Hepatitis E in Singapore: A Case-Series and Viral Phylodynamics Study

Esmeralda Chi-Yuan Teo Department of Haematology, Singapore General Hospital, Singapore.

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Boon-Huan Tan DSO National Laboratories, Singapore.

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Michael A Purdy Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Pui-San Wong DSO National Laboratories, Singapore.

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Pei-Jun Ting DSO National Laboratories, Singapore.

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Pik-Eu Jason Chang Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Duke-NUS Medical School, National University of Singapore, Singapore.

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Lynette Lin-Ean Oon Department of Pathology, Singapore General Hospital, Singapore.

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Amanda Sue Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Chong-Gee Teo Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Chee-Kiat Tan Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Duke-NUS Medical School, National University of Singapore, Singapore.

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The incidence of hepatitis E in Singapore appears to be increasing. A retrospective case-series study of patients diagnosed with hepatitis E in a tertiary hospital from 2009 to 2013 was conducted. Of 16 cases, eight (50%) were solid-organ transplant recipients (SOTRs), and 14 (88%) were found infected by genotype 3 hepatitis E virus (HEV-3). Bayesian inferences based on HEV subgenomic sequences from seven cases suggest that HEV-3 strains were introduced to Singapore as two principal lineages. Within limitations of the study, it can be inferred that one lineage, in the 3efg clade, emerged about 83 years ago, probably originating from Japan, whereas the other, in the 3abchij clade, emerged about 40 years ago, from the United States. Establishment and subsequent transmissions of strains from these two lineages likely contribute to the current endemicity of hepatitis E in Singapore.

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Author Notes

Address correspondence to Esmeralda Chi-Yuan Teo, Singapore General Hospital, Outram Road, Singapore, S169608. E-mail: esmeralda.teo.c.y@sgh.com.sg

Authors' addresses: Esmeralda Chi-Yuan Teo, Department of Haematology, Singapore General Hospital, Singapore, E-mail: esmeralda.teo.c.y@sgh.com.sg. Boon-Huan Tan, Pui-San Wong, and Pei-Jun Ting, DSO National Laboratories, Singapore, E-mails: tboonhua@dso.org.sg, wpuisan@dso.org.sg, and tpeijun@dso.org.sg. Michael A Purdy, Amanda Sue, and Chong-Gee Teo, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: mup3@cdc.gov, ykr9@cdc.gov, and teocg1@hotmail.com. Pik-Eu Jason Chang and Chee-Kiat Tan, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, E-mails: jason.chang@singhealth.com.sg and tan.chee.kiat@singhealth.com.sg. Lynette Lin-Ean Oon, Department of Pathology, Singapore General Hospital, Singapore, E-mail: lynette.oon.l.e@singhealth.com.sg.

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