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Here, we investigated the characteristics of 26 patients in our hospital located in Tochigi prefecture, 90\u2009km north of Tokyo, between 2000 and 2019. The reported number of patients with acute hepatitis E is increasing in Japan because measurement of IgA\u2010class anti\u2010HEV antibody was commercially available from 2011. In contrast, the numbers at our hospital were 1.5\/y and 1.0\/y in 2000 to 2011 and 2012 to 2019, respectively. This is attributed to the fact that we have been investigating HEV as a cause of unknown hepatitis before 2011. Among isolated HEV subgenotypes, including 3a, 3b, 4b, 4c, and 4d, all three patients with subgenotype 4c infection presented acute liver failure. Four HEV strains shared more than or equal to 99% identity within the 412\u2010nucleotide partial sequence, in which the time and place of HEV infection varied, except for one intrafamilial infection. In addition, some strains were similar to HEV strains isolated far from Tochigi prefecture. In conclusion, the number of patients with acute hepatitis E was not increasing at Jichi Medical University Hospital and some strains were found to circulate in Japan.<\/jats:p>","DOI":"10.1002\/jmv.26248","type":"journal-article","created":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T16:02:01Z","timestamp":1593619321000},"page":"3572-3583","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical and virologic features of hepatitis E virus infection at a university hospital in Japan between 2000 and 2019"],"prefix":"10.1002","volume":"92","author":[{"given":"Naoto","family":"Sato","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunji","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8036-6544","authenticated-orcid":false,"given":"Kouichi","family":"Miura","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Morimoto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshinari","family":"Takaoka","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Nomoto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norio","family":"Isoda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeo","family":"Nagashima","sequence":"additional","affiliation":[{"name":"Division of Virology, Department of Infection and Immunity Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaharu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Division of Virology, Department of Infection and Immunity Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0827-0964","authenticated-orcid":false,"given":"Hiroaki","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Division of Virology, Department of Infection and Immunity Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hironori","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Jichi Medical University School of Medicine  Shimotsuke Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.00822-17"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.12175"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.4014\/jmb.1910.10059"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1872-034X.2012.01006.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2003.12.026"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12560-017-9319-z"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.21730"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1099\/vir.0.068429-0"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13357"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1099\/0022-1317-83-8-1931"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.2957\/kanzo.61.11"},{"key":"e_1_2_7_13_1","unstructured":"National Institute of infectious Diseases: Infectious Diseases Weekly Report. 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