{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T21:53:06Z","timestamp":1759009986276,"version":"3.37.3"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,7,27]],"date-time":"2016-07-27T00:00:00Z","timestamp":1469577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the clinical and virological features of acute hepatitis\u00a0E (AH\u2010E) in Gunma prefecture and focus on the hepatitis\u00a0E virus (HEV) infection in immunocompromised patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 30 patients with AH\u2010E diagnosed at our Gunma University Hospital, and located in 3\u201039\u201015 Showa\u2010machi, Maebashi, Gunma 371\u20108511 Japan, and its affiliated hospitals from 2004 to 2015, were studied. We evaluated the detailed medical histories, laboratory examinations and virological features of these participants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 30 patients, 21 patients were men, with a median age of 61\u00a0years. Three of these patients had a history of recent oversea travel. A total of 14 patients had eaten raw or undercooked meat\/viscera from animals, and two patients had contracted transfusion\u2010transmitted AH\u2010E. Eight patients were immunocompromised, including those with hematological disease, cancer receiving systemic chemotherapy and kidney transplant or connective tissue disease undergoing immunosuppressive medications. The alanine aminotransferase and total bilirubin levels were more significantly reduced in these immunocompromised patients than in the non\u2010immunocompromised patients. Severe thrombocytopenia, an extra\u2010hepatic manifestation of AH\u2010E, occurred in one case. Among the 22 HEV strains whose subgenotype was determined, two were imported strains (1a and 1f), and 11 strains formed four distinct phylogenetic clusters within subgenotype\u00a03b. The remaining nine strains differed from each other by 9.8\u201322.4%, and were classified into four subgenotypes (3a, 3b, 3e and 3f).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Markedly divergent HEV strains (3a, 3b, 3e and 3f) were found to circulate in Gunma. Although immunosuppression appears to play a crucial role in establishing chronic sequels, AH\u2010E in eight immunocompromised patients, including transfusion\u2010transmitted HEV infection in two patients, did not become chronic.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hepr.12765","type":"journal-article","created":{"date-parts":[[2016,6,20]],"date-time":"2016-06-20T17:23:41Z","timestamp":1466443421000},"page":"435-445","source":"Crossref","is-referenced-by-count":17,"title":["Clinical and virological features of acute hepatitis E in Gunma prefecture, Japan between 2004 and 2015"],"prefix":"10.1111","volume":"47","author":[{"given":"Yuichi","family":"Yamazaki","sequence":"first","affiliation":[{"name":"Department of Medicine and Molecular Science Gunma University Graduate School of Medicine  Maebashi 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