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. 2025 Apr 1;81(4):1343-1352.
doi: 10.1097/HEP.0000000000001081. Epub 2024 Aug 30.

Large-scale HEV genotype 3 outbreak on New Caledonia Island

Florence Abravanel  1   2 , Clémence Vignon  3 , Ambroise Mercier  4 , Jean-Baptiste Gaumery  5 , Antoine Biron  4 , Clément Filisetti  5 , Marie-Amélie Goujart  4 , Julien Colot  4 , Xavier Chamillard  6 , Justine Demortier  6 , Maxime Raz  6 , Catherine Boutet  5 , Laura Dupont  5 , Sylvie Duval  7 , Catherine Castric  7 , Denise Desoutter  7 , Anais Desoutter  7 , Marjorie Verge  7 , Clémentine De Smet  1 , Sofia Demmou  1 , Sébastien Lhomme  1   2 , Ann-Claire Gourinat  5 , Florence Nicot  1 , Jacques Izopet  1   2
Affiliations

Large-scale HEV genotype 3 outbreak on New Caledonia Island

Florence Abravanel et al. Hepatology. .

Abstract

Background and aims: Several symptomatic cases of HEV infections were reported to the New Caledonia Island Public Health Service between August and December 2023. This prompted epidemiological and virological investigations to identify the source of infection.

Approach and results: HEV RNA was assessed in symptomatic patients, various food items, and pig farms on the Island. HEV strains were characterized by sequencing. A seroprevalence study was also conducted on asymptomatic blood donors before and after the outbreak. One hundred twenty-seven symptomatic cases were reported. Hospitalization was required for 29/127 patients (22.8%). Hospitalized patients presented more frequently with comorbidities, including liver and cardiovascular diseases (80.7% vs. 27%, p < 0.01), and 3 persons died (2.3%). Among the 100 HEV RNA-positive samples received at the French National Reference Centre for HEV, viral sequencing was possible for 76 samples. All strains were identified as HEV genotype 3, and 74/76 strains were grouped together (nucleotide identity: 98%-100%). Full-length sequencing indicated a new HEV-3 subtype within HEV-3 subclade abk. Only genotype 3f strains were detected on the Island's pig farms. No food items tested positive for HEV RNA. The seroprevalence of HEV IgG and IgM in blood donors was 9.2% (9/98) and 0%, respectively, in 2020, rising to 17.3% (17/98) and 2% (2/98) in 2024.

Conclusions: Although all previous large-scale epidemics in Asia and Africa were associated with HEV-1 or 2, the New Caledonia outbreak was linked to HEV-3. A high number of symptomatic cases were admitted to the hospital, with a case-fatality rate of 2.3%.

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