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Review
. 2021 Jun 4;10(6):699.
doi: 10.3390/pathogens10060699.

Hepatitis E Virus in Croatia in the "One-Health" Context

Anna Mrzljak  1   2 , Lorena Jemersic  3 , Vladimir Savic  4 , Ivan Balen  5 , Maja Ilic  6 , Zeljka Jurekovic  7 , Jadranka Pavicic-Saric  8 , Danko Mikulic  9 , Tatjana Vilibic-Cavlek  2   10
Affiliations
Review

Hepatitis E Virus in Croatia in the "One-Health" Context

Anna Mrzljak et al. Pathogens. .

Abstract

Hepatitis E virus (HEV) is the most common cause of viral hepatitis globally. The first human case of autochthonous HEV infection in Croatia was reported in 2012, with the undefined zoonotic transmission of HEV genotype 3. This narrative review comprehensively addresses the current knowledge on the HEV epidemiology in humans and animals in Croatia. Published studies showed the presence of HEV antibodies in different population groups, such as chronic patients, healthcare professionals, voluntary blood donors and professionally exposed and pregnant women. The highest seroprevalence in humans was found in patients on hemodialysis in a study conducted in 2018 (27.9%). Apart from humans, different studies have confirmed the infection in pigs, wild boars and a mouse, indicating the interspecies transmission of HEV due to direct or indirect contact or as a foodborne infection. Continued periodical surveys in humans and animals are needed to identify the possible changes in the epidemiology of HEV infections.

Keywords: Croatia; One-Health; animal; epidemiology; hepatitis E virus; human; molecular testing; phylogenetic analysis; serology.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hepatitis E virus IgG prevalence in different population groups in Croatia [51,52,53,54,55,56,57,58,59].
Figure 2
Figure 2
The radial phylogenetic tree displays genus Orthohepevirus comprising four species: Orthohepevirus A, B, C and D, respectively, with the main hosts indicated as figures. The rectangular phylogenetic tree displays the genetic and host diversity of the selected hepatitis E virus (HEV) isolates from Croatia, which belong to genotype 3 of Orthohepevirus A, as indicated in the radial phylogenetic tree. The evolutionary history was inferred using the Neighbor-Joining method. Supporting (≥50%) bootstrap values of 1000 replicates are displayed at the nodes in the rectangular tree. Scale bars indicate nucleotide substitutions per site. HEV isolates from Croatia are color-coded (blue—human origin, green—wild boar origin, brown—pig origin and purple—mouse origin). Designations also include detection years for Croatian strain and GenBank accession numbers. The taxa in black color in the rectangular tree are genotype 3 subtype reference strains, according to Smith et al. [62].
Figure 3
Figure 3
HEV RNA prevalence in Croatia for: (a) domestic pigs and (b) wild boars.
See this image and copyright information in PMC

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