ArticlePloS one2018
Hepatitis E virus genotypes and subgenotypes causing acute hepatitis, Bulgaria, 2013-2015.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.
- Seroprevalence of hepatitis E virus infection in the Americas: Estimates from a systematic review and meta-analysis.PloS one · 2022Pooled it
- Current global estimates, risk factors, and knowledge gaps for Hepatitis E virus (HEV): A scoping review.PLoS neglected tropical diseases · 2026Article
- Distinct distribution of HEV-3 subtypes across humans, animals, and environmental waters in Sweden.Emerging microbes & infections · 2025Article
- varVAMP: degenerate primer design for tiled full genome sequencing and qPCR.Nature communications · 2025Article
- First Insight into the Seroprevalence of Hepatitis E Virus and Associated Risk Factors Among Liver Transplant Recipients from Bulgaria.Vector borne and zoonotic diseases (Larchmont, N.Y.) · 2025Article
- Article
- A comprehensive review on seroepidemiology and molecular epidemiology of hepatitis E Virus in Iran.Gastroenterology and hepatology from bed to bench · 2025Review
- Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria.Pathogens (Basel, Switzerland) · 2023Article
- Article
- Age and Gender Trends in the Prevalence of Markers for Hepatitis E Virus Exposure in the Heterogeneous Bulgarian Population.Life (Basel, Switzerland) · 2023Article
- Review
- Comparative Analysis on Clinical Characteristics Among Patients with Acute Hepatitis A Virus (HAV) and Patients with Acute Hepatitis E Virus (HEV): A Single-Center Retrospective Study from Bulgaria.Infection and drug resistance · 2023Article
- Molecular Characterization and Phylogenetic Analysis of Hepatitis E Virus (HEV) Strains from Pigs Farmed in Eight European Countries between 2020 and 2022.Transboundary and emerging diseases · 2023Article
- Molecular epidemiology and genotype-specific disease severity of hepatitis E virus infections in Germany, 2010-2019.Emerging microbes & infections · 2022Article
- Hepatitis E virus genotype 3 microbiological surveillance by the Spanish Reference Laboratory: geographic distribution and phylogenetic analysis of subtypes from 2009 to 2019.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2022Article
- A Molecular Study on Hepatitis E Virus (HEV) in Pigs in Bulgaria.Veterinary sciences · 2021Article
- Hepatitis E Outbreak in the Central Part of Italy Sustained by Multiple HEV Genotype 3 Strains, June-December 2019.Viruses · 2021Article
- Article
- Autochthonous and Travel Acquired Hepatitis E Virus in Australia.Frontiers in microbiology · 2021Article
- Increasing Hepatitis E Virus Seroprevalence in Domestic Pigs and Wild Boar in Bulgaria.Animals : an open access journal from MDPI · 2020Article
Corrections and comments
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Authors and funding
13 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn industrialized areas of the world, including Europe, Hepatitis E Virus (HEV) is considered an emerging pathogen. In fact, autochthonous cases caused by HEV genotype 3 (HEV-3) are increasingly reported. Several studies described the human HEV-3 subtypes and strains circulating in West Europe countries; in contrast, very little is known about the HEV strains responsible for acute hepatitis E in countries of East Europe/Balkans, such as Bulgaria. METHODS AND
findingsAnti-HEV IgM positive serum samples (n = 103) from acute hepatitis cases (2013-2015) from all over Bulgaria were analysed for HEV RNA by Real-Time PCR. Viremia was detected in 90/103 samples. A fragment of the viral genome (ORF-2 region) was amplified by nested PCR from 76/90 viremic samples, leading to a sequence in 64 of them. Genotyping by phylogenetic analysis with standard reference sequences showed HEV-1 in 1/64 cases, HEV-3 in 63/64. Subtyping of HEV-3 sequences showed 3e (39/63, 62%), 3f (n = 15/63, 24%) and 3c (n = 8/63, 13%) subtypes; in one case the sequence subtype was uncertain and classified as 3hi. In the phylogenetic tree, most 3e sequences grouped in two well distinct clusters (A and B), each one with very low intragroup genetic distances. In contrast, 3f and 3c were interspersed with reference sequences and showed lower tendency to cluster and/or higher intragroup distances. Geographically, while 3f and 3c were scattered throughout the country, 3e was restricted to the South-West area, with most cases in two towns about 40 kilometres apart from each other.
conclusionsMost acute hepatitis E cases in Bulgaria are caused by HEV-3, subtypes 3e, 3f and 3c. Circulation of 3e appears quite different from 3f and 3c, with 3e restricted to the South-West area while 3f and 3c diffused over the country. The factors underlying the observed molecular and geographical differences remain to be investigated.
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