialized regions are zoonotic infections likely spread the food chain. Both acute and chronic infection has been observed, and a wide range of extrahepatic manifestations have been reported. This includes neurological, haematological and renal conditions. As the complete clinical phenotype of HEV infection is yet to be characterized, a large proportion of cases go unrecognized or misdiagnosed. In many cases HEV infection does not feature in the differential diagnosis due to a lack of knowledge and awareness of the disease amongst clinicians. In combination, these factors have contributed to an underestimation of the threat posed by HEV. Improvements are required in terms of recognition and diagnosis of HEV infection if we are to understand the natural history of the disease, improve management and reduce the burden of disease around the world.
戊型肝炎病毒（HEV）是全球病毒性肝炎最常见的病因。据估计，每年有数百万人感染，导致数万人死亡。然而，这些估计不包括工业化地区，且基于采用目前已知灵敏度较低检测方法的研究。因此，这很可能极大低估了该疾病的全球真实负担。在发展中世界，HEV引发大规模疫情，构成重大公共卫生问题。直到最近，HEV在工业化国家还被认为不常见，与这些地区的临床医生关系不大。我们现在知道这是错误的，HEV在发达地区实际上非常常见。事实证明，HEV很难研究，直到最近才有可靠的模型。因此，我们对HEV生命周期的了解并不完整。传播途径因基因型和地点而异：流行地区经历大规模水源性疫情，而工业化地区的散发病例是可能通过食物链传播的人畜共患感染。已观察到急性和慢性感染，并且报告了广泛的肝外表现。这包括神经、血液和肾脏疾病。由于HEV感染的完整临床表型尚未得到描述，很大一部分病例未被识别或误诊。在许多情况下，由于临床医生对该疾病缺乏了解和认识，HEV感染未被列入鉴别诊断。综合起来，这些因素导致低估了HEV构成的威胁。如果我们要了解该疾病的自然史、改善管理并减轻全球疾病负担，就需要在HEV感染的识别和诊断方面加以改进。
