Semin Liver Dis 2013; 33(01): 050-061
DOI: 10.1055/s-0033-1338114
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Autochthonous Hepatitis E in Developed Countries and HEV/HIV Coinfection

H. R. Dalton
1   Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, Truro, United Kingdom
2   European Centre of Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
,
J. G. Hunter
1   Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, Truro, United Kingdom
,
R. Bendall
2   European Centre of Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
3   Clinical Microbiology, Royal Cornwall Hospital Trust, Truro, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
05 April 2013 (online)

Abstract

A novel hepatitis virus was long suspected as the cause of outbreaks of unexplained hepatitis with high maternal mortality in Asia. An outbreak of unexplained hepatitis in a Soviet military camp in Afghanistan led one investigator to ingest a pooled fecal extract from affected service personnel. This resulted in the discovery of the hepatitis E virus (HEV) in 1983. Subsequent studies showed that HEV was endemic in large parts of the developing world. Its incidence in industrialized nations was initially attributed to travel-related exposure. For many years after the discovery of HEV, it was considered a “new” virus, and of no relevance to developed countries. This perceived wisdom has proven to be hopelessly inaccurate. Human infections with HEV are not “new,” and are of considerable global importance, including in developed countries.

 
  • References

  • 1 Khuroo MS. Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type. Am J Med 1980; 68 (6) 818-824
  • 2 Wong DC, Purcell RH, Sreenivasan MA, Prasad SR, Pavri KM. Epidemic and endemic hepatitis in India: evidence for a non-A, non-B hepatitis virus aetiology. Lancet 1980; 2 (8200) 876-879
  • 3 Balayan MS, Andjaparidze AG, Savinskaya SS , et al. Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route. Intervirology 1983; 20 (1) 23-31
  • 4 Dalton HR, Bendall R, Ijaz S, Banks M. Hepatitis E: an emerging infection in developed countries. Lancet Infect Dis 2008; 8 (11) 698-709
  • 5 Teo C-G. Fatal outbreaks of jaundice in pregnancy and the epidemic history of hepatitis E. Epidemiol Infect 2012; 140 (5) 767-787
  • 6 Kerksig F. Of a jaundice epidemic [in German]. Journal der Practischen Arzneykunde und Wundarzneykunst 1799; 8: 94-109
  • 7 Saint-Vel O. Note on a form of severe jaundice in pregnant women [in French]. Gazette des Hôpitaux Civils et Militaires 1862; 65: 538-539
  • 8 Ballot. Jaundice epidemic observed in 1858 in Martinique in the Principality of St. Pierre [in French]. Gazette des Hôpitaux Civils et Militaires 1859; 62: 262
  • 9 Purdy MA, Khudyakov YE. Evolutionary history and population dynamics of hepatitis E virus. PLoS ONE 2010; 5 (12) e14376
  • 10 Zaaijer HL, Kok M, Lelie PN, Timmerman RJ, Chau K, van der Pal HJ. Hepatitis E in The Netherlands: imported and endemic. Lancet 1993; 341 (8848) 826
  • 11 Zanetti AR, Dawson GJ. Study Group of Hepatitis E. Hepatitis type E in Italy: a seroepidemiological survey. J Med Virol 1994; 42 (3) 318-320
  • 12 Dalton HR, Stableforth W, Thurairajah P , et al. Autochthonous hepatitis E in southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease. Eur J Gastroenterol Hepatol 2008; 20 (8) 784-790
  • 13 Christensen PB, Engle RE, Hjort C , et al. Time trend of the prevalence of hepatitis E antibodies among farmers and blood donors: a potential zoonosis in Denmark. Clin Infect Dis 2008; 47 (8) 1026-1031
  • 14 Kuniholm MH, Purcell RH, McQuillan GM, Engle RE, Wasley A, Nelson KE. Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988–1994. J Infect Dis 2009; 200 (1) 48-56
  • 15 Beale MA, Tettmar K, Szypulska R, Tedder RS, Ijaz S. Is there evidence of recent hepatitis E virus infection in English and North Welsh blood donors?. Vox Sang 2011; 100 (3) 340-342
  • 16 Boutrouille A, Bakkali-Kassimi L, Crucière C, Pavio N. Prevalence of anti-hepatitis E virus antibodies in French blood donors. J Clin Microbiol 2007; 45 (6) 2009-2010
  • 17 Bendall R, Ellis V, Ijaz S, Ali R, Dalton H. A comparison of two commercially available anti-HEV IgG kits and a re-evaluation of anti-HEV IgG seroprevalence data in developed countries. J Med Virol 2010; 82 (5) 799-805
  • 18 Mansuy JM, Bendall R, Legrand-Abravanel F , et al. Hepatitis E virus antibodies in blood donors, France. Emerg Infect Dis 2011; 17 (12) 2309-2312
  • 19 Dalton HR, Fellows HJ, Gane EJ , et al. Hepatitis E in New Zealand. J Gastroenterol Hepatol 2007; 22 (8) 1236-1240
  • 20 Legrand-Abravanel F, Kamar N, Sandres-Saune K , et al. Hepatitis E virus infection without reactivation in solid-organ transplant recipients, France. Emerg Infect Dis 2011; 17 (1) 30-37
  • 21 Drobeniuc J, Favorov MO, Shapiro CN , et al. Hepatitis E virus antibody prevalence among persons who work with swine. J Infect Dis 2001; 184 (12) 1594-1597
  • 22 Meng XJ, Wiseman B, Elvinger F , et al. Prevalence of antibodies to hepatitis E virus in veterinarians working with swine and in normal blood donors in the United States and other countries. J Clin Microbiol 2002; 40 (1) 117-122
  • 23 Berto A, Martelli F, Grierson S, Banks M. Hepatitis E virus in pork food chain, United Kingdom, 2009-2010. Emerg Infect Dis 2012; 18 (8) 1358-1360
  • 24 Colson P, Borentain P, Queyriaux B , et al. Pig liver sausage as a source of hepatitis E virus transmission to humans. J Infect Dis 2010; 202 (6) 825-834
  • 25 Feagins AR, Opriessnig T, Guenette DK, Halbur PG, Meng XJ. Detection and characterization of infectious hepatitis E virus from commercial pig livers sold in local grocery stores in the USA. J Gen Virol 2007; 88 (Pt 3) 912-917
  • 26 Yazaki Y, Mizuo H, Takahashi M , et al. Sporadic acute or fulminant hepatitis E in Hokkaido, Japan, may be food-borne, as suggested by the presence of hepatitis E virus in pig liver as food. J Gen Virol 2003; 84 (Pt 9) 2351-2357
  • 27 Banks M, Martelli F, Grierson S , et al. Hepatitis E virus in retail pig livers. Vet Rec 2010; 166 (1) 29
  • 28 Matsuda H, Okada K, Takahashi K, Mishiro S. Severe hepatitis E virus infection after ingestion of uncooked liver from a wild boar. J Infect Dis 2003; 188 (6) 944
  • 29 Wichmann O, Schimanski S, Koch J , et al. Phylogenetic and case-control study on hepatitis E virus infection in Germany. J Infect Dis 2008; 198 (12) 1732-1741
  • 30 Rutjes SA, Lodder WJ, Lodder-Verschoor F , et al. Sources of hepatitis E virus genotype 3 in The Netherlands. Emerg Infect Dis 2009; 15 (3) 381-387
  • 31 Ijaz S, Arnold E, Banks M , et al. Non-travel-associated hepatitis E in England and Wales: demographic, clinical, and molecular epidemiological characteristics. J Infect Dis 2005; 192 (7) 1166-1172
  • 32 Madden RG, Hunter JG, Stone AM , et al. Locally acquired hepatitis E. Geographical clustering and environmental factors: a nested case control study. J Hepatol 2012; 56 (Suppl. 02) s64
  • 33 Brassard J, Gagné MJ, Généreux M, Côté C. Detection of human food-borne and zoonotic viruses on irrigated, field-grown strawberries. Appl Environ Microbiol 2012; 78 (10) 3763-3766
  • 34 Crossan C, Baker PJ, Craft J, Takeuchi Y, Dalton HR, Scobie L. Hepatitis E virus genotype 3 in shellfish, United Kingdom. Emerg Infect Dis 2012; 18 (12) 2085-2087
  • 35 Li TC, Miyamura T, Takeda N. Detection of hepatitis E virus RNA from the bivalve Yamato-Shijimi (Corbicula japonica) in Japan. Am J Trop Med Hyg 2007; 76 (1) 170-172
  • 36 Donia D, Dell'Amico MC, Petrinca AR , et al. Presence of hepatitis E RNA in mussels used as bio-monitors of viral marine pollution. J Virol Methods 2012; 186 (1–2) 198-202
  • 37 Said B, Ijaz S, Kafatos G , et al; Hepatitis E Incident Investigation Team. Hepatitis E outbreak on cruise ship. Emerg Infect Dis 2009; 15 (11) 1738-1744
  • 38 Tsang TH, Denison EK, Williams HV, Venczel LV, Ginsberg MM, Vugia DJ. Acute hepatitis E infection acquired in California. Clin Infect Dis 2000; 30 (3) 618-619
  • 39 Mansuy JM, Peron JM, Abravanel F , et al. Hepatitis E in the south west of France in individuals who have never visited an endemic area. J Med Virol 2004; 74 (3) 419-424
  • 40 Dalton HR, Thurairajah PH, Fellows HJ , et al. Autochthonous hepatitis E in southwest England. J Viral Hepat 2007; 14 (5) 304-309
  • 41 Mizuo H, Yazaki Y, Sugawara K , et al. Possible risk factors for the transmission of hepatitis E virus and for the severe form of hepatitis E acquired locally in Hokkaido, Japan. J Med Virol 2005; 76 (3) 341-349
  • 42 Colson P, Romanet P, Moal V , et al. Autochthonous infections with hepatitis E virus genotype 4, France. Emerg Infect Dis 2012; 18 (8) 1361-1364
  • 43 Krawczynski K. Hepatitis E. Hepatology 1993; 17 (5) 932-941
  • 44 Aggarwal R, Kamili S, Spelbring J, Krawczynski K. Experimental studies on subclinical hepatitis E virus infection in cynomolgus macaques. J Infect Dis 2001; 184 (11) 1380-1385
  • 45 Dalton HR, Bendall RP, Rashid M , et al. Host risk factors and autochthonous hepatitis E infection. Eur J Gastroenterol Hepatol 2011; 23 (12) 1200-1205
  • 46 Vine LJ, Shepherd K, Hunter JG , et al. Characteristics of Epstein-Barr virus hepatitis among patients with jaundice or acute hepatitis. Aliment Pharmacol Ther 2012; 36 (1) 16-21
  • 47 Kamar N, Bendall RP, Peron JM , et al. Hepatitis E virus and neurologic disorders. Emerg Infect Dis 2011; 17 (2) 173-179
  • 48 Dalton HR, Fellows HJ, Stableforth W , et al. The role of hepatitis E virus testing in drug-induced liver injury. Aliment Pharmacol Ther 2007; 26 (10) 1429-1435
  • 49 Davern TJ, Chalasani N, Fontana RJ , et al; Drug-Induced Liver Injury Network (DILIN). Acute hepatitis E infection accounts for some cases of suspected drug-induced liver injury. Gastroenterology 2011; 141 (5) 1665-1672 , e1–e9
  • 50 Andersson MI, Hughes J, Gordon FH, Ijaz S, Donati M. Of pigs and pregnancy. Lancet 2008; 372 (9644) 1192
  • 51 Dalton HR, Hazeldine S, Banks M, Ijaz S, Bendall R. Locally acquired hepatitis E in chronic liver disease. Lancet 2007; 369 (9569) 1260
  • 52 Péron JM, Bureau C, Poirson H , et al. Fulminant liver failure from acute autochthonous hepatitis E in France: description of seven patients with acute hepatitis E and encephalopathy. J Viral Hepat 2007; 14 (5) 298-303
  • 53 Nanji AA, French SW. Relationship between pork consumption and cirrhosis. Lancet 1985; 1 (8430) 681-683
  • 54 Dalton HR, Bendall RP, Pritchard C, Henley W, Melzer D. National mortality rates from chronic liver disease and consumption of alcohol and pig meat. Epidemiol Infect 2010; 138 (2) 174-182
  • 55 Di Bartolo I, Diez-Valcarce M, Vasickova P , et al. Hepatitis E virus in pork production chain in Czech Republic, Italy, and Spain, 2010. Emerg Infect Dis 2012; 18 (8) 1282-1289
  • 56 Barnaud E, Rogée S, Garry P, Rose N, Pavio N. Thermal inactivation of infectious hepatitis E virus in experimentally contaminated food. Appl Environ Microbiol 2012; 78 (15) 5153-5159
  • 57 Péron JM, Mansuy JM, Poirson H , et al. Hepatitis E is an autochthonous disease in industrialized countries. Analysis of 23 patients in South-West France over a 13-month period and comparison with hepatitis A. Gastroenterol Clin Biol 2006; 30 (5) 757-762
  • 58 Mitsui T, Tsukamoto Y, Hirose A , et al. Distinct changing profiles of hepatitis A and E virus infection among patients with acute hepatitis, patients on maintenance hemodialysis and healthy individuals in Japan. J Med Virol 2006; 78 (8) 1015-1024
  • 59 Health Protection Agency Available at: http://www.hpa.org.uk/hpr/archives/2012/news3212.htm . Accessed September 13, 2012
  • 60 Scobie L, Dalton HR. Hepatitis E: Source and route of infection, clinical manifestations and new developments. J Viral Hepat 2013; 20 (1) 1-11
  • 61 Faramawi MF, Johnson E, Chen S, Pannala PR. The incidence of hepatitis E virus infection in the general population of the USA. Epidemiol Infect 2011; 139 (8) 1145-1150
  • 62 Peron JM, Danjoux M, Kamar N , et al. Liver histology in patients with sporadic acute hepatitis E: a study of 11 patients from South-West France. Virchows Arch 2007; 450 (4) 405-410
  • 63 Malcolm P, Dalton H, Hussaini HS, Mathew J. The histology of acute autochthonous hepatitis E virus infection. Histopathology 2007; 51 (2) 190-194
  • 64 Lockwood GL, Fernandez-Barredo S, Bendall R, Banks M, Ijaz S, Dalton HR. Hepatitis E autochthonous infection in chronic liver disease. Eur J Gastroenterol Hepatol 2008; 20 (8) 800-803
  • 65 Sood A, Midha V, Sood N. Guillain-Barré syndrome with acute hepatitis E. Am J Gastroenterol 2000; 95 (12) 3667-3668
  • 66 Dixit VK, Abhilash VB, Kate MP, Jain AK. Hepatitis E infection with Bell's palsy. J Assoc Physicians India 2006; 54: 418
  • 67 Fong F, Illahi M. Neuralgic amyotrophy associated with hepatitis E virus. Clin Neurol Neurosurg 2009; 111 (2) 193-195
  • 68 Mandal K, Chopra N. Acute transverse myelitis following hepatitis E virus infection. Indian Pediatr 2006; 43 (4) 365-366
  • 69 Kejariwal D, Roy S, Sarkar N. Seizure associated with acute hepatitis E. Neurology 2001; 57 (10) 1935
  • 70 Del Bello A, Arné-Bes MC, Lavayssière L, Kamar N. Hepatitis E virus-induced severe myositis. J Hepatol 2012; 57 (5) 1152-1153 [Epub ahead of print]
  • 71 Maurissen I, Jeurissen A, Strauven T, Sprengers D, De Schepper B. First case of anti-ganglioside GM1-positive Guillain-Barré syndrome due to hepatitis E virus infection. Infection 2012; 40 (3) 323-326
  • 72 Despierres LA, Kaphan E, Attarian S , et al. Neurologic disorders and hepatitis E, France, 2010. Emerg Infect Dis 2011; 17 (8) 1510-1512
  • 73 Dalton HR, Keane FE, Bendall R, Mathew J, Ijaz S. Treatment of chronic hepatitis E in a patient with HIV infection. Ann Intern Med 2011; 155 (7) 479-480
  • 74 Kamar N, Izopet J, Cintas P , et al. Hepatitis E virus-induced neurological symptoms in a kidney-transplant patient with chronic hepatitis. Am J Transplant 2010; 10 (5) 1321-1324
  • 75 Kamar N, Weclawiack H, Guilbeaud-Frugier C , et al. Impact of hepatitis E virus infection on kidney function and histology in organ-transplant patients. Am J Transplant 2011; ; Abstract 864
  • 76 Deniel C, Coton T, Brardjanian S, Guisset M, Nicand E, Simon F. Acute pancreatitis: a rare complication of acute hepatitis E. J Clin Virol 2011; 51 (3) 202-204
  • 77 Dumoulin FL, Liese H. Acute hepatitis E virus infection and autoimmune thyroiditis: yet another trigger?. BMJ Case Rep 2012; ; pii: bcr1220115441
  • 78 Fourquet E, Mansuy JM, Bureau C , et al. Severe thrombocytopenia associated with acute autochthonous hepatitis E. J Clin Virol 2010; 48 (1) 73-74
  • 79 Huang S, Zhang X, Jiang H , et al. Profile of acute infectious markers in sporadic hepatitis E. PLoS ONE 2010; 5 (10) e13560
  • 80 Bendall R, Ellis V, Ijaz S, Thurairajah P, Dalton HR. Serological response to hepatitis E virus genotype 3 infection: IgG quantitation, avidity, and IgM response. J Med Virol 2008; 80 (1) 95-101
  • 81 Chauhan A, Jameel S, Dilawari JB, Chawla YK, Kaur U, Ganguly NK. Hepatitis E virus transmission to a volunteer. Lancet 1993; 341 (8838) 149-150
  • 82 Clayson ET, Myint KS, Snitbhan R , et al. Viremia, fecal shedding, and IgM and IgG responses in patients with hepatitis E. J Infect Dis 1995; 172 (4) 927-933
  • 83 Engle RE, Yu C, Emerson SU, Meng XJ, Purcell RH. Hepatitis E virus (HEV) capsid antigens derived from viruses of human and swine origin are equally efficient for detecting anti-HEV by enzyme immunoassay. J Clin Microbiol 2002; 40 (12) 4576-4580
  • 84 Emerson SU, Clemente-Casares P, Moiduddin N, Arankalle VA, Torian U, Purcell RH. Putative neutralization epitopes and broad cross-genotype neutralization of Hepatitis E virus confirmed by a quantitative cell-culture assay. J Gen Virol 2006; 87 (Pt 3) 697-704
  • 85 Legrand-Abravanel F, Mansuy JM, Dubois M , et al. Hepatitis E virus genotype 3 diversity, France. Emerg Infect Dis 2009; 15 (1) 110-114
  • 86 Drobeniuc J, Meng J, Reuter G , et al. Serologic assays specific to immunoglobulin M antibodies against hepatitis E virus: pangenotypic evaluation of performances. Clin Infect Dis 2010; 51 (3) e24-e27
  • 87 Herremans M, Bakker J, Duizer E, Vennema H, Koopmans MP. Use of serological assays for diagnosis of hepatitis E virus genotype 1 and 3 infections in a setting of low endemicity. Clin Vaccine Immunol 2007; 14 (5) 562-568
  • 88 Mansuy JM, Peron JM, Bureau C, Alric L, Vinel JP, Izopet J. Immunologically silent autochthonous acute hepatitis E virus infection in France. J Clin Microbiol 2004; 42 (2) 912-913
  • 89 Baylis SA, Hanschmann KM, Blümel J, Nübling CM. HEV Collaborative Study Group. Standardization of hepatitis E virus (HEV) nucleic acid amplification technique-based assays: an initial study to evaluate a panel of HEV strains and investigate laboratory performance. J Clin Microbiol 2011; 49 (4) 1234-1239
  • 90 Dalton HR, Bendall RP, Keane FE, Tedder RS, Ijaz S. Persistent carriage of hepatitis E virus in patients with HIV infection. N Engl J Med 2009; 361 (10) 1025-1027
  • 91 Kamar N, Rostaing L, Abravanel F , et al. Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection. Gastroenterology 2010; 139 (5) 1612-1618
  • 92 Tanaka T, Takahashi M, Kusano E, Okamoto H. Development and evaluation of an efficient cell-culture system for Hepatitis E virus. J Gen Virol 2007; 88 (Pt 3) 903-911
  • 93 Shukla P, Nguyen HT, Torian U , et al. Cross-species infections of cultured cells by hepatitis E virus and discovery of an infectious virus-host recombinant. Proc Natl Acad Sci U S A 2011; 108 (6) 2438-2443
  • 94 Wu T, Zhang J, Su ZJ , et al. Specific cellular immune response in hepatitis E patients. Intervirology 2008; 51 (5) 322-327
  • 95 Husain MM, Srivastava R, Akondy R, Aggarwal R, Jameel S, Naik S. Evidence of hepatitis E virus exposure among seronegative healthy residents of an endemic area. Intervirology 2011; 54 (3) 139-143
  • 96 Colson P, Coze C, Gallian P, Henry M, De Micco P, Tamalet C. Transfusion-associated hepatitis E, France. Emerg Infect Dis 2007; 13 (4) 648-649
  • 97 Matsubayashi K, Nagaoka Y, Sakata H , et al. Transfusion-transmitted hepatitis E caused by apparently indigenous hepatitis E virus strain in Hokkaido, Japan. Transfusion 2004; 44 (6) 934-940
  • 98 Boxall E, Herborn A, Kochethu G , et al. Transfusion-transmitted hepatitis E in a 'nonhyperendemic' country. Transfus Med 2006; 16 (2) 79-83
  • 99 Ijaz S, Szypulska R, Tettmar KI, Kitchen A, Tedder RS. Detection of hepatitis E virus RNA in plasma mini-pools from blood donors in England. Vox Sang 2012; 102 (3) 272
  • 100 Baylis SA, Gärtner T, Nick S, Ovemyr J, Blümel J. Occurrence of hepatitis E virus RNA in plasma donations from Sweden, Germany and the United States. Vox Sang 2012; 103 (1) 89-90
  • 101 Kamar N, Selves J, Mansuy JM , et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med 2008; 358 (8) 811-817
  • 102 Kenfak-Foguena A, Schöni-Affolter F, Bürgisser P , et al; Data Center of the Swiss HIV Cohort Study, Lausanne, Switzerland. Hepatitis E Virus seroprevalence and chronic infections in patients with HIV, Switzerland. Emerg Infect Dis 2011; 17 (6) 1074-1078
  • 103 Renou C, Lafeuillade A, Cadranel JF , et al; ANGH. Hepatitis E virus in HIV-infected patients. AIDS 2010; 24 (10) 1493-1499
  • 104 Keane F, Gompels M, Bendall R , et al. Hepatitis E virus coinfection in patients with HIV infection. HIV Med 2012; 13 (1) 83-88
  • 105 Kaba M, Richet H, Ravaux I , et al. Hepatitis E virus infection in patients infected with the human immunodeficiency virus. J Med Virol 2011; 83 (10) 1704-1716
  • 106 Mateos-Lindemann ML, Gonzalez-Galdámez A, Bordallo-Cardona M, Pérez-Gracia MT. Are HIV-infected patients a high-risk population for hepatitis E virus infection in Spain?. Enferm Infecc Microbiol Clin 2012; 30 (9) 582-583
  • 107 Jagjit Singh GK, Ijaz S, Rockwood N , et al. Chronic Hepatitis E as a cause for cryptogenic cirrhosis in HIV. J Infect Infect 2013; 66 (1) 103-106
  • 108 Crum-Cianflone NF, Curry J, Drobeniuc J , et al; Infectious Disease Clinical Research Program HIV Working Group. Hepatitis E virus infection in HIV-infected persons. Emerg Infect Dis 2012; 18 (3) 502-506
  • 109 Kaba M, Brouqui P, Richet H , et al. Hepatitis E virus infection in sheltered homeless persons, France. Emerg Infect Dis 2010; 16 (11) 1761-1763
  • 110 Larrat S, Gaillard S, Baccard M , et al; French National Agency for Research on AIDS and viral hepatitis HC02 Ribavic Study Team. Hepatitis e virus infection in sheltered homeless persons, France. Emerg Infect Dis 2012; 18 (6) 1031 , author reply 1032
  • 111 Goyal R, Kumar A, Panda SK, Paul SB, Acharya SK. Ribavirin therapy for hepatitis E virus-induced acute on chronic liver failure: a preliminary report. Antivir Ther 2012; 17 (6) 1091-1096
  • 112 Péron JM, Dalton H, Izopet J, Kamar N. Acute autochthonous hepatitis E in western patients with underlying chronic liver disease: a role for ribavirin?. J Hepatol 2011; 54 (6) 1323-1324 , author reply 1324–1325
  • 113 Zhu FC, Zhang J, Zhang XF , et al. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 2010; 376 (9744) 895-902