{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T13:50:34Z","timestamp":1791121834052,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2012,5,9]],"date-time":"2012-05-09T00:00:00Z","timestamp":1336521600000},"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":[[2012,9]]},"abstract":"<jats:p><jats:bold>Aim:\u2002<\/jats:bold> In developed countries including Japan, the transmission route of indigenous hepatitis E virus (HEV) infection is obscure. Accordingly, public health implications of indigenous HEV infection have not been well addressed. The aim of this study was to clarify the route of transmission of a small outbreak of acute hepatitis E and assess the public health implications of indigenous zoonotic HEV transmission.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> Three patients with non\u2010A, B and C acute hepatitis, two of whom presented in a critical condition, were assessed for HEV infection using polymerase chain reaction and their route of infection; the genome sequences of the infecting HEV were also analyzed. A phylogenetic tree based on the full, or near full, HEV RNA sequences were constructed by neighbor\u2010joining method.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> All three patients ingested grilled pork meat and entrails at the same barbecue restaurant in Abashiri, Hokkaido, Japan. When comparing partial to entire, or nearly entire, nucleotide sequences of HEV detected in these patients, they were 99.9\u2013100% identical to each other. These genotype 4 isolates had great resemblance to the genome sequences of the isolates from the mini\u2010outbreak in 2004 in Kitami, a city adjacent to Abashiri. These Kitami\/Abashiri strains were segregated into a single cluster on the phylogenetic tree of HEV genotype 4 indigenous to Japan.<\/jats:p><jats:p><jats:bold>Conclusion:\u2002<\/jats:bold> Indigenous HEV transmission via a zoonotic food\u2010borne route has been demonstrated in Kitami and Abashiri via pork meat and entrails contaminated with virulent HEV strains. Because a similar outbreak can recur in the future, infection sources and distribution routes should be clarified rapidly for public health.<\/jats:p>","DOI":"10.1111\/j.1872-034x.2012.01006.x","type":"journal-article","created":{"date-parts":[[2012,3,29]],"date-time":"2012-03-29T11:44:38Z","timestamp":1333021478000},"page":"870-878","source":"Crossref","is-referenced-by-count":62,"title":["Three cases of acute or fulminant hepatitis E caused by ingestion of pork meat and entrails in Hokkaido, Japan: Zoonotic food\u2010borne transmission of hepatitis E virus and public health 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