In a recent study published in the Journal of Hepatology last month, researchers describe the first cases of acute hepatitis related to Orthohepevirus C infection (HEV-C), also known as rat Hepatitis E virus, detected in Europe:
Hepatitis E virus (HEV) is the only member of the Hepeviridae family with zoonotic potential. Nevertheless, this consideration was reassessed because recent evidence reported several cases of acute and chronic hepatitis linked to the Orthohepevirus C genus. Because the circulation of Orthohepevirus C in rodents has been described worldwide, the risk of zoonotic transmission is plausible globally.
Orthohepevirus C RNA was retrospectively evaluated in two cohorts of patients in follow-up in Spain. The first cohort included patients with acute hepatitis without etiological diagnosis after screening for hepatotropic virus infection. The second cohort included patients diagnosed with acute HEV infection, defined as positivity for anti-HEV IgM antibodies and/or detectable HEV RNA in serum.
Cohort 1 was composed 169 patients (64.4% male, median age 43 years) and cohort 2 by 98 individuals (68.3% male, median age 45 years). Of the individuals included in Cohort 1, two (1.18%; 95% CI: 0.2-3.8) showed detectable Orthohepevirus C RNA in serum. In Cohort 2, of the 98 included patients, 58 showed detectable HEV RNA, while 40 only showed positivity for IgM antibodies. Among those bearing only IgM antibodies, Orthohepevirus C RNA was detected in one (2.5%; 95% CI: 0.06-13.1) individual. All strains were consistent with genotype C1. The infection in two patients resulted in mild acute hepatitis with self-resolution. In the other one coursed as severe acute hepatitis, deceasing because of liver and renal failure.
We described three cases of Orthohepevirus C in patients with acute hepatitis, resulting in the first description of this infection in Europe. The prevalence obtained in our study suggests that Orthohepevirus C can be an emerging disease in Europe.