Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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S78 Abstracts / Journal of Clinical Virology 82S (2016) S1–S142
avidity index was determined for HAV RNA negative samples. HEV
IgM positive samples and all samples from acute hepatitis patients
were assessed for HEV RNA by using a quantitative real-time RT-
PCR assay.
Results: Among asymptomatic pregnant women (mean age
32 ± 8), HAV seroprevalence was 98.61%, none presented anti-HAV
IgMandHEV seroprevalencewas 5.09% and three (1.38%) presented
weakly reactive anti-HEV IgMwithout detectable HEV RNA. Among
acute hepatitis patients (mean age 18.5 ± 14), HEV seroprevalence
was 20.65%, none presented anti-HEV IgM. HAV seroprevalence
reached 95% by the age of 5 and HAV IgM was detected in 23
patients (25%) aged 11.7 ± 26.9. HAV RNA was negative high anti-
HAV avidity index demonstrating past infection in 3/22 available
samples. Detectable HAV RNA confirmed HAV infection in 19/22
available samples. Confirmed HAV cases represented 52%, 10%, and
7% of acute hepatitis in Gabes, Medenine and Tatouine, respec-
tively. Phylogenetic analysis identified genotype IA strains with a
1st cluster responsible for 10/13 cases in Gabes, a 2nd responsible
for 5/5 cases in Medenine, the remaining cases being associated
with unique strains.
Conclusion: The present study confirmed low HEV endemicity
and evidenced a high level of HAV circulation in South Tunisia
probably associated with inadequate wastewater treatment.
Reference
[1] Jacobsen, et al., Hepatitis A virus seroprevalence by age and world region, 1990
and 2005, Vaccine 28 (41) (2010) 6653–6657.
[2] Kim, et al., A systematic review of the epidemiology of hepatitis E virus in
Africa, BMC Infect. Dis. 14 (2014) 308.
Abstract no: 297
Presentation at ESCV 2016: Poster 115
Detection and genetic characterization of
imported hepatitis E virus genotype 1 of
probable Indian origin, Portugal, 2016
M. Santos ∗ R. Mesquita . Fernandes
F. Maltez , S. Lino , L. Alves , J. Abreu-Silva ,
R.M.S. Oliveir D. Curran
M.S.J. Nascimento
1 Laboratório de Patologia Clínica, Hospital Curry
Cabral, Lisboa, Portugal
2 Escola Superior Agrária de Viseu, Instituto
Politécnico de Viseu, Viseu, Portugal
3 Servic¸ o de Doenc¸ as Infeciosas CHLC, Hospital Curry
Cabral, Lisboa, Portugal
4 Laboratório de Microbiologia, Departamento de
Ciências Biológicas, Faculdade de Farmácia da
Universidade do Porto, Porto, Portugal
5 Clinical Microbiology and Public Health Laboratory,
PHE, Addenbrooke’s Hospital, Cambridge, United
Kingdom
Introduction: Until recently hepatitis E virus (HEV) infection
was thought to occur exclusively in developing countries but it is
now known that locally acquired HEV is common in industrialized
regions. Unlike genotypes 3 and 4 that circulate in industrialized
countries, genotypes 1 and 2 of developing countries produce more
severe disease and occur in the epidemic formwith mortality rates
ranging from 0.2% to 4.0%. These HEV genotypes are considered
a serious public health problem and are known to cause an esti-
mated 20.1 million infections with 3.4 million acute cases annually
worldwide with an estimated 70,000 deaths. In the present work
we report the first case of HEV genotype 1 in Portugal associated to
a severe acute hepatitis in a patient that had returned from India.
Epidemiological and laboratory investigations: On January
2016, a 31-year-old Indian man was admitted to the Emergency
Unit of Centro Hospitalar de Lisboa Central, Lisboa, Portugal, with
clinical signs compatible with acute hepatitis. Upon admission he
reported to have resided in the North of India until coming to
Portugal 6 weeks earlier. Blood tests showed elevation of hepatic
enzymes supporting the presumptive diagnosis of an acute viral
hepatitis. Serum was tested for the hepatitis virus panel and was
negative for all viruses, however HEV markers were not searched
for. Instead, RT-qPCR detection for HEV RNA in sera using generic
primers/probe targeting the open reading frame (ORF) 2 region
was performed confirming the presence of HEV RNA. HEV sequence
was characterized using a nested broad-spectrum reverse tran-
scription PCR with amplification within the ORF 1 ollowed by
phylogenetic analysis.
Results: Genetic characterization indicated that the virus iso-
lated from this patient belonged to genotype 1, clustering with HEV
genotype 1 sequences from India and Nepal retrieved in 2013 and
2014. In particular, sequence identity matching with the isolated
virus showed that it shared the highest nucleotide identity (96.0%)
with sequences isolated in 2013 and 2014 in Jabalpur District, India,
and from an HEV outbreak in Nepal, 2014.
Discussion: In this case report we describe a patient presenting
an acute hepatitis E caused by HEV genotype 1 most likely acquired
during his stay in India. Our findings demonstrate the need to
implement and improve strategic HEV surveillance in countries
with substantial migration flows.
Reference
[1] K.J. Rolfe, M.D. Curran, N. Mangrolia, W. Gelson, G.J. Alexander, M. L’estrange, R.
Vivek, R. Tedder, S. Ijaz, First case of genotype 4 human hepatitis E virus
infection acquired in India, J. Clin. Virol. 48 (1) (2010) 58–61.
[2] R. Johne, A. Plenge-Bönig, M. Hess, R.G. Ulrich, J. Reetz, A. Schielke, Detection of
a novel hepatitis E-like virus in faeces of wild rats using a nested
broad-spectrum RT-PCR, J. Gen. Virol. 91 (Pt 3) (2010) 750–758.
Abstract no: 300
Presentation at ESCV 2016: Poster 116
Preliminary study of the prevalence of hepatitis
E virus infection in liver transplant recipients in
Portugal
J. Pereira-Vaz ∗, L. Correia , S. Ferreira ,
C. Gonc¸ alves , A. Vaz , A. Mendes , C. Morais ,
V. Mota , I. Gonc¸ alves , H. Pereira ,
F. Rodrigues
1 Laboratory of Molecular Biology, Clinical Pathology
Unit, Centro Hospitalar e Universitário de Coimbra,
Coimbra, Portugal
2 Hepatic Transplant Unit – Pediatric and Adults,
Centro Hospitalar e Universitário de Coimbra,
Coimbra, Portugal
3 Clinical Pathology Unit, Centro Hospitalar e
Universitário de Coimbra, Coimbra, Portugal
Background: Hepatitis E virus (HEV) is classified within the
genus Hepevirus of the Hepeviridae family. HEV has caused a signif-
icant number of acute hepatitis outbreaks in developing countries
which have been associated with contaminated water transmis-
sion. In contrast, sporadic autochthonous infections in developed
countries have been mainly associated with zoonotic strains with