{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:14:16Z","timestamp":1793060056685,"version":"4.5.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>\n                      Hepatitis E virus (HEV) variants causing human infection predominantly belong to HEV species\n                      <jats:italic toggle=\"yes\">A<\/jats:italic>\n                      (HEV\u2010A). HEV species\n                      <jats:italic toggle=\"yes\">C<\/jats:italic>\n                      genotype 1 (HEV\u2010C1) circulates in rats and is highly divergent from HEV\u2010A. It was previously considered unable to infect humans, but the first case of human HEV\u2010C1 infection was recently discovered in Hong Kong. The aim of this study is to further describe the features of this zoonosis in Hong Kong.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach and Results<\/jats:title>\n                    <jats:p>We conducted a territory\u2010wide prospective screening study for HEV\u2010C1 infection over a 31\u2010month period. Blood samples from 2,860 patients with abnormal liver function (n\u00a0=\u00a02,201) or immunosuppressive conditions (n\u00a0=\u00a0659) were screened for HEV\u2010C1 RNA. In addition, 186 captured commensal rats were screened for HEV\u2010C1 RNA. Sequences of human\u2010derived and rat\u2010derived HEV\u2010C1 isolates were compared. Epidemiological and clinical features of HEV\u2010C1 infection were analyzed. HEV\u2010C1 RNA was detected in 6\/2,201 (0.27%) patients with hepatitis and 1\/659 (0.15%) immunocompromised persons. Including the previously reported case, eight HEV\u2010C1 infections were identified, including five in patients who were immunosuppressed. Three patients had acute hepatitis, four had persistent hepatitis, and one had subclinical infection without hepatitis. One patient died of meningoencephalitis, and HEV\u2010C1 was detected in cerebrospinal fluid. HEV\u2010C1 hepatitis was generally milder than HEV\u2010A hepatitis. HEV\u2010C1 RNA was detected in 7\/186 (3.76%) rats. One HEV\u2010C1 isolate obtained from a rat captured near the residences of patients was closely related to the major outbreak strain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HEV\u2010C1 is a cause of hepatitis E in humans in Hong Kong. Immunosuppressed individuals are susceptible to persistent HEV\u2010C1 infection and extrahepatic manifestations. Subclinical HEV\u2010C1 infection threatens blood safety. Tests for HEV\u2010C1 are required in clinical laboratories.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hep.31138","type":"journal-article","created":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T00:34:20Z","timestamp":1579566860000},"page":"10-22","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":200,"title":["Transmission of Rat Hepatitis E Virus Infection to Humans in Hong Kong: A Clinical and Epidemiological Analysis"],"prefix":"10.1097","volume":"73","author":[{"given":"Siddharth","family":"Sridhar","sequence":"first","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"},{"name":"State Key Laboratory of Emerging Infectious Diseases,The University of Hong Kong,Hong Kong,China"},{"name":"Carol Yu Centre for Infection,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril Chik\u2010Yan","family":"Yip","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shusheng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas Foo\u2010Siong","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kit\u2010Hang","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper Fuk\u2010Woo","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"},{"name":"State Key Laboratory of Emerging Infectious Diseases,The University of Hong Kong,Hong Kong,China"},{"name":"Carol Yu Centre for Infection,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pyrear Suhui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan\u2010Mui","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosana Wing\u2010Shan","family":"Poon","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoi\u2010Wah","family":"Tsoi","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian\u2010Piao","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen Shuk\u2010Ying","family":"Chan","sequence":"additional","affiliation":[{"name":"The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony Wai\u2010Shing","family":"Leung","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy Wing\u2010Sze","family":"Tse","sequence":"additional","affiliation":[{"name":"Princess Margaret Hospital,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonpaul Sze\u2010Tsing","family":"Zee","sequence":"additional","affiliation":[{"name":"Kwong Wah Hospital,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen Tak\u2010Yin","family":"Tsang","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent Chi\u2010Chung","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna Kar\u2010Pui","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"},{"name":"State Key Laboratory of Emerging Infectious Diseases,The University of Hong Kong,Hong Kong,China"},{"name":"Carol Yu Centre for Infection,The University of Hong Kong,Hong Kong,China"},{"name":"Tuen Mun Hospital,Hong Kong,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Chiu\u2010Yat","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Microbiology,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China"},{"name":"State Key Laboratory of Emerging Infectious Diseases,The University of Hong Kong,Hong Kong,China"},{"name":"Carol Yu Centre for Infection,The University of Hong Kong,Hong 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