亚临床戊型肝炎病毒基因 1 型感染:动态人类储库 "的概念

IF 2.5 Q2 GASTROENTEROLOGY & HEPATOLOGY
Ananta Shrestha, Suresh Basnet, Sudhamshu Kc
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引用次数: 0

摘要

戊型肝炎病毒(HEV)在南亚和非洲流行严重,占全球 HEV 总负担的一半。戊型肝炎病毒有八种基因型。其中,已知可感染人类的四种常见基因型中,基因型 1 和基因型 2 盛行于发展中国家,而基因型 3 和基因型 4 则给工业化国家带来了挑战。世界各地都有文献报道普通人群,尤其是献血者中存在无症状 HEV 病毒血症。这种无症状病毒血症的临床影响尚不明确,需要进一步探讨。健康献血者中显然也有因 HEV 基因型 1 感染而检测到病毒血症的报道,但对其感染率却知之甚少。同样,虽然已知 HEV 基因型 3 可通过输血在人体内传播,并已在许多欧洲国家进行了筛查,但也有记录显示存在传播情况,尽管未造成重大临床后果。HEV 基因型 1 在流行地区的流行病学通常呈现消长模式。偶尔发生的零星 HEV 感染常被疫情爆发打断。由于没有已知的动物贮藏库,疫情爆发间歇期 HEV 存在于何处仍是一个谜,需要进一步探索。然而,在流行病学静止期,HEV 基因型 1 导致无症状 HEV 病毒血症的发生,可能说明这种现象可能是一种动态贮藏库。由于 HEV 基因 1 型感染不会导致慢性化,亚临床一过性感染和病毒传播可能是它在流行病间歇期持续存在的原因。这可能与 SARS COVID-19 日冕病毒感染的现象相似,尽管注射了疫苗,但该病毒在全球范围内的流行仍有明显的阶段性高峰和低谷。鉴于现有证据,我们提出了 "动态人类储库 "的概念。静止的亚临床感染 HEV 但没有任何临床后果,随后的传播可能会导致病毒在社区中的存在。无症状 HEV 感染者通过粪便脱落病毒传播 HEV 感染的可能性尚未见文献报道。这一缺失的环节可能是潘多拉盒子的关键,有助于了解基因 1 型占主导地位地区 HEV 感染的流行病学。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Subclinical hepatitis E virus genotype 1 infection: The concept of “dynamic human reservoir”
Hepatitis E virus (HEV) is hyperendemic in South Asia and Africa accounting for half of total Global HEV burden. There are eight genotypes of HEV. Among them, the four common ones known to infect humans, genotypes 1 and 2 are prevalent in the developing world and genotypes 3 and 4 are causing challenge in the industrialized world. Asymptomatic HEV viremia in the general population, especially among blood donors, has been reported in the literature worldwide. The clinical implications related to this asymptomatic viremia are unclear and need further exploration. Detection of viremia due to HEV genotype 1 infection, apparently among healthy blood donors is also reported without much knowledge about its infection rate. Similarly, while HEV genotype 3 is known to be transmitted via blood transfusion in humans and has been subjected to screening in many European nations, instances of transmission have also been documented albeit without significant clinical consequences. Epidemiology of HEV genotype 1 in endemic areas often show waxing and waning pattern. Occasional sporadic occurrence of HEV infection interrupted by outbreaks have been frequently seen. In absence of known animal reservoir, where HEV exists in between outbreak is a mystery that needs further exploration. However, occurrence of asymptomatic HEV viremia due to HEV genotype 1 during epidemiologically quiescent period may explain that this phenomenon may act as a dynamic reservoir. Since HEV genotype 1 infection cannot cause chronicity, subclinical transient infection and transmission of virus might be the reason it sustains in interepidemic period. This might be the similar phenomenon with SARS COVID-19 corona virus infection which is circulating worldwide in distinct phases with peaks and plateaus despite vaccination against it. In view of existing evidence, we propose the concept of “Dynamic Human Reservoir.” Quiescent subclinical infection of HEV without any clinical consequences and subsequent transmission may contribute to the existence of the virus in a community. The potential for transmitting HEV infection by asymptomatic HEV infected individuals by fecal shedding of virus has not been reported in literature. This missing link may be a key to Pandora's box in understanding epidemiology of HEV infection in genotype 1 predominant region.
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来源期刊
World Journal of Hepatology
World Journal of Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.10
自引率
4.20%
发文量
172
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