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Hepatitis E in Latin America
Rosa Elena Sarmiento-Silvaa,
Corresponding author
rosass@unam.mx

Corresponding author.
, Francisco Arenas-Huerterob
a Departamento de Microbiología e Inmunología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, México
b Laboratorio de Investigación en Patología Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México, México
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hepatitis E virus produces an emerging health problem&#44; the World Health Organization &#40;WHO&#41; estimates 20 million of infections by Hepatitis E virus &#40;HEV&#41;&#44; over 3 million symptomatic cases and 70&#44;000 HEV-related deaths each year&#46; HEV is the major cause of enterically transmitted hepatitis world wide&#44; and is not limited to countries with low sanitary standards&#46; HEV has been detected in environmental samples &#40;water&#41; in several countries from Europe and Asia&#44; representing a risk factor for waterborne infection&#46; While hepatitis E virus infections are relevant in Europe&#44; knowledge about epidemiology of hepatitis E virus infections in the USA and Latin America is still limited <a class="elsevierStyleCrossRef" href="#bib0040">&#91;1&#93;</a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The HEV is classified in the genus Orthohepevirus&#44; with four species that affect different hosts &#40;A&#8211;D&#41;&#46; The specie with the highest rank of hosts is Orthohepevirus A&#44; which includes 7 reported genotypes that infect humans &#40;1&#44; 2&#44; 3&#44; 4 and 7&#41;&#44; pigs &#40;3 and 4&#41;&#44; rabbits &#40;3&#41;&#44; wild boar &#40;3&#44; 4&#44; 5 and 6&#41;&#44; mongooses &#40;3&#41;&#44; deer &#40;3&#41;&#44; yaks &#40;4&#41; and camels &#40;7&#41; <a class="elsevierStyleCrossRef" href="#bib0045">&#91;2&#93;</a>&#46; Genotypes 1 and 2 are responsible for epidemics outbreaks&#44; mainly in developing countries&#44; and have been isolated from humans exclusively&#44; zoonotic transmission due to contact with infected animals and consumption of contaminated undercooked or raw meat has been identified as an important risk factor&#44; especially in industrialized countries <a class="elsevierStyleCrossRef" href="#bib0050">&#91;3&#93;</a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">HEV affects mainly young and middle aged adults&#44; mainly between 15 and 40 years of age&#44; however&#44; cases of chronic infection of HEV have been reported in immunosuppressed people&#44; as in people with chronic liver disease&#44; organ transplantation or people infected with the human immunodeficiency virus in which the disease rapidly evolves to liver cirrhosis&#44; loss of the transplanted organ and death&#46; HEV &#40;genotype 3&#41; seroprevalence was higher in livertransplant recipients compromised by cirrhosis <a class="elsevierStyleCrossRef" href="#bib0055">&#91;4&#93;</a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">HEV genotypes 1 and 2 are known as a cause of acute hepatitis and fulminant hepatic failure in pregnant women during large waterborne outbreaks in developing countries&#44; transmitted vertically and resulting in water-borne sporadic cases or large epidemics <a class="elsevierStyleCrossRef" href="#bib0060">&#91;5&#93;</a>&#46; HEV is also recognized as transfusion transmitted virus&#46; Extrahepatic manifestations of HEV infection have been reported in both acute and chronic cases <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a><a class="elsevierStyleCrossRef" href="#bib0050">&#91;3&#93;</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Recently&#44; it has been reported that the seroprevalence in Latin America was significantly smaller than USA&#46; Patients in the USA had a more than doubled estimated seroprevalence &#40;up to 9&#37;&#41; than those in Brazil &#40;up to 4&#46;2&#37;&#41; and Mixed Caribbean &#40;up to 1&#37;&#41;&#46; A comparison with published data from Europe demonstrated that anti-hepatitis E virus seroprevalence in the USA and Europe did not differ significantly &#40;OR&#58; 1&#46;33 &#40;0&#46;81&#8211;2&#46;19&#41;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;25&#41;&#44; while rate in South America was significantly lower than that in Europe &#40;OR&#58; 0&#46;67 &#40;0&#46;45&#8211;0&#46;98&#41;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41;&#46; HEV infection has been reported in several Latin American countries&#46; The highest seroprevalence has been reported in Nicaragua and Chile &#40;12&#37;&#41;&#44; however the anti-HEV seroprevalence rate has continuously increased over time between 1995 and 2015 <a class="elsevierStyleCrossRef" href="#bib0065">&#91;6&#93;</a>&#46; HEV genotype 3 being the most frequent genotype in the region&#44; identified both in humans and pigs&#46; Cases of viral hepatitis reported in Mexico are typically identified as hepatitis A&#44; B and C&#46; However&#44; unspecified cases are reported annually&#46; In Mexico&#44; HEV genotype 2 is considered endemic&#44; though it&#39;s the prevalence is not well known&#44; prevalence reported in adults 10&#8211;36&#37; <a class="elsevierStyleCrossRef" href="#bib0070">&#91;7&#93;</a> and the information on the prevalence of HEV in paediatric patients is scarce&#44; our working group has found a seroprevalence of 3&#37;&#44; unpublished data&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Knowledge about epidemiology of hepatitis E virus infections in the USA and Latin America is still limited&#44; it is likely to represent a massive underestimatation of the true global burden of disease&#44; epidemiologically the HEV incidence is low in humans but serological data show a high proportion of subclinical infections&#46; Clinical and diagnostic accuracy are critical to improve patient management and reduce the burden of HEV infection worldwide&#46; Also&#44; developing specific tests with high sensitivity and specificity for detecting viral RNA or anti-HEV antibodies is important&#46;</p></span></span>"
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                  \t\t\t\t">Thrombocytopenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Pancreatitis and autoimmune conditions including Henoch&#8211;Sch&#246;nlein purpura&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46; Autoimmune haemolytic anaemia2&#46; Aplastic anaemia3&#46; Pure red-cell aplasia4&#46; Thyroiditis and myasthenia gravis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46; Guillain&#8211;Barr&#180; syndrome2&#46; Neuralgic amyotrophy3&#46; Encephalitis&#47;myelitis&nbsp;\t\t\t\t\t\t\n
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ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos