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Gepatit E: Versiyalar orasidagi farq

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„Hepatitis E“ sahifasi tarjima qilib yaratildi
(Farq yoʻq)

9-iyul 2023, 18:59 dagi koʻrinishi

Gepatit E - gepatit E virusi (HEV) infeksiya natijasida paydo boʻladigan jigarning yallig'lanish kasalligi[1][2]. Bu virusli gepatitning bir turi hisoblanadi[3]. Gepatit E asosan gepatit A ga o'xshash fekal-oral yoʻl orqali yuqadi, ammo ikkala virus bir-biriga bog'liq emas[4][5][6]. Virus tarixiga nazar tashlaydigan bo'lsak, gepatit E ning eng qadimgi epidemiyasi 1955-yilda Nyu-Dehlida sodir bo'lgan[7][8]. Gepatit E oʻtkir yuqumli kasallik hisoblanib, asosan suv orqali yuqadi. Gepatit E asosan katta yoshli odamlarda koʻp uchraydi. Homiladorlik holatida ogʻir kechishi kuzatilgan.

Gepatit E ning ham manifest ham subklinik turlari bilan kasallangan insonlar kasallik manbayi hisoblanishadi. Homilador ayollar va immuniteti zaif odamlarda o'lim darajasi ancha yuqorilgi kuzatilgan. Homilador ayollarda, ayniqsa uchinchi trimestrda, kasallik ko'proq og'ir kechadi. Klinik sindromlardan asosan jigar yetishmovchiligi koʻp kuaztiladi. Bu sindrom ortidan o'lim darajasi 20% atrofida[5][9][10]. Homilador ayollarda tez immunitet tizimini zaiflashishi va organlar yetishmovchiligini keltirib chiarqadi[11][12]. Gepatit E genetik jihatdan 8 ta genotipga boʻlinadi. Bularda 3 va 4-genotiplari immuniteti zaif odamlarda surunkali gepatitni keltirib chiqarishi mumkin[13][14][15]. Gepatit E ning virusi Gepatit A virusidan biroz kattaroq.

2017-yilda gepatit E 19 milliondan ortiq odamda mavjud ekanligi taxmin qilingan[16]. Gepatit E bilan asosan kasallanadigan toifa bu 15-35 yosh orasidagi erkakalr hisoblanadi[8]. Profilaktik vaktsina (HEV 239) Xitoyda foydalanish uchun tasdiqlangan[17].

Klinik belgilari

Oʻtkir infeksiya

Gepatit E ning o'rtacha inkubatsiya davri 40 kun. Infeksiya asosan 2 haftadan 8 haftagacha davom etadi. Qisqa prodromal davrdan keyin bemorda kasallikning ilk alomatlar sifatida sariqlik, charchoq va ko'ngil aynish paydo boʻlishi mumkin, ammo gepatit E infeksiyalarining aksariyati asimptomatik yani simptomlarsiz kechadi. Simptomatik bosqich jigar aminotransferaza darajasining oshishi bilan kuzatilsa paydo boʻlishi mumkin[18][19][20][21]. Virusli RNK inkubatsiya davrida axlat va qon zardobida aniqlanadi. Qon zardobida gepatit E ga qarshi IgM va IgG antitanalari kasallikning ilk klinik belgilar boshlanishidan oldin paydo bo'ladi. Bemorning tiklanishi virusning qondan tozalanishiga olib keladi, virus bemor axlatda ancha uzoq vaqt turishi mumkin. Qayta tiklash IgM antitelalarining yo'qolishi va IgG antitelalari darajasining oshishi bilan ham belgilanadi[5][20].

Surunkali infeksiya

Odatda bir necha hafta davom etadi va keyin o'tib ketadi. Ammo immuniteti zaif odamlarda, organ koʻchirib oʻtkazilgan odamlarda - gepatit E surunkali infeksiyasi ogʻir kechib tuzalish davri uzoq vaqtga choʻzilishi mumkin[22]. Ba'zida bu hayot uchun xavfli kasallikka olib keladi, masalan, jigar yetishmovchiligi yoki jigar sirrozi shular jumlasidandur[23][24].

Boshqa organlar

Gepatit E virusi insonning boshqa aʻzolariga ham kuchli taʻsir koʻrsatadi. Tayanch-harakat apparati yoki immun taʻsirchanlik bilan bog'liq ba'zi holatlar hali toʻliq oʻrganib chiqilmagan, biroq bir nechta nevrologik va qon kasalliklari gepatit E virusining asorati sifatida oʻrganilgan[25][26][27][28].

  • O'tkir pankreatit (Gepatit E ning 1 genotipi taʻsirida[2])
  • Nevrologik asoratlar (hozirgi vaqtda nevrologik shikastlanish mexanizmi noma'lum[8]) quyidagilardan iborat: Guillain-Barre sindromi (asab ta'sirilanishidan kelib chiqqan o'tkir oyoq-qo'llarning zaifligi), nevrologik amiotrofiya (qo'l va yelkaning zaifligi, Parsonaj-Tyorner sindromi deb ham ataladi), o'tkir transvers mielit va o'tkir meningoensefalit.
  • Nefrotik sindrom yoki krioglobulinemiya bilan kechadigan glomerulonefrit
  • Qon oqimidagi antitanalar past haroratlarda noto'g'ri reaksiyaga kirishadigan aralash krioglobulinemiya
  • Og'ir trombotsitopeniya (qondagi trombotsitlar sonining pastligi), bu xavfli qon ketishga olib kelishi mumkin.

Homiladorlikda infeksiya

Homilador ayollarda boshqa virusga chalingan insonlarga nisbatan kasallikni ogʻirroq oʻtkazishadi. Rivojlanayotgan mamlakatlarda 1 va 2-genotip gepatit E epidemiyasi natijasida o'lim darajasi 20% dan 25% gacha ekanligi aniqlangan. Bu oʻlimlarning asosiy sababi gepatit E tufayli paydo boʻladigan jigar yetishmovchiligi sindromi ekanligi aniqlangan. jigar yetishmovchilik belgilaridan tashqari, ona va homilada gepatit E tufayli muddatidan erta tug'ilish, abort, o'lik tug'ilish va neonatal o'lim kabi holatlar koʻp uchraydi[9][29][30].

Homiladorlikda infeksiyalarining salbiy oqibatlarini keltirib chiqargan faktorlar ortidagi patologik va biologik mexanizmlar noaniqligicha qolmoqda. Viruslarning ko'payishi va gormonal o'zgarishlarning immunitet tizimiga ta'siri hozirgi vaqtda infeksiyaning populatsiyasiga va bemorlarda ogʻir sindiromlar bilan kechishiga sabab boʻlishi tahmin qilinmoqda[31]. Bundan tashqari, platsentada virus replikatsiyasining mavjud yoki yoʻqligini ko'rsatadigan yoki in vitro platsentadan olingan hujayralardagi virusning mavjud yoki yoʻqligi haqida xabar beradigan tadqiqotlar, inson yo'ldoshida jigardan tashqari ham virusli replikatsiya joyi bo'lishi mumkinligini ko'rsatgan[32]. Homiladorlik davrida gepatit E ogʻir va asoratli oʻtishining sabablari noʻmalumligicha qolmoqda[8].

Virusologiya

Klassifikatsiya

Gepatit E Hepeviridae oilasiga mansub, ular ikki turga bo'linadi: Ortohepevirus (barcha sutemizuvchilar va parrandalarning qon oqsillarida uchrashi mumkin) va Piscihepevirus (o'tkir gepatit E)[31]. Inson virusining faqat bitta serotipi ma'lum va tasnifi genomning nukleotidlar ketma-ketligiga asoslanadi[33]. 1- genotip beshta kichik tipga[34], 2-genotip ikkita kichik tipga[35], 3-genotip 10 ta kichik tipga va 4-genotip yettita kichik tipga boʻlinadi[36]. Bundan tashqari 5, 6, 7 va 8 genotiplari ham mavjud[15]. Kalamush orasida Gepatit birinchi marta Germaniyada Norveg olimlari tomonidan kalamushlardan ajratilgan[37] va 2018-yilgi CDC maqolasi transplantatsiya qilingan organni qabul qiluvchi insonda kalamush gepatit E RNKsi aniqlanganligini ko'rsatgan[38].

Tarqalishi

1 va 2-genotiplari odamlarda kamdan kam uchraydi va ko'pincha sanitariya sharoitlari yomon rivojlanayotgan mamlakatlarda katta epidemiyalar koʻrinishida paydo boʻladi[39]. 3 va 4-genotiplari odamlar, cho'chqalar va boshqa hayvonlar turlarini yuqishi, rivojlanayotgan va sanoati rivojlangan mamlakatlarda gepatit E ning sporadik holatlariga sabab bo'lganligi kuzatilgan[43][44].

Yuqishi

Cho‘chqa jigari kesmasida gepatit E virusi (A rasmdagi koʻrsatkichlar virionga ishora qiladi, B, C va D dagilar virusni aniqlashda ishlatiladigan bog‘langan oltin nanozarrachalarga ishora qiladi)[45].

Gepatit E (genotip 1 va nisbatan genotip 2) endemik bo'lib, Janubi-Sharqiy Osiyo, Shimoliy va Markaziy Afrika, Hindiston va Markaziy Amerikada epidemiyalarni keltirib chiqarishi mumkin[2][46]. Virus asosan fekal-oral yoʻl orqali suv yoki oziq-ovqat mahsulotlarining ifloslanishi tufayli tarqaladi. Bevosita odamdan odamga yuqishi kam uchraydi[2][19]. 1 va 2-genotiplardan farqli o'laroq, 3 va 4-genotiplar hayvonlar bilan to'g'ridan-to'g'ri aloqa qilish yoki bilvosita ifloslangan suv yoki pishmagan go'sht tufayli zoonotik tarzda yuqadigan sporadik holatlarga olib kelishi mumkin[2][47].

Epidemik gepatit E ning tarqalishi ko'pincha kuchli yog'ingarchiliklardan keyin, ayniqsa musson yomg'iridan keyin sodir bo'ladi, chunki ular suv ta'minotini buzadi; kuchli suv toshqini kanalizatsiya suv manbalarini ifloslanishiga olib kelishi mumkin[48][49]. Jahon sog'liqni saqlash tashkilotining gepatit E inaktivatsiyasida xlor bo'yicha quydagicha tavsiya bergan: erkin xlor qoldig'i 0.5 mg/L (6.7×10−5 oz/US gal) 30 daqiqa davomida (pH, <8,0) ishlov beriladi[50]. Asosiy epidemiyalar Hindistonning Nyu-Dehlisida (1955–1956-yillarda 30 000 ta holat)[51], Birmada (1976–1977-yillarda 20 000 ta holat)[52], Kashmirda, Hindiston (1978-yilda 52 000 ta holat)[53], Kanpur, Hindiston (1991-yilda 79 000 ta holat)[51] va Xitoy (1986-yildan 1988-yilgacha 100 000 ta holat) bo'lib o'tgan[54]. Ma'lumotlariga ko'ra, gepatit E genotiplari 1 va 2 umumiy hisobda 20,1 million gepatit E infeksiyasini paydo qilgan bo'lsa 3 va 4- genotiplar bir necha million simptomatik kasallik hamda 2005-yilda 70 000 o'limni keltirib chiqargan[55].

Atrof-muhit, oziq-ovqat va qishloq ishlari departamentining ma'lumotlariga ko'ra, Buyuk Britaniyada cho'chqa go'shtidan tayyorlangan kolbasalarning 10 foizida gepatit E virusi borligi aniqlangan. Tadqiqotga asoslanib Buyuk Britaniyada gepatit E ning ko'payishi oziq-ovqat orqali yuqadigan zoonozlar tufayli bo'lganligi isbotlangan. Ba'zi tadqiqotlar shuni ko'rsatadiki, oziq-ovqat pishirilayotganda harorat 70 °C (158 °F) darajaga yetishi kerak. Kerakli darajaga yetganda infeksiya xavfini bartaraf etish uchun 20 daqiqa davomida ovqatni shu darajada pishirish kerak. Hayvonlar salomatligi va veterinariya laboratoriyalari agentligi Shotlandiyadagi barcha cho'chqalarning deyarli yarmida gepatit E ni aniqlagan[56][57].

Gepatit E infeksiyasi gemodializda bo'lgan odamlarda ko'proq uchraydi, ammo yuqishning o'ziga xos xavf omillari aniqlanmagan[58].

Hayvonlardan yuqishi

Gepatit E 1 va 2 dan boshqa genotiplar tufayli zoonoz deb hisoblanadi, bunda hayvonlar asosiy rezervuar hisoblanadi. Bunda kiyik va cho'chqalarda juda ko'p gepatit E virusi aniqlangan[59]. Uy hayvonlari gepatit E virusi uchun rezervuar sifatida qayd etilgan, ba'zi so'rovlar cho'chqalar orasida infeksiya darajasi 95% dan oshganini ko'rsatgan[60]. Eksperimental infeksiyalangan cho'chqalarning ingichka ichaklari, limfa tugunlari, yo'g'on ichak va jigarida replikativ virus topilgan. Yovvoyi cho'chqa go'shti va pishirilmagan kiyik go'shtini iste'mol qilgandan keyin bu virusni odamlarga yuqish ehtimoli kattaligi haqida xabar qilingan[61]. Chala pishirilgan hayvon go'shtini iste'mol qilgandan keyin virusning odamlarga yuqish tezligi va buning aholi salomatligi uchun qay darajada xavfli ekanligi to'liq o'rganilmagan[62]. Boshqa hayvonlarning suv omborlarida yashashi va odamlarning bu suvni qayta ishlovsiz iste'mol qilishi oqibatida kasallik yuqish ehtimoli ham yuqoriligi ta'kidlangan[8].

Bir qator boshqa kichik sutemizuvchilar potentsial rezervuar sifatida aniqlangan: kichik kalamush ( Bandicota bengalensis ), qora kalamush ( Rattus rattus brunneusculus ) va Osiyo uy sichqonchasi ( Suncus murinus ). Sichqoncha gepatiti E virusi deb atalgan yangi virus alohida ajratib olingan[63].

Genomlar

Gepatit E ikkita poliproteinni (O1 va O2 oqsilini) kodlaydigan uchta ochiq o'qish ramkasiga (ORF) ega. ORF2 uchta kapsid oqsilini kodlaydi, O1 esa virus replikatsiyasida ishtirok etadigan yetti fragmentni va boshqa fragmentlarni kodlashda ishtirok etadi[64][65][66].

Gepatit E genomidagi eng kichik ORF3 ORF3 subgenomik RNKdan 113-115 aminokislotalardan iborat O3 oqsiliga uzatiladi. ORF3 gepatit E virusida immunitetni zaiflashtirishda muhim ahamiyatga ega. Oldingi tadqiqotlar shuni ko'rsatdiki, ORF3 bemor labarator surtmalarida topilgan va hujayra rivojlanishida ishlab chiqarilgan virusli zarralar bilan bog'langan. O'stirilgan hujayralarda ORF3 gepatit E RNK replikatsiyasi, virus birikmasi yoki infeksiya uchun zarur bo'lmagan bo'lsa-da, zarrachalarni chiqarish uchun zarur hisoblanadi[67].

Geldanamitsin

Virusning aylanish sikli

Gepatit E virusining aylanish sikli noma'lum; kapsid oqsili hujayra retseptorlari bilan bog'lanib, virusga qo'shila oladi. ORF2 (c-terminal) HSC70 bilan bog'lanish orqali virusgs qo'shilishni mo'tadil holga olib keladi[68][69].

Geldanamitsin HEV239 kapsid oqsilining tashilishini bloklaydi, lekin bo'lingan kapsid oqsilining kirishini bloklay olmaydi, bu Hsp90 gepatit E tashilishida muhim rol o'ynashini ko'rsatadi[68].

Diagnostika

Gepatit E tashxisi nuqtai nazaridan faqat gepatit E RNK yoki gepatit E ga IgM antitanalari mavjudligini tasdiqlovchi laboratoriya qon tekshiruviga ishonish mumkin[10][70]. Amerika Qo'shma Shtatlarida gepatit E infeksiyasini tashxislash uchun hech qanday serologik testlarga oziq-ovqat va farmatsevtika idorasi tomonidan ruxsat berilmagan[10]. Jahon sog'liqni saqlash tashkiloti gepatit E RNKni aniqlash va miqdorini bilish uchun xalqaro standart shtammni ishlab chiqgan[71][72].

Virusologik belgilar

Emlash amalga oshmagan deb faraz qilsak, testlar quyidagilarni ko'rsatishi mumkin:[2]

  • agar insonning immuniteti normal bo'lsa, u holda
    • agar IgM anti-GEV salbiy bo'lsa, GEV infeksiyasi inkor qilinadi
    • agar IgM anti-GEV ijobiy bo'lsa, u holda tekshirilayotgan odam GEV infeksiyasini yuqtirib olgan bo'lishi mumkin
  • agar odamning immuniteti kasallik yoki tibbiy davolanish tufayli zaiflashgan bo'lsa, organ transplantatsiyasini boshidan o'tkazgan bo'lsa, u holda
    • agar IgM anti-GEV salbiy bo'lsa, qo'shimcha qon tekshiruvi o'tkaziladi
      • ijobiy GEV RNK, odam GEV infeksiyasi mavjud
      • salbiy GEV RNK infeksiya belgilari yo'q
    • agar IgM anti-GEV ijobiy bo'lsa, u holda tekshirilayotgan odam GEv infeksiyasini yuqtirib olgan bo'lishi mumkin.

Profilaktika

Sanitariya ishlari

Sanitariya gepatit E ning oldini olishda eng muhim chora hisoblanadi. Bu ishlar qatoriga: chiqindilarini to'g'ri tozalash va yo'q qilish, umumiy suv ta'minoti uchun yuqori standartlar, shaxsiy gigiyena tartib-qoidalarini yaxshilash va oziq-ovqat mahsulotlarini sanitariya qoidalariga muvofiq tayyorlash kabilar kiradi. Gepatit E kasalligini oldini olish strategiyasi rivojlanayotgan mamlakatlarda uchraydigan ko'plab boshqa kasalliklarga o'xshaydi[19]. Go'shtni 71 °C (159.8 °F) da to'liq pishirish gepatit E virusi xavfini kamaytiradi, turli haroratlarda virusni inaktivatsiya qilish uchun har xil vaqt davomida ishlov berishni talab qiladi[57].

Donorlik

Transfuzyon yo'l orqali yuqadigan infeksiyani (TTI) keltirib chiqarish uchun zarur bo'lgan qon mahsulotlarida mavjud bo'lgan virus miqdori o'zgaruvchan bo'ladi. Gepatit E virusini transfiuzyon orqali yuqtirish minipool GEV NAT (nuklein kislotasi testi) skriningi orqali tekshirilishi mumkin[73][74]. NAT - qon topshirilganda qonni molekulyar tekshirish uchun ishlatiladigan usul[75].

Vaksinalar

Rekombinant virusli oqsillarga asoslangan vaksina 1990-yillarda ishlab chiqilgan va 2001-yilda yuqori xavfli populyatsiyada ( Nepalda ) sinovdan o'tkazilgan[76]. Vaksina samarali va xavfsiz bo'lib chiqgan, ammo ishlab chiqarish homiylik yo'qligi sababli to'xtatilgan, chunki rivojlangan mamlakatlarda gepatit E kam uchraydi[77]. Qo'shma Shtatlarda gepatit E ga qarshi vaksinadan foydalanish uchun litsenziya mavjud emas[10].

Istisno tariqasida- Xitoy Davlat oziq-ovqat va farmatsevtika idorasi (SFDA) tomonidan bir yildan ortiq tekshiruvdan so'ng, xitoylik olimlar tomonidan ishlab chiqilgan gepatit E vaksinasi 2012-yil oxirida foydalanishga ruhsat berilgan. Uning ishlab chiqaruvchisi Xiamen Innovax Biotech tomonidan GEV 239 deb nomlangan. Vaksina 2012-yilda Xitoy Fan va Texnologiya Vazirligi tomonidan Szyansu provinsiyasidan 100 000 dan ortiq odam ustidan nazorat ostida o'tkazilgan sinovdan so'ng gepatit E ning oldini olish uchun ma'qullangan, bunda emlanganlarning birortasi ham infeksiyani yuqtirmagan[78]. Birinchi vaksina partiyalari Innovax zavodidan 2012-yil oktyabr oyi oxirida Xitoy distribyutorlari tomonidan savdoga chiqarilgan[77].

Dalillar yo'qligi sababli Jahon sog'liqni saqlash tashkiloti 2015-yildan boshlab GEV 239 vaksinasini muntazam ravishda qo'llash bo'yicha tavsiyalar bermagan[79]. Uning 2015-yildagi pozitsiyasi shundan iborat ediki, milliy hukumatlar mahalliy epidemiologik ahvolga asoslangan holda vaksinadan mustaqil foydalanishga qaror qilishlari mumkin edi[79].

Davolash

Gepatit E uchun xavfsizlik va samaradorlikni aniqlagan hech qanday dori yo'q va virusga qarshi dorilarning katta qismiga klinik sinovlar o'tkazilmagan[5]. Mavjud kichik tadqiqotlarning natijalari shuni ko'rsatganki, ribavirin surunkali infeksiyani rivojlantirgan immuniteti zaif odamlarda samarali deb hisoblangan[80][81].

Surunkali GEV infeksiyasi immunosupressiv terapiya bilan bog'liq va bu a'zolar transplantatsiyasini boshidan o'tkazgan odamlarda sodir bo'lganda, immunosupressiv dorilarni kamaytirish bemorlarning uchdan birida GEV stabillashuviga olib kelishi mumkinligi isbotlangan[2].

Epidemiologiya

Gepatit E virusi yiliga 20 millionga yaqin infeksiyani keltirib chiqaradi. Bu uch millionga yaqin o'tkir kasalliklarga olib keladi va 2015-yilda 44 000 kishining o'limiga sabab bo'lgan[5]. Homilador ayollar, ayniqsa, 30% yoki undan ko'proq hollarda o'limga olib keladigan kasallikning o'tkir shaklini boshlaridan o'tkzishadi. GEV rivojlanayotgan mamlakatlarda kasallik va o'limning asosiy sababidir. Gepatit E Markaziy Osiyoda endemik hisoblanadi, Markaziy Amerika va Yaqin Sharqda esa yuqumli kasalliklar qayd etilganligi ma'lum[82][83]. Rivojlangan mamlakatlarda gepatit E tobora ko'payib bormoqda, 2015-yilda Angliya va Uelsda gepatit E virusi bilan kasallangan 848 ta holat qayd etilgan[84].

So'nggi epidemiyalar

2007-yil oktyabr oyida Uganda shimolidagi Kitgum tumanida gepatit E epidemiyasi paydo bo'lgan. Ushbu epidemiya dunyoda ma'lum bo'lgan gepatit E ning eng yirik epidemiyalaridan biriga aylangan. 2009-yil iyun oyiga kelib, 10 196 kishi kasal bo'lib, 160 kishi vafot etgan[85]. GEV epidemiyasi mamlakatda ilgari hech qanday epidemiya qayd etilmaganiga qaramay sodir bo'ldi, ayollar GEVdan eng ko'p zarar ko'rganlar[85].

Namibiya, Afrika

2012-yil iyul oyida Sudan chegarasi yaqinidagi Maban okrugidagi Janubiy Sudanlik qochqinlar lagerlarida kasallik avj olgani haqida xabar berilgan. Janubiy Sudan Sog'liqni saqlash vazirligi 2012-yil 13-sentyabr holatiga ko'ra 400 dan ortiq kasallik va 16 kishi o'lganini ma'lum qilgan[86]. 2013-yil 2-fevral holatiga ko'ra, 88 kishi epidemiya tufayli vafot etgan. Chegara bilmas shifokorlar xayriya tashkiloti 4000 ga yaqin odamni davolaganini e'lon qilishgan[87]. 2014-yil aprel oyida Nepalning Biratnagar munitsipalitetidagi epidemiya 6000 dan ortiq mahalliy aholining infeksiyasiga va kamida 9 kishining o'limiga sabab bo'lgan[88].

Namibiyadagi epidemiya paytida, zararlanganlar soni 2018-yil yanvar oyida 490 dan 2019-yil aprelida 5014 taga (42 o'lim bilan), 2019-yil avgustiga kelib 6151 holatga (56 o'lim bilan) ko'tarilgan. JSSTning hisob-kitoblariga ko'ra, o'lim darajasi 0,9% ni tashkil qilgan[89][90][91].

2020-yil may oyida Gonkongda kalamushlar tomonidan yuqtirgan gepatit E ning kamida 10 ta holati va yuqish mexanizmi toʻliq aniqlanmagan yuzlab holatlar qayd etilgan[92].

Evolyutsiya

Bugungi kunda mavjud bo'lgan GEV shtammlari 1344 yil oldin umumiy virusdan kelib chiqqan bo'lishi mumkin[93]. Boshqa bir tahlil gepatit E ning kelib chiqishini ~ 6000 yil oldinga to'g'ri kelishini ko'rsatgan, bu cho'chqalarni xonakilashtirish bilan bog'liq degan taxmin mavjud[94]. Bir vaqtning o'zida ikkita tur ajralib chiqishi mumkin - antropotrop shakl va enzootik shakl - keyinchalik ular mos ravishda 1 - 2 va 3 - 4 genotiplarga aylangan bo'lishi mumkin[95].

2-genotip boshqa genotiplarga qaraganda kamroq aniqlangan bo'lsada, genetik evolyutsion tahlillar shuni ko'rsatadiki, 1, 3 va 4 genotiplari tarqalishi so'nggi 100 yil ichida sezilarli darajada oshgan[8].

Manbalar

Andoza:Viral systemic diseasesAndoza:Pathology of pregnancy, childbirth and the puerperium

  1. ↑ Hepatitis E: Background, Etiopathophysiology, Epidemiology. Medscape. 2019. https://emedicine.medscape.com/article/178140-overview. 
  2. ↑ 2,0 2,1 2,2 2,3 2,4 2,5 2,6 Kamar, Nassim; Dalton, Harry R.; Abravanel, Florence; Izopet, Jacques (2014). "Hepatitis E Virus Infection". Clinical Microbiology Reviews 27 (1): 116–138. doi:10.1128/CMR.00057-13. ISSN 0893-8512. PMID 24396139. PMC 3910910. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3910910.  Manba xatosi: Invalid <ref> tag; name "emer" defined multiple times with different content
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  5. ↑ 5,0 5,1 5,2 5,3 5,4 „Hepatitis E“ (en). www.who.int. WHO. Qaraldi: 2019-yil 17-aprel. Manba xatosi: Invalid <ref> tag; name "hepe" defined multiple times with different content
  6. ↑ Weston, Debbie. Infection Prevention and Control at a Glance (en). John Wiley & Sons, 2016 — 12 bet. ISBN 9781118973554. 
  7. ↑ Kumar, Subrat; Subhadra, Subhra; Singh, Bhupinder; Panda, B.K. (April 2013). "Hepatitis E virus: the current scenario" (en). International Journal of Infectious Diseases 17 (4): e228–e233. doi:10.1016/j.ijid.2012.11.026. ISSN 1201-9712. PMID 23313154. https://www.ijidonline.com/article/S1201-9712(12)01319-7/fulltext. 
  8. ↑ 8,0 8,1 8,2 8,3 8,4 8,5 Izopet, Jacques; Abravanel, Florence; Dalton, Harry R.; Kamar, Nassim (1 January 2014). "Hepatitis E Virus Infection" (en). Clinical Microbiology Reviews 27 (1): 116–138. doi:10.1128/CMR.00057-13. ISSN 0893-8512. PMID 24396139. PMC 3910910. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3910910.  Manba xatosi: Invalid <ref> tag; name "izo" defined multiple times with different content
  9. ↑ 9,0 9,1 Patra, Sharda; Kumar, Ashish; Trivedi, Shubha Sagar; Puri, Manju; Sarin, Shiv Kumar (2007-07-03). "Maternal and Fetal Outcomes in Pregnant Women with Acute Hepatitis E Virus Infection" (en). Annals of Internal Medicine 147 (1): 28–33. doi:10.7326/0003-4819-147-1-200707030-00005. ISSN 0003-4819. PMID 17606958. https://www.semanticscholar.org/paper/dedb6d08e9678a676c029307197bd44c18cd5567.  Manba xatosi: Invalid <ref> tag; name "pregn" defined multiple times with different content
  10. ↑ 10,0 10,1 10,2 10,3 „Hepatitis E Questions and Answers for Health Professionals“ (en-us). www.cdc.gov. CDC (2018-yil 13-iyun). Manba xatosi: Invalid <ref> tag; name "cdchev" defined multiple times with different content
  11. ↑ Zhou X, de Man RA, de Knegt RJ, Metselaar HJ, Peppelenbosch MP, Pan Q.; De Man; De Knegt; Metselaar; Peppelenbosch; Pan (2013). "Epidemiology and management of chronic hepatitis E infection in solid organ transplantation: a comprehensive literature review". Rev. Med. Virol. 23 (5): 295–304. doi:10.1002/rmv.1751. PMID 23813631. 
  12. ↑ Kamar, Nassim; Izopet, Jacques; Dalton, Harry R. (2013). "Chronic hepatitis e virus infection and treatment". Journal of Clinical and Experimental Hepatology 3 (2): 134–140. doi:10.1016/j.jceh.2013.05.003. ISSN 0973-6883. PMID 25755487. PMC 3940092. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3940092. 
  13. ↑ Kamar, N.; Abravanel, F.; Selves, J.; Garrouste, C.; Esposito, L.; Lavayssière, L.; Cointault, O.; Ribes, D. et al. (2010). "Influence of Immunosuppressive Therapy on the Natural History of Genotype 3 Hepatitis-E Virus Infection After Organ Transplantation". Transplantation 89 (3): 353–360. doi:10.1097/tp.0b013e3181c4096c. PMID 20145528. https://doi.org/10.1097/tp.0b013e3181c4096c. 
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  15. ↑ 15,0 15,1 Sridhar, Siddharth; Teng, Jade L. L.; Chiu, Tsz-Ho; Lau, Susanna K. P.; Woo, Patrick C. Y. (20 April 2017). "Hepatitis E Virus Genotypes and Evolution: Emergence of Camel Hepatitis E Variants". International Journal of Molecular Sciences 18 (4): 869. doi:10.3390/ijms18040869. ISSN 1422-0067. PMID 28425927. PMC 5412450. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5412450.  Manba xatosi: Invalid <ref> tag; name "gen8" defined multiple times with different content
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  17. ↑ Li, Shao-Wei; Zhao, Qinjian; Wu, Ting; Chen, Shu; Zhang, Jun; Xia, Ning-Shao (2015-02-25). "The development of a recombinant hepatitis E vaccine HEV 239". Human Vaccines & Immunotherapeutics 11 (4): 908–914. doi:10.1080/21645515.2015.1008870. ISSN 2164-5515. PMID 25714510. PMC 4514148. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4514148. 
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  20. ↑ 20,0 20,1 Hoofnagle, J. H.; Nelson, K. E.; Purcell, R. H. (2012). "Hepatitis E". New England Journal of Medicine 367 (13): 1237–1244. doi:10.1056/NEJMra1204512. PMID 23013075. 
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  23. ↑ Behrendt, Patrick; Steinmann, Eike; Manns, Michael P.; Wedemeyer, Heiner (2014-12-01). "The impact of hepatitis E in the liver transplant setting". Journal of Hepatology 61 (6): 1418–1429. doi:10.1016/j.jhep.2014.08.047. PMID 25195557. 
  24. ↑ Kamar, Nassim; Pischke, Sven (7 May 2018). "Acute and Persistent Hepatitis E Virus Genotype 3 and 4 Infection: Clinical Features, Pathogenesis, and Treatment". Cold Spring Harbor Perspectives in Medicine 9 (7): a031872. doi:10.1101/cshperspect.a031872. ISSN 2157-1422. PMID 29735575. PMC 6601456. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6601456. 
  25. ↑ Bazerbachi, F; Haffar, S; Garg, SK; Lake, JR (February 2016). "Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature.". Gastroenterology Report 4 (1): gov042. doi:10.1093/gastro/gov042. PMID 26358655. PMC 4760069. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4760069. 
  26. ↑ Rivero-Juárez, Antonio; Aguilera, Antonio; Avellón, Ana; García-Deltoro, Miguel; García, Federico; Gortazar, Christian; Granados, Rafael; Macías, Juan et al. (30 July 2018). "Executive summary: Consensus document of the diagnosis, management and prevention of infection with the hepatitis E virus: Study Group for Viral Hepatitis (GEHEP) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC)". Enfermedades Infecciosas y Microbiologia Clinica 38 (1): 28–32. doi:10.1016/j.eimc.2018.06.014. ISSN 1578-1852. PMID 30072282. 
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  78. ↑ Labrique, Alain B.; Sikder, Shegufta S.; Krain, Lisa J.; West, Keith P.; Christian, Parul; Rashid, Mahbubur; Nelson, Kenrad E. (2012-09-01). "Hepatitis E, a Vaccine-Preventable Cause of Maternal Deaths". Emerging Infectious Diseases 18 (9): 1401–1404. doi:10.3201/eid1809.120241. ISSN 1080-6040. PMID 22931753. PMC 3437697. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3437697. 
  79. ↑ 79,0 79,1 "Hepatitis E vaccine: WHO position paper, May 2015.". Relevé Épidémiologique Hebdomadaire 90 (18): 185–200. 1 May 2015. PMID 25935931. https://www.who.int/wer/2015/wer9018.pdf?ua=1. 
  80. ↑ Dalton, Harry R.; Kamar, Nassim (2016). "Treatment of hepatitis E virus". Current Opinion in Infectious Diseases 29 (6): 639–644. doi:10.1097/QCO.0000000000000316. ISSN 1473-6527. PMID 27607911. 
  81. ↑ Peters van Ton, A. M.; Gevers, T. J. G.; Drenth, J. P. H. (Dec 2015). "Antiviral therapy in chronic hepatitis E: a systematic review". Journal of Viral Hepatitis 22 (12): 965–973. doi:10.1111/jvh.12403. ISSN 1365-2893. PMID 25760481. 
  82. ↑ Teshale. „Hepatitis E – Infectious Diseases Related to Travel Chapter 3 – 2018 Yellow Book“. www.cdc.gov. CDC (2017-yil 31-may).
  83. ↑ Navaneethan, Udayakumar; Mohajer, Mayar Al; Shata, Mohamed T (2008). "Hepatitis E and Pregnancy- Understanding the pathogenesis". Liver International 28 (9): 1190–1199. doi:10.1111/j.1478-3231.2008.01840.x. ISSN 1478-3223. PMID 18662274. PMC 2575020. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2575020. 
  84. ↑ Public Health England. „Common animal associated infections quarterly report (England and Wales) – fourth quarter 2015“. gov.uk. Qaraldi: 2019-yil 27-iyul.
  85. ↑ 85,0 85,1 "Hepatitis E epidemic, Uganda". Emerging Infect. Dis. 16 (1): 126–129. 2010. doi:10.3201/eid1601.090764. PMID 20031058. PMC 2874362. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2874362. 
  86. ↑ Investigation of Hepatitis E Outbreak Among Refugees — Upper Nile, South Sudan, 2012–2013 (Report). 62. CDC Morbidity and Mortality Weekly Report. 26 July 2013. pp. 581–586. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a2.htm. 
  87. ↑ Hereward Holland. „Hepatitis outbreak kills 88 in South Sudan—aid agency“. Reuters (2013-yil 2-fevral).
  88. ↑ Sharma. „Nepal, hepatitis E epidemic: 9 dead and over 6 thousand infected“. www.asianews.it (2014-yil 5-sentyabr).
  89. ↑ „Hepatitis E cases in Namibia rise to 490“ (en). www.xinhuanet.com. Xinhua News (2018-yil 28-yanvar). 2018-yil 29-yanvarda asl nusxadan arxivlangan.
  90. ↑ „Weekly bulletins on outbreaks and other emergencies“. World Health Organization. WHO.int. Qaraldi: 2019-yil 20-may.
  91. ↑ „Outbreaks and Emergencies Bulletin, Week 33: 12 – 18 August 2019“ (en). WHO | Regional Office for Africa. Qaraldi: 2019-yil 20-avgust.
  92. ↑ Jessie Yeung. „Rats are infecting humans with hepatitis, and nobody knows how“. CNN (2020-yil 8-may). Qaraldi: 2020-yil 11-may.
  93. ↑ Khudyakov, Yury E.; Purdy, Michael A. (2010). "Evolutionary History and Population Dynamics of Hepatitis E Virus" (en). PLOS ONE 5 (12): e14376. doi:10.1371/journal.pone.0014376. ISSN 1932-6203. PMID 21203540. PMC 3006657. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3006657. 
  94. ↑ Baha, Sarra; Behloul, Nouredine; Liu, Zhenzhen; Wei, Wenjuan; Shi, Ruihua; Meng, Jihong (2019-10-29). "Comprehensive analysis of genetic and evolutionary features of the hepatitis E virus". BMC Genomics 20 (1): 790. doi:10.1186/s12864-019-6100-8. ISSN 1471-2164. PMID 31664890. PMC 6820953. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6820953. 
  95. ↑ Mirazo S, Mir D, Bello G, Ramos N, Musto H, Arbiza J (2016). "New insights into the hepatitis E virus genotype 3 phylodynamics and evolutionary history". Infect Genet Evol 43: 267–273. doi:10.1016/j.meegid.2016.06.003. PMID 27264728.  
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