World's second human case of rat hepatitis discovered

A second case of rat hepatitis E has been reported in a human in Hong Kong, making it also the second record...

Posted: Nov 23, 2018 2:18 AM
Updated: Nov 23, 2018 2:18 AM

A second case of rat hepatitis E has been reported in a human in Hong Kong, making it also the second recorded globally.

A 70-year-old woman from the Wong Tai Sin district of Hong Kong was diagnosed with the disease this month, according to Hong Kong's Department of Health. She does not recall having direct contact with rodents or their excreta (feces and bodily fluids) and didn't notice any rodents in her residence, the Department of Health said in a statement.

Animals

Asia

China

Continents and regions

Diseases and disorders

East Asia

Government and public administration

Government bodies and offices

Government departments and authorities

Health and medical

Health departments

Hong Kong

Infectious diseases

Life forms

Mammals

Public health

Public health administration

Rodents

Hepatitis

Liver disease

Investigations

Microscopic life

Viruses

Accidents, disasters and safety

Food and drink

Food safety

Product safety

Safety issues and practices

The woman was admitted to a public hospital on May 4, 2017, for headache, anorexia, malaise, abdominal pain and palpitations, which she had developed since May 1, 2017.

She soon recovered and was discharged four days later, on May 8. The woman had underlying illnesses, according to the Department of Health.

In September, the first case was reported, involving a 56-year old man. Before this, it was not known that the disease could be passed from rats to humans.

After that case, the Centre for Health Protection of the Department of Health provided blood samples from patients who had tested positive for immune protein called anti-HEV immunoglobulin -- a sign someone is infected with hepatitis E, known as HEV. Further investigations by Hong Kong University detected elements of DNA evident of rat HEV.

This is how the new case of the 70-year-old woman was identified.

Genetic sequencing results show the viruses in both cases to be highly similar, wrote Dr. Yh Leung, senior medical and health officer from the Centre for Health Protection, in the Department of Health's newsletter Thursday.

"Rat hepatitis E virus now joins this list of infections as an important pathogen that may be transmitted from rats to humans," Dr. Siddharth Sridhar, clinical assistant professor at the University of Hong Kong, previously said, adding that the risk of rat hepatitis E affecting humans has been underestimated.

The Centre for Health Protection's investigation showed that the two people with hepatitis E infections caused by rats had no travel history during the virus' usual incubation period of two to 10 weeks. Both the 56-year-old man and the 70-year-old woman resided in Hong Kong's Wong Tai Sin District, just over a mile apart. There are no other findings hinting at epidemiological links between the two cases, Leung wrote.

The apparent clustering of the two cases is of concern, and the Centre for Health Protection will continue to closely monitor the situation, Leung wrote, adding that the sources and routes of the infections could not be determined.

"It is likely that the virus can be found commonly in rats, with one study in Vietnam suggesting that more than 10% of them may have been infected," Martin Hibberd, professor of emerging infectious diseases at the London School of Hygiene & Tropical Medicine, wrote in an email. "Infection can be acquired by close contact with rats, or perhaps more likely through rat contaminated food or water."

Hong Kong's Public Health Laboratory Services Branch has implemented a molecular test targeting different hepatitis E viruses and will use this to test cases testing positive for anti-HEV immunoglobulins.

To prevent future infections, the public is advised to practice food safety, such as keeping hands and utensils clean, cooking thoroughly and keeping food at safe temperature, the letter adds.

Specific food safety suggestions include choosing safe raw materials, keeping hands and utensils clean, separating raw and cooked food, keeping food at safe temperature and cooking thoroughly.

The increasing number of case observations in Hong Kong is, according to Hibberd, "likely at this stage to be due to improved diagnostic tools and increased surveillance, as the clinical presentation can be confused with other diseases."

Hibberd said that "the recommendation by the Hong Kong team for increased surveillance in immune compromised patients seems sensible, given the observations of disease in them. Luckily the disease can be treated, so diagnosis therapy can play an important role in disease prevention."

Hepatitis causes inflammation of the liver, with various viruses that cause it. Most commonly, hepatitis A, B and C spread through contaminated food and water or blood and other body fluids, depending on the virus.

The human form of hepatitis E is typically transmitted through contaminated water and is estimated to infect 20 million people worldwide, resulting in 3.3 million people showing symptoms each year, according to the World Health Organization. It caused approximately 44,000 deaths in 2015, making up 3.3% of all deaths from viral hepatitis.

The animal form of the disease is thought to infect wild boars, domestic pigs and deer, as well as rats and other rodents.

California Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 271035

Reported Deaths: 6441
CountyConfirmedDeaths
Los Angeles1165703534
Riverside20555486
Orange17882366
San Diego16726387
San Bernardino15345269
Imperial7190117
Alameda6855140
Fresno611077
Santa Clara5408164
Kern536982
Tulare5009136
San Joaquin447455
Sacramento423669
San Francisco399250
Contra Costa387885
Ventura378950
San Mateo3599108
Santa Barbara326129
Marin280921
Kings267333
Stanislaus266045
Monterey215115
Solano147625
Sonoma135911
Merced127211
Placer91111
San Luis Obispo7652
Yolo67726
Madera5785
Santa Cruz4593
Napa4364
San Benito2732
Sutter2523
Lassen2420
El Dorado2260
Butte2063
Shasta1544
Humboldt1444
Nevada1291
Yuba1282
Glenn1220
Lake961
Tehama881
Mendocino850
Colusa700
Del Norte581
Calaveras530
Mono471
Tuolumne430
Amador330
Inyo331
Siskiyou320
Mariposa311
Plumas110
Alpine20
Trinity20
Sierra10
Unassigned00
Chico
Clear
68° wxIcon
Hi: 95° Lo: 59°
Feels Like: 68°
Oroville
Clear
69° wxIcon
Hi: 96° Lo: 60°
Feels Like: 69°
Paradise
Clear
68° wxIcon
Hi: 88° Lo: 58°
Feels Like: 68°
Chester
Clear
50° wxIcon
Hi: 79° Lo: 48°
Feels Like: 50°
Red Bluff
Clear
73° wxIcon
Hi: 97° Lo: 61°
Feels Like: 73°
Willows
Clear
68° wxIcon
Hi: 99° Lo: 58°
Feels Like: 68°
We began the new week with plenty of sunshine and heat around northern California, but more heat, more wind and more potential fire danger are ahead for our area.
KHSL Severe
KHSL Radar
KHSL Temperatures

Community Events