Intrafamilial transmission of hepatitis E in France

Abstract number: p785

Ducancelle  A., Nicand  E., Payan  C., Le Guillou  H., Calès  P., Lunel-Fabiani  F.

Introduction: 

Hepatitis E virus (HEV) infection is an important cause of epidemic and acute sporadic hepatitis in developing countries. HEV is transmitted principally via the faecal-oral route. In some industrialized countries, autochthonous cases have emerged in patients who had never travelled to endemic areas. We report an autochthonous case of acute HEV infection with person-to-person transmission in the same family.

Methods: 

A 41-year-old man with clinical symptoms of acute hepatitis and increased bilirubin and aminotransferase levels was admitted in our hospital. Anti-hepatitis A, B, C virus antibodies (Ab) (HAV, HBV, HCV) and anti-herpes viruses Ab (CMV, EBV) were negative. Diagnosis of HEV was considered. Samples from the patient and all the household contacts were tested for the presence of serum IgG and IgM anti-HEV (Ab) and HEV RNA.

Results: 

Anti-HEV IgG and IgM Ab were found in the patient (index case) 14 days after the onset of hepatitis. The presence of serum HEV RNA was detected only 4 months later. In his wife (case contact 1), who presented with asthenia and moderate cytolysis, HEV RNA was detected in sequential samples, before the detection of anti-HEV Ab. Anti-HEV Ab and HEV RNA were also found positive in the second contact case (5 years old child), who had fever and asthenia. The second child was anti-HEV Ab and HEV RNA negative. Clinical interview indicated that the index case and his wife had eaten shellfish and that all the family have had a swim in the Saint-Ferreol lake located in the south west part of France.

Conclusion: 

Diagnosis of HEV infection have to be considered in case of acute hepatitis when markers of acute HAV, HBV, and HCV infection are negative, even if patients have not recently travelled in endemic areas. In our study, in the first contact case, hepatitis occurred within two weeks after the index case and may not be due to intrafamilial transmission, but to a simultaneous faecal-oral contamination via shellfish consumption or lake swim. In the second case (child), the detection of HEV RNA occurred after 6 weeks from the onset of disease in the index case, suggesting that the infection had been contracted by household contact. This case report and other published data may indicate that HEV is emerging in the south part of France.