Clin Infect Dis. 2014 Feb;58(4):509-16. doi: 10.1093/cid/cit782.

Endemic hepatitis E in the Czech Republic.

Chalupa P, Vasickova P, Pavlik I, Holub M.

Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University in Prague and Na Bulovce Hospital, Prague.



Background: Increasing incidence of endemic hepatitis E (HE) has been reported in the developed countries. Thus, it is warranted to evaluate personal history, clinical picture, laboratory findings and utility of diagnostic methods in patients with endemic HE.

Methods: Group of 51 adult patients with acute hepatitis E hospitalized between the years 2009 – 2012 in single center was evaluated. Serological and molecular techniques (detection of HEV RNA from stool and serum samples by quantitative real time RT-PCR) with next sequence and phylogenetic analysis were used in diagnostics and also clinical, biochemical, hematological and epidemiological parameters were evaluated in these patients.

Results: Forty-nine (96.1%) pts had acute endemic HE and two (3.9%) pts had imported infection. Some typical clinical signs were present in the group with endemic HE: men predominated women; higher age in both genders; prevalence of icteric illnesses; markedly elevated levels of alkaline phosphatase activity and gamma-glutamyltransferase; no hepatic encephalopathy was noted. Furthermore, all HEV isolates from endemic cases belonged to genotype 3. Consummation of meat or inwards (e.g. porcine offal) and other food prepared during the pig home slaughter (white pudding, scraps, sausages etc.), tasting of raw meat and liverballs before the cooking, eating raw or inadequately cooked venison or wild boar meat (e.g. goulash from wild boar) were the most frequent data in personal history detected from 25 (49.0%) pts.

Conclusions: Significantly prevailing number of endemic cases was detected.

PMID: 24280093



A group of 51 adult patients with endemic hepatitis E was evaluated. Increasing incidence of endemic (92.2%) in comparison with imported cases (3.9%) was detected. This recognition from our catchment area is in accordance with the situation in the whole Czech Republic.


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Created with GIMP Figure 1. Number of imported and endemic (autochthonous) cases of acute HE reported to the central Czech databasis EPIDAT in the National Institute of Public Health in Prague (

Figure-2Figure 2. Phylogenetic tree constructed by neighbor-joining method with 1000 replications in bootstrap test based on partial nucleotide sequences (242-nt) of hepatitis E virus (HEV) open reading frame 1 (ORF1; nucleotides 125-366); only bootstrap values (percentages) >70 are indicated on the tree. Present Czech human isolates (●) as well as Czech animal isolates of swine (Δ) and wild boar (□) origin are marked. Sequences of Czech human HEV isolates were compared with prototype sequences representing different genotype 1, 2, 3 and 4 clusters as well as the two sequences with homology of 95% were supplemented from GenBank using BLAST utility. Avian hepatitis E virus was used as an out group for the analysis. GenBank accession numbers of chosen sequences are: IND-HEV-FHF2-2004 (JF443723), Nep1 (AF051830), B1 (M73218), C1 (D11092), P1 (M80581), I1 (X9822, Cs13 (AF082092), T3 (AY204877), Morroco (AY230202), M1 (M74506), swCH25 (AY594199), T1 (AJ272108), HE-JVN1 (AB168095), V091ORF1 (AB075967), V228ORF1 (AB075970), JAK-Sai (AB074915), S15 (AF082093), CCC220 ((AB108537), VH1 (AF195064), Gr1 (AF110388), HEV ORF1/swine/Ger/06 (JN415695), HEV ORF1/swine/Ger/03 (JN415693), Gr2 (AF110389), UK1 (AJ315768), Osh 205 (AF455784), HEV/SW/NL/2005-1048 (EF372554), NLSW22 (AF336002), US2 (AF060669), swArkell (AY115488), swMexico (AF521654), swJL97 (AB108662), JDEER-Hyo03 (AB189071), It1 (AF110387), swNZ (AF215661), Au1 ((AF279122), swAr (AY258006), 3039 2 (JQ863408), NLSW105 (AF336013), NLSW68 (AF336007) and Avian hepatitis E virus (JN597006).


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