Duration and clinical relevance of viral shedding of HEV by the stool: results from an observational prospective study

Background: Hepatitis E Virus (HEV) shedding in stool in India (endemic for HEV genotype 1) has been described to last up to 30 days. This has never been investigated in genotype 3 regions, like Germany. This study covers the duration of HEV shedding and the resulting relevance of contamination of bathroom furniture.

Methods: Blood, stool, and urine from 12 immunocompetent patients with acute HEV infection were tested by PCR (Cobas TaqMan™). Additionally, surface contamination in the bathrooms of 13 patients with Hepatitis E following toilet use, was tested by PCR (Altona diagnostics).

Results: The observational cohort included 12 immunocompetent patients (8 men and 4 women, aged 39-83 years) with autochthonous HEV infection. Ten had acute Hepatitis E, and two were asymptomatic HEV-infected blood donors. HEV was detected in 83%, (n=10) in their stool. The maximum duration of viremia was 12 weeks (average 7±2 weeks). Fecal virus shedding lasted up to 8 weeks (average 4±2 weeks).

HEV-RNA was detected on toilet seats in six patients, flush buttons in three patients, faucet handles in five, and door handles in two patients, with very low contamination levels.

Conclusion: HEV infections in Germany (genotype 3) can persist longer than previously described in India (genotype 1). While blood viral load at diagnosis can predict the duration of viremia, initial stool viral load does not reliably predict the duration of HEV shedding. Surface contamination of bathroom furniture is low, suggesting a minimal risk of transmission through contaminated surfaces within a household.

Publication History

Article published online:
20 January 2025