[57] It has also been reported that 8.7% of raw oysters collected from the coastal regions in Korea tested positive for HEV belonging to genotype 3.[136] Ishida et al.[93] reported that genotype 3 HEV was detected in a sewage sample and a seawater sample in Japan. In other reports, the isolation of HEV from sewage and river water raised the possibility of the contamination of shellfish by infectious HEV.[137, 138] Therefore, river water contaminated with swine feces or incompletely sanitized sewage may prove to be the

principal source of HEV contamination in shellfish. At present, the route of HEV transmission is unknown for nearly half of autochthonous hepatitis E cases, and the possible source of infection is considered STA-9090 to differ by geographic region in Japan (Table 4). Galunisertib cost Although

six (3.0%) of the 199 patients with domestic hepatitis E reported ingestion of venison before the disease onset, the low prevalence of HEV infection among wild deer may suggest the necessity of considering other unrecognized infectious source(s). Further efforts to clarify the sources and routes of infection are needed to improve the control of infection of this zoonotic, food-borne hepatitis virus in Japan. HEPATITIS E HAD been considered to be a travel-associated, acute, limiting liver disease that rarely progresses to fulminant hepatic failure in Japan. However, it became evident that HEV infection can also be acquired in Japan, as a zoonotic disease, with several species of animals, including pigs and wild boars, serving as reservoirs

for HEV in humans. Since the recognition of the presence of a domestic hepatitis E case and HEV-viremic domestic pigs in 2001, serological and PCR-based assay systems for HEV infection have been developed, and knowledge on the genomic diversity of HEV strains in humans and animals has been broadened. In addition, sporadic cases and clusters of autochthonous hepatitis E in many parts of Japan have been accumulated, contributing to a better understanding of the pathogenesis of 5-Fluoracil datasheet HEV infection. Furthermore, a serological test for hepatitis E, which is covered by the government insurance program, has been included in the strategy for the diagnosing acute hepatitis since October 2011 in Japan, and should be used to evaluate all patients with increased levels of liver transaminases. Because chronic hepatitis E has been observed in organ transplant recipients and HIV-infected patients in European countries and North America, it is necessary to test immunocompromised individuals with elevated liver enzymes for HEV RNA, and to elucidate their infection status in Japan, because such populations are also likely affected in our country. The animal reservoirs for HEV and the route/source of transmission are not fully understood. When the apparent zoonotic nature and chronicity of HEV are taken into consideration, control of this virus seems to be difficult.