ArticleEpidemiology and infection2016
Epidemiological investigation of a tap water-mediated hepatitis E virus genotype 4 outbreak in Zhejiang Province, China.
Article in Epidemiology and infection, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Hepatitis E Virus (HEV) Infection in the Context of the One Health Approach: A Systematic Review.Pathogens (Basel, Switzerland) · 2025Pooled it
- Pooled it
- Analysis of the epidemiological trends of hepatitis A and E in Zhejiang Province and clinical characteristics of severe patients.BMC infectious diseases · 2026Article
- Variations of the Virome in Raw and Treated Water: A One-Year Follow-Up at Six Different Drinking Water Treatment Plants.Environmental microbiology reports · 2025Article
- Meteorological determinants of hepatitis E dynamics in Jiangsu Province, China: a pre-COVID-19 era study focusing on multi-route transmission (2005-2018).Frontiers in public health · 2025Article
- Epidemiological survey and risk factors associated withOne health (Amsterdam, Netherlands) · 2023Article
- Review
- Periodic Characteristics of Hepatitis Virus Infections From 2013 to 2020 and Their Association With Meteorological Factors in Guangdong, China: Surveillance Study.JMIR public health and surveillance · 2023Article
- Seroprevalence of anti-HEV IgG in children: very early exposure in young children in a hyperendemic region.Frontiers in public health · 2023Article
- [Consensus on prevention and treatment of hepatitis E].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2022Article
- Predicting incidence of hepatitis E using machine learning in Jiangsu Province, China.Epidemiology and infection · 2022Article
- Revisiting the Mongolian Gerbil Model for Hepatitis E Virus by Reverse Genetics.Microbiology spectrum · 2022Article
- Viral hepatitis update: Progress and perspectives.World journal of gastroenterology · 2021Review
- Natural Host-Environmental Media-Human: A New Potential Pathway of COVID-19 Outbreak.Engineering (Beijing, China) · 2020Article
- Challenges for Safe and Healthy Drinking Water in China.Current environmental health reports · 2020Review
- Acute sporadic hepatitis E in the Zhejiang coastal area of China: a 14-year hospital-based surveillance study.Virology journal · 2019Article
- Transmission and Epidemiology of Hepatitis E Virus Genotype 3 and 4 Infections.Cold Spring Harbor perspectives in medicine · 2018Review
- Hiding in Plain Sight? It's Time to Investigate Other Possible Transmission Routes for Hepatitis E Virus (HEV) in Developed Countries.Food and environmental virology · 2018Review
- Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
An outbreak of acute hepatitis recently occurred in a nursing home in Zhejiang Province, China. The objectives of this study were to confirm the outbreak and identify the aetiology, source and transmission patterns. All residents and staff in or near the nursing home during the period from 1 October 2014 to 21 May 2015 were investigated regarding hygiene and for epidemiological information including water and food (eating meat especially pork products). Serum and stool specimens were collected for detection of hepatitis E virus (HEV) antibodies using ELISA and RNA using RT-PCR. Samples that were RNA positive were genotyped. Of 185 senior residents and 24 staff in the nursing home, there were 37 laboratory-confirmed cases during the outbreak. Of these cases, 12 patients (three deaths) were symptomatic with jaundice, a common clinical symptom for hepatitis E infection. HEV strains were isolated from three cases and they formed a single cluster within genotype 4d. A case-control study was conducted to investigate potential risk factors for the outbreak and the results revealed that cases more often washed their dishes and rinsed their mouths using tap water than the controls (P < 0·05). Based on hygiene investigation and meteorological information, it is likely that HEV-infected sewage and faeces contaminated the water network on rainy days. Collectively, these results suggest that the outbreak of HEV genotype 4 infection was most likely caused by contaminated tap water rather than food.
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