[29, 30] High genomic similarity between genotype 4 HEV strains isolated from our patient and those previously reported from Aichi may support the zoonotic food-borne transmission of HEV from wild boar infected with genotype 4 HEV to our patient. INCB024360 in vivo In the present study, raw pig liver as food sold in grocery stores in Mie was found to be contaminated with HEV at the frequency of 4.9% of the total examined packages (12/243). The detection of HEV RNA in raw pig liver intended for human consumption in Mie is not surprising, because

contamination of commercially sold pig livers with HEV has been reported not only in Japan,[11] but also in the USA,[15] the Netherlands,[31] India,[32] France[33] and Germany.[34] However, this finding was contrary to our assumptions, because HEV RNA was detected significantly more frequently in commercially sold pig livers in Mie than in Hokkaido (4.9% vs 1.9% [7/363], P = 0.0372), where hepatitis E is endemic and approximately one-third of hepatitis E patients in Japan have been reported annually.[14] Some Japanese people Romidepsin have a habit of eating raw pig liver, and it is served

at some restaurants in Japan. Based on the evidence that HEV infection is distributed widely in domestic pigs in Japan,[8, 35] it is very likely that the raw pig livers as food sold in grocery stores or supermarkets throughout Japan are contaminated with HEV, although the rate of virus contamination may differ by region, and should be examined

in various areas in Japan, including both endemic and non-endemic regions (northern and southern parts, respectively, of Japan),[36] to assess the actual Thiamet G risk of HEV transmission from pig livers to humans. Importantly, the contaminating virus in commercial pig livers sold in local grocery stores remains infectious when inoculated into pigs[15] and cultured cells.[37] Of note, the virus sequences recovered from pig livers (nos. 152 and 193) were 99.5–100% identical to the viruses recovered from hepatitis E patients (nos. 13 and 17). However, these two patients did not remember consuming pig liver before the onset of hepatitis E (Table 2). The route of HEV transmission was unknown for patient nos. 13 and 17, although patient no. 17 reported frequent ingestion of raw horse meat and sushi. The HEV sequences recovered from the two patients and two pig liver specimens differed by 7.8% or more from the deposited HEV sequences as of June 2013, thus suggesting the uniqueness of these human and swine HEV sequences, and that the source of the HEV in the patients was likely pigs. It is now evident that pigs constitute a major reservoir, and are able to shed the virus into the environment.[12, 38] Contrary to our expectation, the distribution of HEV genotype/subgenotype was different between hepatitis E patients and purchased pig liver packages (Table 4). The reason for this discrepancy remains unknown.