Hepatitis E Virus Genotype 3 in Sewage and Genotype 1 in Acute Hepatitis Cases, Israel

Daniela Ram Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel.

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Yossi Manor Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel.

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Yael Gozlan Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel.

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Eli Schwartz Center for Geographic Medicine and Tropical Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

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Ziv Ben-Ari Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Liver Diseases Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.

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Ella Mendelson School of Public Health, Tel Aviv University, Tel Aviv, Israel.

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Orna Mor Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel.

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Hepatitis E virus (HEV) is an emerging infectious agent in developed countries. HEV genotypes 1 (G1) and 3 (G3) have been identified in environmental and clinical samples in Europe. In Israel, the overall prevalence of anti-HEV IgG antibodies was found to be 10.6%; however, reports of HEV infection are scarce. In this study, the presence of HEV in Israel was investigated using 169 sewage samples from 32 treatment facilities and 49 samples from acute hepatitis patients, all collected between 2013 and 2015. Fourteen sewage samples, from Haifa (11/18 samples), Tel Aviv (2/29 samples), and Beer Sheva (1/17 samples), regions with good sanitary conditions and middle-high socioeconomic populations, were HEV positive. Among the patient samples, 6.1% (3/49) were HEV positive, all returning travelers from India. Genotype analysis revealed G1 HEV in patients and G3 HEV sequences in sewage. Evidence that HEV could be establishing itself in our region may justify more active surveillance to monitor its spread.

Author Notes

* Address correspondence to Orna Mor, Central Virology Laboratory, Public Health Services, Israel Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel. E-mail: orna.mor@sheba.health.gov.il
† These authors contributed equally to this work.

Authors' addresses: Daniela Ram, Yossi Manor, Yael Gozlan, and Orna Mor, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel, E-mails: daniela.Ram@sheba.health.gov.il, yossi.Manor@sheba.health.gov.il, yael.Gozlan@sheba.health.gov.il, and orna.mor@sheba.health.gov.il. Eli Schwartz, Center for Geographic Medicine and Tropical Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, E-mail: eli.schwartz@sheba.health.gov.il. Ziv Ben-Ari, Liver Diseases Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, E-mail: ziv.ben-ari@sheba.health.gov.il. Ella Mendelson, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel and School of Public Health, Tel Aviv University, Tel Aviv, Israel, E-mail: ella.mendelson@sheba.health.gov.il.

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