Hepatitis E infection is typically associated with areas in which hepatitis
E virus (HEV) is endemic. Except for a few cases in Europe and in the Unit
ed States, acute hepatitis E is usually associated with travel to endemic a
reas. We set out to determine the etiologic role of HEV in acute non-A-C he
patitis in Italy. The presence of HEV-RNA and antibody was determined in 21
8 patients diagnosed with acute viral non-A-C hepatitis. Acute hepatitis E
infection was defined by the presence of HEV-RNA in sera and positivity for
IgM anti-HEV and seroconversion to IgG anti-HEV. Acute hepatitis E was fou
nd in 10.1% of the patients with acute non-A-C, with 95.5% exhibiting a ben
ign course. A more severe course was observed in a patient co-infected with
HAV and HEV. Most cases were travelers to endemic areas, although 18.2% re
ported no travel. One patient was from a household with an infected patient
. Sequence analyses of the polymerase chain reaction (PCR) product derived
from a patient who never visited endemic areas, identified an isolate that
is divergent significantly from all reported isolates of HEV (79.5-85.8% nu
cleotide identity). Evidence from this study suggests that HEV accounts for
approximately 10% of acute non-A-C viral hepatitis in Italy, diagnosed gen
erally in travelers returning from endemic areas. However, the identificati
on of a new HEV variant in an individual who never indicated travel or cont
act with individuals associated with endemic areas, suggests that this viru
s may be native to (C) 1999 Wiley-Liss, Inc.