Indigenous Hepatitis E Virus Genotype 1 Infection, Uruguay

To the Editor: Hepatitis E virus (HEV) is the only virus in the genus Hepevirus, which is the only member of the family Hepeviridae. HEV is the causative agent of acute hepatitis E, a moderately severe enteric disease with death rates <4% in the general population and >30% in pregnant woman (1). The virus is transmitted primarily by the fecal-oral route associated with consumption of contaminated drinking water (2). HEV infection is of public health concern because it causes large epidemics and endemic waterborne outbreaks in Asia, Africa, and Latin America (2,3). During the past decade, an increasing number of locally acquired cases have been reported in industrialized and previously non–HEV-endemic countries, where evidence of zoonotic transmission has been discovered (4,5). Human HEV sequences are classified into genotypes 1–4, which are subdivided into subtypes. Genotype 1 was isolated in Asian and African countries and from Cuba and Venezu-ela in Latin America. Genotype 2 was described in Mexico and Africa. These genotypes have been isolated from human samples and are mostly associated with large epidemics and outbreaks of HEV. Genotype 3 is distributed worldwide, and genotype 4 is found in Asia and central Europe. Genotypes 3 and 4 have been isolated from humans and animal reservoirs, mainly pigs and wild boars, and are commonly found in persons with sporadic acute hepatitis cases (6). Thus, zoonotic transmission of HEV also poses a danger to public health Several countries in South Amer-ica, including Argentina, Brazil, Bo-livia, Venezuela, and Uruguay, have reported the detection and characterization of HEV strains. In these studies, 2 Venezuelan strains were classified within genotype 1; the remaining 70 published strains were indigenous isolates belonging to genotype 3 (7). However, little data regarding molecular epidemiology of HEV infection in South America exists. Here, we report the identification and molecular characterization of a genotype 1 strain detected in Uru-guay, isolated from a person with locally acquired HEV infection. The patient was a male, 26 years of age, and a member of the National Army Force, who had symptoms and paraclinical findings compatible with acute hepatitis: malaise, fever, chol-uria, jaundice, and elevated levels of bilirubin and liver enzymes. Syphilis , leptospirosis, hepatitis A–C, cy-tomegalovirus, Epstein-Barr virus, and HIV infection were ruled out by laboratory testing. No risk factor for HEV infection arose from the formal questionnaire, including travel out of Uruguay during the 40 days before the onset of the symptoms. Dietary …