Hepatitis E virus genotype 3 microbiological surveillance by the Spanish Reference Laboratory: geographic distribution and phylogenetic analysis of subtypes from 2009 to 2019

Author:

Muñoz-Chimeno Milagros1,Bartúren Silvia1,García-Lugo Maira Alejandra1,Morago Lucia1,Rodríguez Álvaro1,Galán Juan Carlos23,Pérez-Rivilla Alfredo4,Rodríguez Mercedes5,Millán Rosario6,del Álamo Manuel7,Alonso Roberto8,Molina Laura9,Aguinaga Aitziber10,Avellón Ana21ORCID

Affiliation:

1. Hepatitis Unit, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain

2. CIBERESP, Madrid, Spain

3. Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain

4. Hospital Universitario 12 de Octubre, Madrid, Spain

5. Hospital Universitario Central de Asturias, Grupo de Microbiología Traslacional (ISPA) Oviedo, Asturias, Spain

6. Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain

7. Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain

8. Hospital General Universitario Gregorio Marañón, Madrid, Spain

9. Hospital Universitario de Fuenlabrada, Madrid, Spain

10. Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain

Abstract

Background Hepatitis E virus genotype 3 (HEV-3) is widely distributed throughout Europe, with incidence of infections increasing in many countries. Belgium, Bulgaria, France, Germany, Italy, the Netherlands and the United Kingdom have reported the distribution of HEV-3 subtypes in cohorts of patients with hepatic disease. Aim To describe the distribution of the HEV-3 subtypes in Spain at national and autonomous community (AC) levels between 2009 and 2019. The study was also extended to Andorra. Methods Of 5,197 samples received by the National Reference Laboratory during the study, 409 were HEV-RNA-positive. Among these, 294 (71.9%) were further typed based on an ORF2 sequence fragment, or, for a subset of 74, based on the full-coding genome sequence. Results HEV-3 was detected in 291 samples. The dominant subtype in Spain was HEV-3f (88.3%; 257/291), which occurred in all ACs, with no change in detection level over time. Within this subtype, three subclusters were characterised: HEV-3f-B, HEV-3f-A1 and HEV-3f-A2. The second most common HEV subtype was the recently described HEV-3m (7%; 21/291), with two subclusters identified: HEV-3m-A, which has been known since 2010, and HEV-3m-B, since 2014. The third most encountered subtype was HEV-3c (4.1%; 12/291), with a frequency not increasing over time, unlike observations in some European countries. Conclusion The importance of the surveillance of HEV-3 subtype and subcluster circulation is yet to be assessed. This surveillance together with the comprehensive epidemiological characterisation of clinical cases, could support the identification of sources of transmission and the establishment of control measures nationally and internationally.

Publisher

European Centre for Disease Control and Prevention (ECDC)

Subject

Virology,Public Health, Environmental and Occupational Health,Epidemiology

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