National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany.
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Emerg Microbes Infect. 2022 Dec;11(1):1754-1763. doi: 10.1080/22221751.2022.2091479.
Zoonotic hepatitis E virus (HEV) is endemic in Europe. Genotype 3 (HEV-3) is predominant but information on subtype distribution, trends and clinical implications in Germany is scarce. We analysed 936 HEV RNA positive samples of human origin and corresponding national surveillance data from 2010 to 2019. Samples were referred to the National Consultant Laboratory and sequenced in at least one of four genomic regions. Sequences were analysed using bioinformatics methods and compared to the latest HEV reference set. 1,656 sequences were obtained from 300 female, 611 male and 25 of unknown sex aged 3-92 years (median 55 years). HEV-3c was predominant (67.3%) followed by HEV-3f, HEV-3e and HEV-3i(-like) with 14.3%, 9.7% and 4.0% (other subtypes ≤1.1%). The proportion of HEV-3 group 2 (3abchijklm) strains increased over time. Jaundice, upper abdominal pain, fever, hospitalization, and death due to HEV were significantly more often reported for patients infected with HEV-3 group 1 (3efg) compared to group 2. Larger spatio-temporal clusters of identical sequences were not observed. HEV-3 group 1 infections are more severe as compared to the predominant group 2. Detection of group 2 strains increased over the last years, possibly due to more frequent diagnosis of asymptomatic and mild courses. The diversity of strains and the space-time distribution is compatible with a foodborne zoonosis with supra-regional distribution of the infection vehicle (pork products).
动物源戊型肝炎病毒（HEV）在欧洲流行。基因型 3（HEV-3）占主导地位，但德国关于其亚型分布、趋势和临床意义的信息很少。我们分析了 2010 年至 2019 年期间 936 份源自人类的 HEV RNA 阳性样本和相应的国家监测数据。这些样本被送到国家顾问实验室，至少在四个基因组区域中的一个进行了测序。使用生物信息学方法对序列进行分析，并与最新的 HEV 参考集进行比较。从 300 名女性、611 名男性和 25 名未知性别的年龄在 3-92 岁（中位数 55 岁）的患者中获得了 1656 条序列。HEV-3c 占主导地位（67.3%），其次是 HEV-3f、HEV-3e 和 HEV-3i（类似），分别占 14.3%、9.7%和 4.0%（其他亚型≤1.1%）。HEV-3 组 2（3abchijklm）株的比例随时间增加。与 HEV-3 组 1（3efg）相比，HEV-3 组 2 感染患者更常报告黄疸、上腹痛、发热、住院和因 HEV 导致的死亡。未观察到相同序列的更大时空聚类。与占主导地位的组 2 相比，HEV-3 组 1 感染更严重。近年来，组 2 菌株的检测有所增加，可能是由于更频繁地诊断出无症状和轻度病程。菌株的多样性和时空分布与食物源性动物源传染病一致，感染载体（猪肉产品）具有区域性分布。
