{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:21:54Z","timestamp":1787757714961,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI16\/01297"],"award-info":[{"award-number":["PI16\/01297"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI19\/00864"],"award-info":[{"award-number":["PI19\/00864"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI21\/00793"],"award-info":[{"award-number":["PI21\/00793"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI22\/01098"],"award-info":[{"award-number":["PI22\/01098"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FI22\/00180"],"award-info":[{"award-number":["FI22\/00180"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FI25\/00103"],"award-info":[{"award-number":["FI25\/00103"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["CM24\/00099"],"award-info":[{"award-number":["CM24\/00099"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["JR24\/00047"],"award-info":[{"award-number":["JR24\/00047"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["CD24\/00007"],"award-info":[{"award-number":["CD24\/00007"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023961","name":"Centro de Investigaci\u00f3n Biotecnol\u00f3gica en Red de Enfermedades Infecciosas","doi-asserted-by":"publisher","award":["CB21\/13\/00083"],"award-info":[{"award-number":["CB21\/13\/00083"]}],"id":[{"id":"10.13039\/501100023961","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023961","name":"Centro de Investigaci\u00f3n Biotecnol\u00f3gica en Red de Enfermedades Infecciosas","doi-asserted-by":"publisher","award":["CB21\/13\/00118"],"award-info":[{"award-number":["CB21\/13\/00118"]}],"id":[{"id":"10.13039\/501100023961","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023961","name":"Centro de Investigaci\u00f3n Biotecnol\u00f3gica en Red de Enfermedades Infecciosas","doi-asserted-by":"publisher","award":["CB21\/13\/00088"],"award-info":[{"award-number":["CB21\/13\/00088"]}],"id":[{"id":"10.13039\/501100023961","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatitis E virus genotype 3 (HEV\u20103) is a major cause of acute hepatitis in Europe. However, the clinical burden of symptomatic infection in routine practice and the relative contribution of host and viral factors to disease severity remain incompletely defined. We aimed to characterise the clinical burden, molecular epidemiology and determinants of adverse outcomes in patients with symptomatic HEV\u20103 infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective multicentre study including patients with suspected HEV infection from ten hospitals in southern Spain between 2022 and 2025. Samples were analysed at a central laboratory using a standardised diagnostic algorithm based on HEV IgM and HEV RNA testing, with molecular characterisation of viraemic cases. Demographic, clinical and outcome data were extracted from medical records. Multivariable logistic regression analyses were performed to identify factors associated with hospital admission and severe acute hepatitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1124 tested patients, 267 HEV infections were diagnosed (23.7%). Overall diagnostic positivity remained consistently high throughout the study period. Of the 267 patients, 111 (41.6%) required hospital admission, 14 (5.2%) developed severe acute hepatitis and three died (overall mortality 1.1%), all of whom had major comorbidities. Major comorbidity was independently associated with hospital admission and severe acute hepatitis, whereas HEV\u20103 clade was not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Symptomatic HEV\u20103 infection in southern Spain was associated with a substantial clinical burden. Adverse outcomes were driven primarily by host comorbidity rather than by the viral features assessed in this cohort, while molecular surveillance provided useful epidemiological context on circulating strains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70790","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T07:51:37Z","timestamp":1781250697000},"page":"792-799","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Burden of Symptomatic\n                    <scp>HEV<\/scp>\n                    \u20103 Infection in Southern Spain"],"prefix":"10.1111","volume":"64","author":[{"given":"Mar\u00eda","family":"Casares\u2010Jimenez","sequence":"first","affiliation":[{"name":"Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sof\u00eda, Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC) Universidad de C\u00f3rdoba (UCO)  C\u00f3rdoba Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Ferreira\u2010Tata","sequence":"additional","affiliation":[{"name":"Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sof\u00eda, Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC) Universidad de C\u00f3rdoba (UCO)  C\u00f3rdoba Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Viciana","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Microbiology and Preventive Medicine Unit Hospital Universitario Virgen de la Victoria  M\u00e1laga Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Freyre\u2010Carrillo","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Unit University Hospital de Puerto Real  C\u00e1diz Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5740-6675","authenticated-orcid":false,"given":"Pedro","family":"Lopez\u2010Lopez","sequence":"additional","affiliation":[{"name":"Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sof\u00eda, Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC) Universidad de C\u00f3rdoba (UCO)  C\u00f3rdoba Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Belen","family":"Perez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"},{"name":"Clinical Microbiology Unit, Hospital Universitario Reina Sof\u00eda Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC)  C\u00f3rdoba Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berta","family":"Becerril\u2010Carral","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Clinical Microbiology Unit Hospital Universitario de Jerez  Cadiz Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Fuentes","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"},{"name":"Clinical Microbiology Unit Hospital Universitario Cl\u00ednico San Cecilio  Granada Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria Ibs. Granada  Granada Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Mac\u00edas","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"},{"name":"Clinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme Instituto de Biomedicina de Sevilla (IBiS)\/CSIC  Seville Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Rios\u2010Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sof\u00eda, Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC) Universidad de C\u00f3rdoba (UCO)  C\u00f3rdoba Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Franco\u2010Alvarez","family":"de Luna","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Unit Hospital Universitario Juan Ram\u00f3n Jimenez  Huelva Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Teresa","family":"Cabezas\u2010Fernandez","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Unit Complejo Hospitalario Torrecardenas  Almeria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Corona\u2010Mata","sequence":"additional","affiliation":[{"name":"Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sof\u00eda, Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC) Universidad de C\u00f3rdoba (UCO)  C\u00f3rdoba Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Rivero\u2010Juarez","sequence":"additional","affiliation":[{"name":"Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sof\u00eda, Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC) Universidad de C\u00f3rdoba (UCO)  C\u00f3rdoba Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Rivero","sequence":"additional","affiliation":[{"name":"Clinical Virology and Zoonoses Research Group, Unit of Infectious Diseases, Hospital Universitario Reina Sof\u00eda, Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC) Universidad de C\u00f3rdoba (UCO)  C\u00f3rdoba Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560\u20107917.ES.2017.22.26.30561"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2903\/j.efsa.2017.4886"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a031872"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15704"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.08.033"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2022.2091479"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560\u20107917.ES.2022.27.23.2100542"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560\u20107917.ES.2024.29.43.2400118"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02075\u201020"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751\u20107915.14247"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560\u20107917.ES.2019.24.10.1800407"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2019.11.015"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiz207"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268819001122"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14329"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens9100832"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1128\/Spectrum.00382\u201021"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2022.06.017"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vetmic.2018.08.020"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vetmic.2024.110256"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12917\u2010018\u20101377\u20104"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.onehlt.2024.100690"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2023.168203"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.2903\/j.efsa.2023.7882"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70790","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.70790","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70790","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:51:15Z","timestamp":1787755875000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.70790"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/apt.70790"],"URL":"https:\/\/doi.org\/10.1111\/apt.70790","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]},"assertion":[{"value":"2026-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}