Serologic identification of hepatitis E virus infections in epidemic and endemic settings

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Abstract
Recombinant chimeric protein C2 containing the N‐terminal region of trpE (37 kilodaltons [kDa]) and the C‐terminal half (46.8 kDa) of the polypeptide encoded by ORF2 of the hepatitis E virus (HEV) genome was used for the construction of a Western blot diagnostic test for IgG and IgM antibodies to the virus (anti‐HEV). (The C2 protein and the trpE protein devoid of C2 activity and used as a control for non‐specific reactions were purified by recovery from sodium dodecyl sulfate‐polyacrylamide gel electrophoresis [SDS‐PAGE] and used for preparation of strips). Specificity of the test was proven with sera obtained from patients with acute hepatitis non‐A, non‐B, non‐C (NANBNC) from outbreaks in different geographic regions of the world. IgG antibodies reactive to the recombinant C2 protein were detected in 93% of patients with acute hepatitis NANBNC and remained detectable in 89‐100% of these patients 1‐24 months after onset of jaundice. IgM antibodies were detected in 73% of patients within 26 days after onset of jaundice, in 50% 1‐4 months after onset, in 6% 6‐7 months after onset, and in no patients by 8 months after onset. When this test was used to identify sporadic hepatitis E cases in different regions of the world, such cases were found almost exclusively in areas where outbreaks of the disease had occurred and rarely in any other regions.