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      Hepatitis E Virus Infection in Bulgaria: A Brief Analysis of the Situation in the Country

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          Abstract

          BACKGROUND:

          Over the past two decades, more thorough investigations for hepatitis E virus (HEV) infection have been done in the world. Reports from Southeast European countries have increased.

          AIM:

          The current article presents a critical analysis of all studies for HEV in Bulgaria.

          MATERIAL AND METHODS:

          A literature search was done using available medical databases. We analysed the literature in PubMed databases and Bulgarian medical databases for English and Bulgarian languages sources. Preference was given to the sources published within the past 24 years (January 1995 – September 2018).

          RESULTS:

          Two thousand two hundred and fifty-seven blood serums were tested for the analysed period (1995 – 2018), and 13.1% of them were positive for acute HEV (Mean ± SD: 20.38 ± 25.77%; 95% CI: 1.29 – 39.47%). The following subtypes were established in the country – HEV Subtype 3e, HEV Subtype 3f, HEV Subtype 3c, HEV Subtype 3i, HEV Subtype 3hi and HEV Subtype 1.

          CONCLUSION:

          We hope that the National Health Organizations will take adequate and timely measures to increase the knowledge and research for HEV among Bulgarian citizens.

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          Most cited references11

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          Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type.

          M S Khuroo (1980)
          A common source waterborne epidemic of viral hepatitis was studied in Kashmir valley over the six month period from November 1978 to April 1979. Highly sensitive serologic tests for hepatitis B and hepatitis A failed to reveal either one as an etiologic agent of hepatitis. Of 16620 inhabitants of the area screened four times in these six months, viral hepatitis developed in 1.65 per cent. In addition, 27.3 per cent of 128 persons who had contacts with patients who had viral hepatitis had biochemical features of anicteric hepatitis. The mode of spread of the epidemic, length of incubation, clinical features and biochemical test results of the patients studied resembled that of hepatitis A. These findings were in contrast to that of non-A, non-B hepatitis following transfusion, which closely resembles hepatitis B. The data strongly suggest the possibility of another human hepatitis virus and established the fecal oral route of its spread.
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            Hepatitis E: Discovery, global impact, control and cure

            Hepatitis E was identified as an epidemic of non-A, non-B hepatitis from Kashmir, India in 1978. Hepatitis E virus (HEV), the etiological agent is the sole member of family Hepeviridae. The virus has marked heterogeneity and infects many animals like bats, camel, chicken, deer, boar, mongoose, pigs, rats, rabbit and cutthroat trout. Hepatitis E is a disease with a major global impact and has two distinct epidemiological patterns. Hepatitis E is an imperative health issue in developing nations, transmitted through sullied water and happens most every now in young adults. The disease is particularly severe during pregnancy and in people with underlying liver cirrhosis. Autochthonous hepatitis E is increasingly recognized in developed countries. The virus infects domestic pigs, wild boar and Sika deer in these countries. HEV infections in humans occur by eating the undercooked game flesh, raw liver from supermarkets and Figatelli sausages. Blood transfusion-associated HEV infections occur in many countries and screening of donors for HEV RNA is under consideration. Hepatitis E causes a number of extrahepatic diseases, including a wide spectrum of neurological syndromes. HEV genotype 3 causes prolonged viremia, chronic hepatitis, liver fibrosis and cirrhosis in organ transplant patients. The virus is amenable to ribavirin monotherapy and most patients clear the virus in a few weeks. Hepatitis E vaccine -239, marketed in China, has shown high efficacy with sustained protection for over four years.
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              Epidemic and endemic hepatitis in India: evidence for a non-A, non-B hepatitis virus aetiology.

              69 serum pairs from two common-source water-borne outbreaks and one series of endemic cases of hepatitis in three parts of India were tested for hepatitis A and hepatitis B virus infections. None of the patients had evidence of HAV infection and only 10.1% had evidence of HBV infection. A large proportion of hepatitis in India seems to be caused by previously unrecognised agents.
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                Author and article information

                Journal
                Open Access Maced J Med Sci
                Open Access Maced J Med Sci
                Open Access Macedonian Journal of Medical Sciences
                Republic of Macedonia (ID Design 2012/DOOEL Skopje )
                1857-9655
                15 February 2019
                25 January 2019
                : 7
                : 3
                : 458-460
                Affiliations
                [1 ]Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
                [2 ]Department of Infectious Pathology, Hygiene, Technology and Control of Foods from Animal Origin, Faculty of Veterinary Medicine, University of Forestry, Sofia, Bulgaria
                [3 ]Department of Microbiology, Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, Trakia University, Stara Zagora, Bulgaria
                Author notes
                [* ] Correspondence: Magdalena Baymakova. Military Medical Academy, Sofia, Bulgaria. E-mail: dr.baymakova@ 123456gmail.com
                Article
                OAMJMS-7-458
                10.3889/oamjms.2019.073
                6390163
                30834019
                e6842a1d-885c-47a4-b594-e4816e7ad4d1
                Copyright: © 2019 Magdalena Baymakova, Georgi T. Popov, Roman Pepovich, Ilia Tsachev.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

                History
                : 16 October 2018
                : 09 January 2019
                : 10 January 2019
                Categories
                Review Article

                hev infection,bulgaria,public health
                hev infection, bulgaria, public health

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