Letter to the Editor: Emergence of Zoonotic Rat Hepatitis E Virus Infection
Bibliographic record
Abstract
To the Editor: We noted the identification of further rat hepatitis E virus (HEV) cases in humans in Hong Kong.(1) This emergence, infection of a Canadian United Nations worker in Africa,(2) and serological evidence of exposure in German foresters(3) and hospitalized Vietnamese patients(4) raises the question of how widespread rat HEV infection is globally. Rat HEV (Orthohepevirus C or HEV-C) is distinct from epidemic HEV strains circulating in Africa, Asia, and to zoonotic pig strains responsible for disease burden in industrialized countries (Orthohepevirus A or HEV-A). In Europe, hepatitis E is not notifiable, and, until recently, lack of awareness by physicians and poorly standardized diagnostics led to underreporting. In 2019, the European Centre for Disease Prevention and Control developed guidance on HEV surveillance (data collection/reporting, case definitions, and testing)(5); this and other guidelines do not currently consider HEV-C. Despite similar clinical presentation of HEV-C and HEV-A (acute and chronic), molecular assays used clinically and for blood donor screening do not detect HEV-C. A commonly used anti-immunoglobulin M (IgM) assay can detect anti-HEV-C antibodies; however, HEV-A/HEV-C-discriminatory assays are unavailable. Of the 169 anti-IgM-positive patients, Sridhar et al. identified 5 HEV-C1 and 82 HEV-A RNA-positive patients.(1) Is more data on the remaining 82 HEV-IgM-positive/RNA-negative patients available? Could variability of HEV-C strains contribute to missed cases? There is a need to develop specific molecular and serological assays and associated control materials for HEV-C, to assess case frequency in previously healthy immunocompetent as well as immunosuppressed individuals and understand the risk to humans. Zoonotic HEV-A is transmitted primarily through consumption of contaminated meat. While Sridhar et al. mentioned the proximity of the HEV-C-infected patients to rat infestations and droppings, there was no discussion about possible transmission of HEV-C by consumption of rat meat or contaminated meat products. More detailed epidemiological investigations (environmental risk factors, consumption habits, and water contamination) are needed to identify infection sources and transmission patterns.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.016 | 0.015 |
| Insufficient payload (model declined to judge) | 0.007 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".