BACKGROUND Hepatitis E virus (HEV) is a pathogen of viral hepatitis. Since 2006, the number of reported HEV cases has ten-fold increase in Hungary. OBJECTIVES The aim of this clinical and laboratory surveillance study was to analyse and confirm HEV IgM-positive sera with different methods in four consecutive years (2014-2017) in Hungary. STUDY DESIGN Between 2014 and 2017, a total of 1439 sera samples were tested for HEV from in/out-patients with unknown hepatitis from university and county hospitals and general practitioners from three counties in Southwest Hungary (covered population: Σ894.000 persons) using combined antibody (serology), various molecular (RT-PCR and RT-qPCR), novel antigen (Ag) and avidity detection methods. RESULTS Total of 162 (11.3%) of the 1439 sera were HEV IgM-positive including 13 (8%) HEV RT-PCR-positive (confirmed as HEV genotype 3 sub-genotypes 3a/c/e/f/i in genus Orthohepevirus A) with up to 1.1383 × 108 RNA copy/ml, 30 (18.5%) HEV Ag-positive and 16 with low avidity index for HEV, respectively. Total of 6 samples were positive simultaneously with the combined four methods and 31 with three methods. If the quotient of serum sample's OD/cut-off of anti-HEV ELISA IgM and IgG scores is higher than ≥1 it predisposes for acute HEV infection. No rat or ferret HEV RNA (genus Orthohepevirus C) were identified from these specimens by RT-PCR. During our surveillance period a 68-year-old professional (meat-packing) hunter with kidney transplantation and immunosuppressive therapy was confirmed and treated as the first documented case of chronic HEV infection in Hungary. CONCLUSION This four-year-long clinical and laboratory surveillance highlights the increasing importance of acute and chronic HEV infections in Hungary and supports the use of confirmatory assays for laboratory diagnosis of HEV in human.

中文翻译：

---

使用抗体，分子，抗原和亲和力联合检测方法对戊型肝炎病毒感染进行为期四年（2014-2017）的临床和实验室监控：匈牙利的发病率和慢性HEV病例增加。

背景技术戊型肝炎病毒（HEV）是病毒性肝炎的病原体。自2006年以来，匈牙利报告的HEV病例数量增加了十倍。目的这项临床和实验室监测研究的目的是连续四年（2014-2017年）在匈牙利使用不同方法分析和确认HEV IgM阳性血清。研究设计2014年至2017年之间，对来自匈牙利大学和县医院的未知肝炎的住院/门诊患者以及匈牙利西南部三个县的全科医生（覆盖人口：Σ894.000人）进行了总计1439份血清样品的戊型肝炎病毒检测组合抗体（血清学），各种分子（RT-PCR和RT-qPCR），新型抗原（Ag）和亲和力检测方法。结果总计162（11。在1439个血清中，有3％是HEV IgM阳性，包括13（8％）HEV RT-PCR阳性（已确认为甲型肝炎病毒A型的HEV基因型3亚型3a / c / e / f / i） RNA拷贝数为1.1383×108 RNA / ml，HEV Ag阳性的HEV为30（18.5％），亲和力较低的16。结合四种方法同时检测的阳性样本共6例，结合三种方法检测阳性的样本共31例。如果血清样品的抗-HEV ELISA OD / OD值与IgM和IgG分数的商高于或大于1，则表明存在急性HEV感染的可能性。通过RT-PCR未从这些标本中鉴定出大鼠或雪貂HEV RNA（正肝病毒C属）。在我们的监视期内，证实了一名68岁的专业（肉类包装）猎人，其进行了肾脏移植和免疫抑制疗法，并将其作为匈牙利首例慢性HEV感染病例。