Original Paper Intervirology 2018;61:105–110 Hepatitis E Virus Genotype 1 and Hepatitis A Virus Dual Infection in Pediatric Patients with a Low Socioeconomic Status from Mexico Mauricio Realpe-Quintero a Santiago Mirazo b Oliver Viera-Segura a, c Edgar D. Copado-Villagrana a, c Arturo Panduro a, c Sonia Roman a, c Juan Arbiza b Nora A. Fierro a, c a Universidad de Guadalajara, Guadalajara, Mexico; b Universidad de la República, Montevideo, Uruguay; c Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico Received: March 6, 2018 Accepted: July 19, 2018 Published online: October 2, 2018 Dr. Nora A. Fierro Unidad de Inmunovirología, Servicio de Biología Molecular en Medicina Hospital Civil de Guadalajara Fray Antonio Alcalde Hospital 278 Col. El Retiro, Guadalajara, Jalisco 44280 (Mexico) E-Mail noraalma @gmail.com © 2018 S. Karger AG, Basel E-Mail karger@karger.com www.karger.com/int DOI: 10.1159/000492425 Keywords Hepatitis E virus-hepatitis A virus dual infection · Hepatitis E virus genotype 1 · Pediatric population Abstract Objective: We aimed to detect and characterize hepatitis E virus (HEV) RNA in sera samples from a pediatric population infected with the hepatitis A virus (HAV) exhibiting acute hepatitis and to correlate the infection status with the clini- cal outcome. Methods: Seventy-five ELISA-positive samples from children containing anti-HAV and anti-HEV IgM were used to amplify and characterize partial regions within HEV ORF2. A statistical comparison of clinical data between HEV IgM-positive/HEV RNA-positive patients and HEV IgM-posi- tive/HEV RNA-negative patients was performed. Results: Thirteen out of 75 IgM-positive samples provided amplifica- tion of discrete regions of the HEV genome. Nested RT-PCR- based detection and subsequent sequencing of 5 samples confirmed the identity of HEV genotype 1 (G1), which had not been previously reported in Mexico. Though not signifi- cant, a trend towards exacerbated clinical manifestations was found in HEV RNA-positive patients relative to HEV RNA- negative patients. Conclusions: An elevated rate of G1 RNA was detected. Hepatitis E seems to be a neglected disease in Mexico and epidemic strains of HEV are likely to play a role as causative agents of acute hepatitis in highly exposed chil- dren. Although HAV is endemic in Mexico, an HEV-RNA de- tection rate of 17% in co-infected samples shows the need for screening for HEV as a part of future vaccination strate- gies. © 2018 S. Karger AG, Basel Introduction Hepatitis E virus (HEV) is a leading causative agent of acute hepatitis globally, with a high incidence in develop- ing countries [1]. The pediatric population is not typi- cally considered an at-risk population despite the subop- timal sanitation conditions and the low income that pre- vails in these countries. Altogether, these factors may promote infection in this population. M. Realpe-Quintero and S. Mirazo contributed equally to this work.