1. HEV in Belgium: An import infection or an emerging viral zoonosis? I.Micalessi, I.Thomas, B. Brochier National Center of Viral Hepatitis Rue Juliette Wytsmanstraat 14 | 1050 Brussels | Belgium T +32 2 642 50 73| F +32 2 642 56 92 | email: Isabel.Micalessi@iph.fgov.be | www.iph.fgov.be

2. Characteristics of HEV (1) Symptoms: similar to hepatitis A virus Transmission: mainly faecal-oral route → faecal contamination of drinking water transmission by blood transfusion may be possible Clinical Evolution Acute self-limited or fulminant hepatitis Chronic hepatitis reported in organ transplant recipients Low mortality: 1-3% Exception pregnant women: 15-25% HEV IgG prevalence Blood donors: 1-3% Persons working with swine: prevalence much higher

3. Characteristics of HEV (2) ssRNA virus (7.2kb), non-enveloped only member of the genus Hepevirus in family Hepeviridae 5 genotypes HEV genotypeGeographic distribution 1 (human)Asia, Africa 2 (human)Mexico 3 (human & swine)Europe, United States 4 (human & swine)China, Taiwan, Japan 5 (avian)Australia, United States

4. HEV: a new public health concern? Risk of transmission Endemic regions = developing countries contaminated drinking water Non-endemic regions = industrialized countries import infection Zoonosis? = suspicion of swine/wild boar as animal reservoir e.g.: The Netherlands HEV suspected transmission from swine to human without travel history is increasing (gt 3 with 91-97% homology between human and Dutch pig strains) e.g.: Japan HEV transmission associated with eating of raw or undercooked wild boar and deer meat

5. (weeks)

6. Laboratory diagnosis HEV IgG and IgM : screening: HEV IgM and IgG ELISA (MP diagnostics) confirmation: HEV IgG/IgM recomBlot (since 2008) (Mikrogen) HEV RNA: nested PCR (primers in ORF 2 region, Gyarmati et al, 2007)

7. HEV in Belgium: preliminary results (1) yeartotal IgM +IgG +HEV RNA + ELISABLOTELISABLOTPCR 20064636/28/12 20074538/24/9 200824217643 2009642322

8. HEV in Belgium: preliminary results (2) HEV gt 3 is present in Belgium High homology to swine isolate from the Netherlands  zoonotic transmission of HEV possible

9. Conclusions Sequencing in progress to determine the prevalence of the HEV genotypes circulating in Belgium. High homology between human and swine gt3 suggesting a viral zoonosis in Belgium  Risk factors & prevention measures Standardised reference material (HEV RNA) and inter-laboratorium panel testing necessary

10. Acknowledgments RIVM, the Netherlands J. Reimerink IPH, Group of Virology I. Fdillate I. Thomas C. Gérard