{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T04:40:06Z","timestamp":1793162406991,"version":"4.5.0"},"reference-count":31,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004008","name":"Istituto Superiore di Sanit\u00e0","doi-asserted-by":"publisher","award":["Funding for of the institutional surveillance activity of the Department of Infectious Diseases"],"award-info":[{"award-number":["Funding for of the institutional surveillance activity of the Department of Infectious Diseases"]}],"id":[{"id":"10.13039\/501100004008","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Italian Ministry of Health","award":["Ricerca corrente, linea epatiti n.3"],"award-info":[{"award-number":["Ricerca corrente, linea epatiti n.3"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>In European countries, autochthonous acute hepatitis E cases are caused by Hepatitis E Virus (HEV) genotype 3 and are usually observed as sporadic cases. In mid\/late September 2019, a hepatitis E outbreak caused by HEV genotype 3 was recognized by detection of identical\/highly similar HEV sequences in some hepatitis E cases from two Italian regions, Abruzzo and Lazio, with most cases from this latter region showing a link with Abruzzo. Overall, 47 cases of HEV infection were finally observed with onsets from 8 June 2019 to 6 December 2019; they represent a marked increase as compared with just a few cases in the same period of time in the past years and in the same areas. HEV sequencing was successful in 35 cases. The phylogenetic analysis of the viral sequences showed 30 of them grouped in three distinct molecular clusters, termed A, B, and C: strains in cluster A and B were of subtype 3e and strains in cluster C were of subtype 3f. No strains detected in Abruzzo in the past years clustered with the strains involved in the present outbreak. The outbreak curve showed partially overlapped temporal distribution of the three clusters. Analysis of collected epidemiological data identified pork products as the most likely source of the outbreak. Overall, the findings suggest that the outbreak might have been caused by newly and almost simultaneously introduced strains not previously circulating in this area, which are possibly harbored by pork products or live animals imported from outside Abruzzo. This possibility deserves further studies in this area in order to monitor the circulation of HEV in human cases as well as in pigs and wild boars.<\/jats:p>","DOI":"10.3390\/v13061159","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T21:29:16Z","timestamp":1623965356000},"page":"1159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Hepatitis E Outbreak in the Central Part of Italy Sustained by Multiple HEV Genotype 3 Strains, June\u2013December 2019"],"prefix":"10.3390","volume":"13","author":[{"given":"Anna","family":"Garbuglia","sequence":"first","affiliation":[{"name":"National Institute for Infectious Diseases \u201cL. Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3035-5510","authenticated-orcid":false,"given":"Roberto","family":"Bruni","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and Oncovirus and Retrovirus Diseases Unit, Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umbertina","family":"Villano","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and Oncovirus and Retrovirus Diseases Unit, Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Vairo","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases \u201cL. Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Lapa","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases \u201cL. Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Madonna","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and Oncovirus and Retrovirus Diseases Unit, Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Picchi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, S. Salvatore Hospital, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5875-4193","authenticated-orcid":false,"given":"Barbara","family":"Binda","sequence":"additional","affiliation":[{"name":"General and Transplant Surgery Unit, ASL 1 Abruzzo, S. Salvatore Hospital, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinalda","family":"Mariani","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Medicine, SS Filippo and Nicola Hospital, 67051 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"De Paulis","sequence":"additional","affiliation":[{"name":"Veterinary Service for the Hygiene of Foods of Animal Origin and Their Derivatives, Department of Prevention, ASL1 Avezzano Sulmona L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"D\u2019Amato","sequence":"additional","affiliation":[{"name":"Ministry of Health, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, S. Salvatore Hospital, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Scognamiglio","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases \u201cL. Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Capobianchi","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases \u201cL. Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Ciccaglione","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and Oncovirus and Retrovirus Diseases Unit, Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the other members of the HEV Outbreak Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1099\/vir.0.068429-0","article-title":"Consensus proposals for classification of the family Hepeviridae","volume":"95","author":"Smith","year":"2014","journal-title":"J. Gen. 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