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Clinical and Diagnostic Laboratory Immunology, November 2001, p. 1213-1219, Vol. 8, No. 6
1071-412X/01/$04.00+0 DOI: 10.1128/CDLI.8.6.1213-1219.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
Prevalence of Hepatitis E Virus Antibodies in
Canadian Swine Herds and Identification of a Novel Variant of Swine
Hepatitis E Virus
Dongwan
Yoo,1,*
Philip
Willson,2
Yanlong
Pei,1
M. Anthony
Hayes,1
Anne
Deckert,3
Catherine E.
Dewey,3
Robert M.
Friendship,3
Yungho
Yoon,4
Marcelo
Gottschalk,5
Carmencita
Yason,6 and
Antonio
Giulivi7
Departments of
Pathobiology1 and Population
Medicine,3 Ontario Veterinary College,
University of Guelph, Guelph, Ontario N1G 2W1, Veterinary
Infectious Disease Organization, Saskatoon, Saskatchewan S7N
5E3,2 College of Veterinary Medicine,
University of Montreal, Saint-Hyacinthe, Quebec J2S
7C6,5 Atlantic Veterinary College,
University of Prince Edward Island, Charlottetown, Prince Edward Island
C1A 4P3,6 and Bureau of Infectious
Diseases, Centre for Infectious Disease Prevention and Control, Health
Canada, Ottawa, Ontario K1A 0L2,7 Canada,
and Department of Animal Science, ChungAng University,
Anseong, Korea4
Received 17 April 2001/Returned for modification 12 July
2001/Accepted 26 July 2001
 |
ABSTRACT |
Swine hepatitis E virus is a newly identified potentially zoonotic
virus from pigs of particular concern for possible direct transmission
to a human xenotransplant recipient by organ transplantation. In the
present study, prevalence of serum antibodies to hepatitis E virus was
examined in Canadian swine herds. A total of 998 serum samples
collected from 6-month-old healthy slaughter hogs were examined by
enzyme immunoassay and Western blot analysis for antibodies to the
recombinant open reading frame 3 (ORF3) protein of hepatitis E virus
expressed in Escherichia coli. These samples represented more than 80 different swine production units from five major swine-producing provinces across Canada. From this study, 594 samples
(59.4%) were found to be positive for hepatitis E virus antibody. The
seroprevalence was higher in Quebec (88.8%) and Ontario (80.1%) than
in Alberta and Saskatchewan (38.3%). By PCR using a pair of
oligonucleotide primers deduced from the ORF2 sequence of human
hepatitis E virus, a specific hepatitis E virus sequence was recovered
from feces of pigs. The nucleotide sequence identity between the U.S.
swine hepatitis E virus and the Canadian isolate (SK3) was only 85.8%,
suggesting that genotypic variations may exist in swine hepatitis E
virus in North America. Among 165 serum samples collected from humans
in Saskatchewan, 2.4% were found to be positive for antibodies to the
hepatitis E virus ORF3 protein. Our data indicate that hepatitis E
virus is highly prevalent in commercial swine populations in Canada and
support the suggestion that the swine hepatitis E virus may be an
important zoonotic agent for humans.
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INTRODUCTION |
Hepatitis E is one of the five
recognized types (A, B, C, D, and E) of human hepatitis caused by viral
agents. Among these five types, hepatitis E is known as non-A non-B,
food-borne, or waterborne hepatitis (2, 34), whereas
hepatitis B, C, and D are known as serum hepatitis since they are
mainly transmitted through blood. Hepatitis G virus (HGV) has been
identified only recently and its clinical significance still remains
unclear. HEV, like HAV, is excreted in the feces of infected
individuals, and thus contaminated feces are assumed to be the primary
environmental source of infections. Accordingly, entry of the virus
into a host is believed to be primarily by a fecal-oral route via
contaminated food and water. In young adults, clinical features for
hepatitis E include jaundice, anorexia, nausea, and hepatomegaly. The
mortality rate for hepatitis E is reported to be 1 to 3%, compared
with only 0.2% for hepatitis A (for a review, see reference
37). Unlike hepatitis B and C, hepatitis E does not
progress to a chronic state, and recovery is always complete. Hepatitis
E has been reported to be severe in pregnant women, with high rates of
fulminating hepatitis and a case fatality rate up to 20%, especially
during the third trimester (11, 14).
The etiological agent for human hepatitis E has recently been
identified and characterized. HEV is a small nonenveloped virus with a
single-stranded positive-sense RNA genome of approximately 7.2 kb. The
full-length genomic sequence has been determined using strains isolated
from different geographical regions, and two distinct genotypes are
known to exist: Asian type and Mexican type (37). HEV was
initially considered to be a member of the family
Caliciviridae. However, on the basis of comparative
phylogenetic analysis, it was recently removed from the
Caliciviridae family and assigned as an unclassified genus
of "hepatitis E-like virus" (4, 29).
Hepatitis E is endemic in the areas of Asia, South America, the Middle
East, and Northern and Western Africa. In contrast to those countries,
HEV has been considered absent in Canada, the United States, and
countries in Western Europe. However, individuals in the countries
where hepatitis E is nonendemic with no known history of traveling to
areas of endemicity have contracted the disease (6, 13, 23, 38,
40), suggesting that HEV may be more widespread than previously
recognized. Recently in the United States, two distinct HEVs have been
isolated from two patients with acute hepatitis E (designated
US-1 and US-2) (18, 32). The US-1 sequence is
substantially divergent from other known human HEVs, with a sequence
identity of only 74% (32). In parallel with this study,
an HEV has been identified from pigs in Illinois (26), and
surprisingly, this swine isolate of HEV is genetically and
antigenically close to the US-1 strain of human HEV. The sequence similarity between the US-1 human and swine HEV genomes is
approximately 97 and 93% in open reading frame 2 (ORF2) and ORF3,
respectively (26, 32). Furthermore, swine HEV is able to
infect primates under experimental conditions (25). These
findings implicate a possible transmission of the virus from pigs to
humans. The potential for HEV to cause disease in swine has not been
adequately evaluated.
Swine has been considered to be a donor animal species for
xenotransplantation, and organ transplantation might directly transmit swine viruses to a human recipient who may pose further xenozoonotic risks in the community (41). Also, HEV from swine might
sometimes be transmitted to humans through environmental contact.
Accordingly, we have serologically surveyed Canadian swine herds for
hepatitis E. In this communication, we report that swine HEV is highly
prevalent in Canadian swine herds and describe a novel genotypic
variant of swine HEV isolated from Canadian pigs.
 |
MATERIALS AND METHODS |
Serum specimens.
Serum samples were collected from
6-month-old, healthy slaughter hogs in the Canadian provinces of
Alberta, Saskatchewan, Ontario, Quebec, and Prince Edward Island. These
pigs represented major pig production areas in Canada. Human serum
samples were obtained from patients admitted to the Royal University
Hospital in Saskatoon, Saskatchewan, Canada, during the period of 1998 to 2000. These human serum samples represented a randomized collection from individuals who tested negative for human immunodeficiency virus and hepatitis C. Both swine and human serum samples were stored
at
70°C until tested for antibody.
Enzyme-linked immunoassays.
Antibodies to HEV in human sera
were determined using a commercial hepatitis E antibody detection kit
according to the manufacturer's instructions (Hepatitis E [rDNA]
Antigen Abbott HEV EIA kit; Abbott GmbH, Biesbaden-Delkenheim,
Germany). Antibodies to HEV in swine sera were also tested using the
commercial kit but with slight modifications. Briefly, pig serum was
diluted in phosphate-buffered saline at 1:400 and incubated for 60 min
at 40°C with a polystyrene bead coated with the recombinant HEV
antigen provided with the kit. The bead was washed four times with 4 ml
of distilled water per wash. The bead was transferred to a fresh tube
and incubated for 1 h at 40°C with a 1:400 dilution of rabbit
anti-swine antibody coupled with horseradish peroxidase (Kirkegaard & Perry Laboratories, Gaithersburg, Md.). The bead was washed four times
again with 4 ml of water each and transferred to a new tube. Substrate
was prepared by adding 2.56 mg of o-phenylenediamine-2HCl
per ml of citrate phosphate buffer containing 0.02% hydrogen peroxide.
Three hundred microliters of the substrate solution was added per
sample, and the reaction mixture was incubated for 30 min to allow
color development. The reaction was terminated by adding 1 ml of 1 N sulfuric acid (Fisher Scientific, Ottawa, Ontario), and the
A492 was determined (Ultraspec 2000;
Amersham Pharmacia Biotech, Baie d'Urfé, Quebec). The cutoff
values were calculated based on the following formula: cutoff
value = negative control + (0.45 × positive control), where
the negative control was a known HEV-negative human serum and the
positive control was a known HEV-positive human serum supplied in the
Abbot HEV EIA kit. Swine sera positive and negative for HEV were
identified using human sera. Once strong positive and negative swine
sera were identified, these swine sera were subsequently used as
controls for evaluating the collection of swine serum samples.
Collections of swine serum samples were initially tested by the
enzyme-linked immunoassay for HEV antibody. To evaluate background
absorbance of swine sera, the identified negative swine serum was
included and tested without antigen. For those which fell into the
positive grey area (A492 = cutoff value + 10% of the positive control), Western blotting was performed to confirm the positive reaction with HEV antigen. Those below the
cutoff value, including the negative grey area
(A492 = cutoff value
10% of the
positive control), were considered HEV negative.
Subcloning of ORF3 gene of HEV.
The coding sequence for the
ORF3 protein of HEV was kindly provided by Burton Beames (Southwest
Foundation for Biomedical Research, San Antonio, Tex.). The ORF3 gene
was originally derived from a Burmese isolate of human HEV. The ORF3
gene was amplified with a pair of oligonucleotides (forward primer,
5'-CGGGATCCATGAATAACATGTCTTTTGC-3; reverse primer,
5'-GCGGATCCTCAGCGGCGCAGCCCCAGCTG-3') by PCR. The PCR
amplification was conducted as follows: denaturation at 95°C for
30 s, annealing at 56°C for 30 s, and extension at 72°C
for 2 min for 30 cycles, followed by 3 min of additional extension time. The ORF3 PCR fragment was digested with BamHI and
inserted into the BamHI site of pGEX-2T (Amersham Pharmacia
Biotech) downstream of the glutathione S-transferase (GST)
gene to generate pGEX-HEVF3. Cloning and manipulation of DNA were
performed according to the standard procedures (30).
Protein expression and partial purification.
Escherichia coli JM109 cells transformed with pGEX-HEVF3
were grown at 37°C in Luria-Bertani medium with vigorous shaking. When the culture reached an optical density of 0.6 at 600 nm, isopropylthio-
-D-galactoside (IPTG) was added
to a final concentration of 2 mM, and the culture was further incubated
for an additional 6 h. Cells were collected by low-speed
centrifugation at 500 × g for 20 min, and the cell
pellet was resuspended in 4 ml of 25% sucrose in 50 mM Tris-HCl (pH
8.0). After two freeze-thaw cycles, 10 mg of lysozyme was added and the
suspension was incubated for 10 min on ice followed by addition of 30 ml of 2× RIPA-TET buffer (5:4; 2× RIPA is 20 mM Tris-HCl [pH 8.0],
300 mM NaCl, and 2% sodium deoxycholate; TET is 100 mM Tris-HCl [pH
8.0], 50 mM EDTA, and 2% Triton X-100). The mixture was sonicated at
the highest scale (model W-385; Ultrasonics Inc., Farmingdale, N.Y.)
and centrifuged at 12,000 rpm for 15 min using an SS34 rotor in the
high-speed centrifuge (Sorvall RC-5B; Du Pont Instruments, Wilmington,
Del.). The pellet as insoluble aggregates was resuspended in water and stored at
20°C.
SDS-PAGE and Western blot analysis.
The partially purified
protein preparation (insoluble aggregates) was resolved by
polyacrylamide gel electrophoresis (PAGE) on a sodium dodecyl sulfate
(SDS)-12% polyacrylamide gel. The gel was either stained with
Coomassie blue (R-250) for direct visualization or transferred to
nitrocellulose membrane for Western blot analysis. For Western
blotting, approximately 1 µg of protein was loaded on a gel and the
transferred membrane was cut into 10 longitudinal strips so as to
contain 100 ng of protein per strip. Membrane strips were blocked
overnight with 1% bovine serum albumin (fraction V) in 20 mM Tris HCl
(pH 7.5)-500 mM NaCl, followed by three washes for 5 min each with
TTBS (Tris-HCl [pH 7.5], 500 mM NaCl, 0.05% Tween 20). The strips
were incubated with serum diluted in the blocking solution for 2 h
at room temperature and washed three times with TTBS. The strips were
then incubated for 1 h at room temperature with a 1:3,000 dilution
of secondary antibody (goat anti-rabbit antibody conjugated with
alkaline phosphatase [Kirkegaard & Perry Laboratories]). The strips
were washed again with TTBS and developed for color reaction by adding
a mixture of 3 mg of nitroblue tetrazolium chloride and 1.5 mg of BCIP
(5-bromo-4-chloro-indolylphosphate p-toluidine salt), both
prepared in 70% N',N'-demethylformide.
Viral RNA extraction.
The U.S. isolate of swine HEV, kindly
provided by Suzanne Emerson (National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda,
Maryland), was used as a positive control. Fecal specimens were diluted
in phosphate-buffered saline to make a 10% fecal suspension. A
100-µl aliquot of the 10% fecal suspension was mixed with Trizol
(GIBCO BRL Canadian Life Technologies; Mississauga, Ontario, Canada)
and extracted once with chloroform. The upper phase was transferred to
a fresh tube, and RNA was precipitated by adding 0.4 volume of
isopropanol with 20 µg of glycogen as a carrier (Boehringer Mannheim,
Laval, Quebec). The RNA precipitate was collected by centrifugation at 12,000 rpm for 10 min in a microcentrifuge (Micromax;
International Equipment Co., Needham Heights, Mass.) and washed once
with 70% ethanol. The RNA was resuspended in water, and the entire
amount of RNA was subjected to cDNA synthesis.
First-strand cDNA synthesis and PCR.
The extracted RNA was
mixed with 300 ng of reverse primer
(5'-CTACAGAGCGCCAGCCTTGATTGC-3') and incubated at 70°C for
10 min followed by immediate transfer to ice. The first-strand cDNA was synthesized at 42°C for 2 h by 200 U of Superscript II RNase
H
Reverse Transcriptase (GIBCO BRL) in the
presence of 0.6 mM deoxynucleoside triphosphates (dTTP, dATP, dCTP, and
dGTP), 4 mM dithiothreitol, 1 U of RNasin (Promega Biotech, Madison,
Wis.), 50 mM Tris-HCl (pH 8.3), 75 mM KCl, and 3 mM
MgCl2. The reaction was terminated by incubating
at 95°C for 5 min and chilled on ice. A first-round PCR was performed
in a volume of 30 µl using 1.5 U of Taq DNA polymerase
(GIBCO BRL), 150 ng of the reverse primer, 150 ng of forward primer
(5'-AGCTCCTGTACCTGATGTTGACTC-3'), a 0.4 mM concentration of
each deoxynucleoside triphosphate (dTTP, dATP, dCTP, and dGTP), 2 mM
MgCl2, 20 mM Tris-HCl (pH 8.4), and 50 mM KCl.
The PCR profile was as follow: 94°C for 30 s, 56°C for 30 s, and 72°C for 2 min for 35 cycles, followed by an additional
incubation at 72°C for 10 min. To increase the detection sensitivity,
a second-round PCR was performed using 3 µl of the first-round PCR
product. The reaction conditions for second-round PCR were identical to
those of the first-round PCR except that the following primers were used: forward primer, 5'-GCTCACGTCATCTGTCGCTGCTGG-3';
reverse primer, 5'-GGGCTGAACCAAAATCCTGACATC-3'. After the
second-round PCR, 3 µl was analyzed by agarose gel electrophoresis.
Nucleotide sequencing.
Nucleotide sequences were determined
by the PCR-based automatic dideoxy cycle sequencing (Perkin-Elmer,
Norwalk, Conn.) at the Guelph Molecular Supercentre, University of
Guelph. Sequences were analyzed using the software package of the
Genetics Computer Group via the Seqweb 1.2 interface at
http://www.cbr.nrc.ca.
Statistical analysis.
Each pig was exclusively classified as
seropositive or seronegative after enzyme-linked immunoassay based on
the criteria described above. The serological data were analyzed with
the aid of a statistical software program (Prism 2.01; GraphPad
Software Inc., San Diego, Calif.). The chi-square statistic was
calculated from the two-by-four contingency table, and significance was
set at a P of <0.05.
Nucleotide sequence accession number.
The nucleotide
sequence reported in this study has been deposited into the GenBank
database under accession number AF347692.
 |
RESULTS |
Expression of the HEV ORF3 protein and cross-reactivity with swine
HEV antibody.
For detection of HEV infection in humans, we used an
immunoassay-based diagnostic kit that is commercially available but not currently available as a diagnostic tool in North America. In order to
corroborate results with this assay, we developed an additional assay
for the ORF3 protein of HEV that was expressed in E. coli.
The full-length ORF3 coding sequence derived from human HEV was
subcloned and expressed as a fusion protein with GST under the
tac promoter. The recombinant fusion protein of approximately 35 kDa was expressed as insoluble aggregates upon induction with IPTG. The insolubility of the expressed protein facilitated partial purification of the protein (Fig.
1, lane 3). The level of protein
expression was estimated to be 2 mg/100 ml of the bacterial culture.

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FIG. 1.
Expression of the HEV ORF3 protein in E.
coli. The entire ORF3 coding sequence was expressed as a fusion
protein with the GST gene. JM109 cells containing pGEX-HEVF3 were grown
to log phase, and the protein expression was induced by adding IPTG to
the bacterial culture at a final concentration of 2 mM. Cells were
harvested and lysed with a mixture of detergents. The cell lysate was
then subjected to partial purification of the recombinant protein as
insoluble aggregates. The partially purified aggregate preparation was
resolved by SDS-PAGE on a 12% polyacrylamide gel and visualized by
Coomassie blue staining. Lanes: 1, molecular mass standard; 2, uninduced pGEX-HEVF3; 3, IPTG-induced pGEX-HEVF3. The arrowhead
indicates the HEV recombinant ORF3 protein expressed as a fusion
protein upon IPTG induction.
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Since the expressed recombinant ORF3 protein was derived from a human
isolate (Burmese genotype) of HEV, the cross-reactivity
of this antigen
with HEV antibodies in pigs was examined. According
to the deduced
amino acid sequences of the ORF3 protein of HEV,
the sequence identity
between Burmese isolate and the swine HEV
appears to be 81% (GenBank
accession numbers
M73218,
D10330,
and
AF082843), suggesting the
likelihood of immunologic cross-reaction.
Previously, an HEV fusion
protein with GST expressed in
E. coli was successfully used
to detect HEV antibodies in human sera (
19).
A small
number of pig sera was initially screened for HEV by immunoassay,
and
two specimens were selected for confirmatory cross-reactivity
testing. One specimen that showed an
A492 of more than 2.0 in
immunoassay
was chosen as a strong positive. Another specimen
was obtained from a
specific-pathogen-free pig maintained at the
high-security isolation
facility at the Ontario Veterinary College,
and this serum showed an
A492 of less than 0.2 and thus was
selected
as a negative control. Both positive and negative controls
were
twofold serially diluted from 1:200 (Fig.
2, lanes 1 and 6) to
1:3,200 (Fig.
2.,
lanes 5 and 10), and the diluted sera were reacted
with the recombinant
ORF3 protein by Western blotting. The reaction
with the recombinant
antigen was detected up to a 1:3,200 dilution
of the positive pig serum
in immunoassay (Fig.
2, lane 5), whereas
the negative control pig serum
in immunoassay remained negative
even at a 1:30 dilution (data not
shown), indicating that the
GST-human HEV ORF3 antigen can be used for
determination of the
prevalence of HEV antibody in pigs.

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FIG. 2.
Immunoreaction of the recombinant ORF2 protein of human
HEV with swine sera. One microgram of the HEVF3-GST fusion protein was
loaded into a wide preparative well and electrophoresed by SDS-PAGE.
The gel was transblotted to nitrocellulose membrane, and the membrane
was cut into 10 longitudinal strips so as to contain 0.1 µg of the
antigen per strip. The individual strips were subjected to Western blot
immunoassay with various dilutions of swine serum known to be positive
or negative for HEV by ELISA. Lanes: M, molecular mass standards; 1 through 5, pig serum positive for human HEV diluted 1:200, 1:400,
1:800, 1:1,600, and 1:3,200, respectively; 6 through 10, pig serum
negative for human HEV diluted 1:200, 1:400, 1:800, 1:1,600, and
1:3,200, respectively; 11, rabbit anti-GST antibody diluted 1:200.
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Seroprevalence of HEV in pigs.
Serum samples were collected
from healthy hogs (6 months old) from representative geographic
locations in Canada (Alberta, Saskatchewan, Ontario, Quebec, and Prince
Edward Island) in approximate proportion to their share of the national
herds. Among 998 samples representing more than 80 different swine
production units from five provinces, a total of 594 were determined to
be seropositive for HEV (Table 1),
indicating that approximately 60% of commercial pigs seroconverted by
6 months of age. The prevalence of HEV antibody in Quebec and Ontario
was very high (88.8 and 80.1%, respectively). Both Alberta
and Saskatchewan had a relatively lower rate of HEV prevalence
(38.3%) in comparison with Ontario and Quebec. In contrast, Prince
Edward Island was the lowest among provinces with 25% positivity. Contingency table analysis showed that the effect of geographic region
on rate of seropositivity was highly significant (P < 0.001). Some of the tested samples appeared to be strongly positive,
with optical density readings of more than 2.0, and this portion
accounted for 5.4% of samples. Five hundred and four samples
were determined to have an A492 of
more than 1.0, indicating that more than 50% of pigs became strongly
seroconverted for HEV antibody by 6 months of age.
Identification of HEV sequence from pig.
To confirm the
presence of HEV or HEV-like virus in swine herds, attempts were made to
identify the HEV-specific sequence from pigs. Fecal samples were
randomly obtained from 8-week-old pigs from different pens in
Saskatchewan and examined for viral sequence by reverse transcriptase
PCR. A specific band of a 289-bp fragment was amplified after two
rounds of PCR amplification from three out of six fecal samples
examined (Fig. 3A, lanes 2, 3, and 4).
Sample number 4 exhibited a relatively weak signal, but it was
considered a definite positive (lane 4). The DNA in the amplified
fragment, designated HEV-SK3, was sequenced to confirm the specificity.
The sequence was found to represent a region of ORF2 of HEV (nucleotide
positions 5649 to 5860 with respect to the sequence of the swine HEV
U.S. isolate) (Fig. 3B). When the HEV-SK3 sequence was compared to that
of swine HEV isolated in the U.S., the sequence identity appeared to be
only 85.8%. It was interesting, however, that the identity of the
predicted amino acid sequence between the two swine HEV isolates was
nearly 100% for this particular region. The identification of specific HEV sequence from pigs demonstrates that a swine form of HEV exists in
Canadian pigs which has maintained near identity at the protein level,
although the nucleotide sequence has diverged from the strain
identified in the United States.

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FIG. 3.
Amplification by PCR of HEV sequence from pig. (A) Total
RNA was extracted from swine feces and the first-strand cDNA was
synthesized using a primer pair deduced from the sequence of the swine
HEV U.S. isolate. The first-strand cDNA was amplified by two
consecutive rounds of nested PCR, and the amplified product was
electrophoresed on a 2% agarose gel. Lanes: M, 100-bp ladder molecular
mass standard; 1 through 6, feces collected from six different barns;
7, swine HEV (U.S. isolate) as a positive control. (B) Nucleotide
sequence of HEV recovered from a Saskatchewan pig in Canada and the
comparison with U.S. swine HEV. Dots represent identical nucleotides.
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Presence of HEV antibody in humans.
Canada is considered a
country of nonendemicity for HEV. Since Canadian pigs were found to
contain high levels of HEV-specific antibodies, it was of interest to
examine if humans could also have anti-HEV antibodies. One hundred
sixty-five serum samples were obtained from humans in Saskatchewan and
tested for HEV antibody. Four individuals (2.4%) were found to be
positive. One individual was strongly positive, with an
A492 of 1.46 (cutoff value, 0.6), and
another individual was weakly positive, with an
A492 of 0.8 (cutoff value, 0.45), but
was a definite positive. The other two individuals showed a lower
signal, with A492 of 0.8 and 0.5 (cutoff values, 0.6 and 0.45, respectively), but it was concluded that these were definite positives after repeat of the test. Clinical correlation with seropositive individuals was not possible to ascertain.
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DISCUSSION |
We employed the commercial HEV immunoassay and the Western
immunoblot to study the prevalence of HEV antibodies in pigs. Both diagnostic approaches utilized recombinant antigens from human HEV
isolates. The enzyme immunoassay was based on two recombinant antigens
(ORF2 and ORF3 proteins of Burmese HEV [SG-3 and 8-5 strains])
expressed in E. coli as a fusion protein with
CMP-2-keto-3-deoxyoctulosonic acid synthetase (27), and
this test has successfully been utilized to detect swine HEV antibody
in pigs (5, 12, 24). Recently, the recombinant
antigen-based anti-HEV antibodies were reevaluated, and the sensitivity
and specificity for immunoglobulin G were demonstrated to be 86.7 and
92.1%, respectively (20). These values were comparable to
those previously reported (9, 19, 22). For our studies, we
also used a Western blot assay to supplement the enzyme immunoassay and
demonstrated the cross-reactivity of swine antibody to the human HEV
GST-ORF3 antigen. With both diagnostic approaches, HEV antibodies were
reliably assayed in a broad sample from the Canadian pig populations.
Susceptibility of pigs to HEV was initially identified in an attempt to
develop pigs as an animal model for HEV infections (3).
Subsequently, domestic pigs were found to have been infected with human
HEV (7). Following the isolation of HEV from pigs, several
studies were conducted in various countries to examine the prevalence
of HEV antibodies in pigs. Those studies revealed that pigs in both
countries where human HEV is endemic and countries where human HEV is
nonendemic were positive for HEV antibodies. Pigs in Australia, New
Zealand, Taiwan, Korea, Canada, and the United States were seropositive
to HEV (all countries where human HEV is nonendemic) (5, 12, 24,
26; Olga Garkavenko [Auckland Hospital, Wellington, New
Zealand], personal communication), as were pigs in China, Thailand,
and Nepal (countries where human HEV is endemic) (7, 24).
In the present study, a large-scale serological survey was conducted to
assess the degree of prevalence of anti-HEV antibodies in swine herds
across Canada. Pigs examined for this study were all healthy,
6-month-old pigs and represent major pig-producing areas of the
country. The prevalence of HEV antibodies in these pigs varied
significantly by geographic region (P < 0.001) and was
surprisingly high, up to 89% in Quebec followed by 80% in Ontario
(Table 1). In a previous study, the prevalence of 15 to 38% was
observed in sows in Ontario and Quebec, respectively (24).
This difference may have been attributed to the age of the animals and
the sample size plus the number of farms tested. Alberta and
Saskatchewan showed a relatively lower prevalence, 38%. In the Western
Provinces, swine production units are generally spatially dispersed,
while Quebec and Ontario farms are rather clustered, and thus the
density of pig farms and the geographical conditions may have
contributed to the different levels of antibody prevalence in those areas.
Although clinical cases of hepatitis E have been rare in Western Europe
and North American countries, antibodies to HEV have been found in
human populations in those countries (36). One study
indicated that 1 to 2% of blood donors in the United States were
seropositive to HEV (17), and another study demonstrated that 1.2 to 1.4% of 5,000 blood donors were seropositive in Northern California (21). Many (31 to 38%) of the seropositive
individuals involved in that study had no history of international
travel (21). In Brazil (a country where HEV is
nonendemic), 2.6 to 3% of healthy blood donors were found to have HEV
antibodies (10). Similarly, the presence of HEV antibodies
was reported in countries where HEV is nonendemic in Europe, including
Spain, Sweden, Germany, Greece, England, Finland, Italy, and The
Netherlands (1, 15, 16, 42, 43). Similar data were
observed in human populations in Ontario (M. Fearon [Ontario Ministry
of Health, Toronto, Ontario], personal communication). In our study,
it was found that 2.4% of the human population in Saskatchewan was
positive to HEV, which is similar to the reported data in other
countries where HEV is nonendemic.
However, in the absence of the virus, there was no evidence that the
anti-HEV antibodies reflected subclinical HEV infections in humans.
Although some cases were reported to have been associated with travel
to regions of endemicity, the reason for a relatively consistent rate
of anti-HEV antibodies in these countries of nonendemicity was unknown.
In New Zealand, a hepatitis E case was reported in a young male who had
not traveled overseas within the previous 2 years and had not been in
contact with any overseas travelers before he was clinically ill
(6). In the United States, at least three cases of
hepatitis E were reported in Minnesota, Tennessee, and California
(8, 32, 38). In the United Kingdom, four cases of acute
hepatitis E were reported without established history of traveling to
areas of endemicity or contacts with patients with diagnosed cases of
HEV (23). HEVs were isolated from the two U.S. patients
(US-1, US-2), and their genomic sequences were found to be divergent
from two major known types of HEV (Asian and Mexican types) by 16 to
17%. Independently from these studies, an HEV was recently isolated
from a pig in the United States (26). While the U.S. human
HEV was only 73 to 74% identical to the genomic sequences of two major
types of human HEV (Asian and Mexican), the sequence identities between
US-1 and swine HEV were strikingly high, with 97% identity for ORF2
and an overall identity of 91% for the entire genome (8, 26,
32).
In the present study, in addition to the prevalence of anti-HEV
antibodies, we demonstrated the presence of a specific viral sequence
directly from pigs from three of the six tested pens of pigs (Fig. 3A).
The identification of HEV-specific viral sequence suggests that this
pig virus might be responsible for the anti-HEV antibodies identified
in Canadian pigs. Three of the six tested pens of pigs appeared to have
actively been infected, suggesting that HEV may be as highly prevalent
in swine in Canada as elsewhere in the world.
In human HEV, at least eight different genotypes have been reported:
Burmese genotype 1 (35), Mexican genotype 2 (13), U.S. genotype 3 (18, 32),
Chinese/Taiwanese genotype 4 (12, 39), European genotypes
5 to 7 (Greek [33], Italian [44], Austrian [40]), and Argentinian genotype 8 (31). Currently, HEV (of swine origin) sequences have been
made available from Spain, Taiwan, and the United States. The Spanish
sequence was identified indirectly from sewage of swine origin
(28), whereas the Taiwanese and the U.S. sequences were
obtained directly from pigs (12, 26). While the entire
genome has been sequenced for U.S. swine HEV, only a small portion of
the viral genome has been sequenced for either the Spanish or the
Taiwanese isolates. Furthermore, the latter sequences do not represent
the same region of the genome. Thus, we were only able to compare the
Canadian HEV-SK3 sequence to the prototype U.S. swine HEV sequence.
According to the sequence comparisons and the phylogenetic analysis
(Fig. 4), the swine HEV-SK3 recovered in
a Saskatchewan farm appears to be distinct from the U.S. swine HEV by
14.2%. This limited available information suggests that a parallel
genetic divergence may also exist in swine HEV, as with human HEV.
Determination of the full-length genomic sequence of the swine HEV-SK3
isolate and identification of additional HEV isolates of swine origin will help us better understand the genetic divergence of swine HEV, and
such studies are currently in progress.

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|
FIG. 4.
Phylogenetic trees of human and swine HEVs based on the
nucleotide sequences representing a portion of the ORF2 gene. Strains
of HEV are indicated, and their GenBank accession numbers are presented
in parentheses. Swine forms of HEV are underlined. The bar indicates a
10-nucleotide difference every 100 nucleotides.
|
|
 |
ACKNOWLEDGMENTS |
We thank J. Hammermueller, J. Zuo, H. Deneer, S. Zou, and C. Rhodes for helping with obtaining and analyzing human serum and swine
fecal specimens. We also thank S. Emerson for providing the U.S. swine
HEV, B. Beames for cDNA clones of a human HEV, and X. J. Meng for
helpful discussions throughout the study.
This study was supported by funding from Imutran Novartis and Health Canada.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Department of
Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada. Phone: (519) 824-4120, ext. 4729. Fax: (519)
767-0809. E-mail: dyoo{at}uoguelph.ca.
 |
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Clinical and Diagnostic Laboratory Immunology, November 2001, p. 1213-1219, Vol. 8, No. 6
1071-412X/01/$04.00+0 DOI: 10.1128/CDLI.8.6.1213-1219.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
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