Healthy adults aged 16–65 years in, Jiangsu Province, China were randomly assigned in a 1:1 ratio to receivethree doses of HEV 239 (30 μg of purifi ed recombinant hepatitis E antigen adsorbed to 0·8 mg aluminium hydroxide suspended in 0·5 mL buff ered saline) or placebo (hepatitis B vaccine) given intramuscularly at 0, 1, and 6 months.Randomisation was done by computer-generated permuted blocks and stratifi ed by age and sex. Participants were ollowed up for 19 months. The primary endpoint was prevention of hepatitis E during 12 months from the 31st day after the third dose. Analysis was based on participants who received all three doses per protocol. Study participants,care givers, and investigators were all masked to group and vaccine assignments. This trial is registered with ClinicalTrials.gov, number NCT01014845.

In The Lancet today, Buddha Basnyat asks why are hepatitis E and the conjugate typhoid vaccines not available, despite their proven effi cacy and safety.

The report by Feng-Cai Zhu and colleagues (Sept 11, p 895)1 of a highly effective recombinant hepatitis E vaccine is very encouraging. However,it is to be hoped that this vaccine is developed and made available to people who need it more promptly than the previous highly eff ective hepatits E vaccine. Years have passed since the development of this vaccine,with no real gain for the people in the country where it was tested nor across the wider global community.

Hepatitis E virus (HEV) remains one of the least understood and perplexing viruses pathogenic to human beings. From 5% to 20% of people in developed countries show a steady increase in the titre of anti-HEV IgG with increasing age,1 but infection with the prevalent genotype in Europe and the USA, genotype 3, rarely results in symptoms. Although this genotype has been recovered from feral and domestic pigs—and sometimes from people who have eaten raw pork or off al—convincing epidemiological evidence that this zoonotic
reservoir is the source of most human exposures or infections remains elusive.2

BACKGROUND: Outbreaks of infection with hepatitis E virus (HEV) are frequently attributed to contaminated drinking water, even if direct evidence for this is lacking. METHODS: We conducted several epidemiologic investigations during a large HEV infection outbreak in Uganda. RESULTS: Of 10,535 residents, 3218 had HEV infection; of these, 2531 lived in households with >1 case. HEV was not detected in drinking water or zoonotic sources. Twenty-five percent of cases occurred > or = 8 weeks after onset of hepatitis in an index case in the household. Households with > or = 2 cases were more likely to have a member(s) who attended a funeral, had close contact with a jaundiced person, or washed hands in a common basin with others (P < .05 for all). CONCLUSIONS: A high attack rate in households, lack of a common source of infection, and poor hygienic practices in households with > or = 2 cases suggest person-to-person transmission of HEV during this outbreak.

p239 is a virus-like particle constituted from hepatitis E virus (HEV) recombinant proteins. It can be used as a surrogate for HEV and as an investigative tool to study cellular interactions because of its ability to adsorb to and penetrate HepG2 cellular membranes. Our objective was to use p239 to define the role of HEV capsid proteins during the early stages of infection. Pull-down and MALDI-TOF MS experiments identified three host-cell proteins, Grp 78/Bip, alpha-tubulin and heat-shock protein 90 (HSP90), and the latter was investigated further. Antibodies to p239 alone or HSP90 alone could detect p239 or HSP90, suggesting the formation of a complex between p239 and HSP90. In the HepG2 cell, geldanamycin (GA), an HSP90-specific inhibitor, blocked intracellular transportation of p239, but had no effect on the binding and cellular entry of p239, suggesting that HSP90 was important for HEV capsid intracellular transportation. RT-PCR results showed that the efficiency of wild-type HEV infection was inhibited significantly by GA treatment, suggesting the importance of HSP90 in virus infectivity. It was concluded that HSP90 plays a crucial role in the intracellular transportation of viral capsids in the early stage of HEV infection.

观察诊断为戊型肝炎的住院患者临床及实验室特点进行分析总结，为临床诊治提供参考。戊肝住院患者141例，男123例，女18例，年龄范围为（18-82）岁。均为散发，无集体发病现象，平均住院天数：31.35+-16.38天；老年患者平均住院天数：39.97+-20.88天，主要症状：发热、乏力、恶心、呕吐等明显消化道症状，伴随疾病有胆囊炎、脂肪肝、酒精性损害等，此外老年人多伴随糖尿病、高血压、心脏病等。症状较其他年龄组重，在治疗肝病期间要注意并发症的治疗。患者临床特征及生化指标符合急性肝损伤的表现，以急性黄疸型肝炎为主，也有病情较重患者，不能忽视

病毒性肝炎是我国法定管理的乙类传染病，它具有传染性强、传播途径复杂、流行面广、发病率较高等特点。长期以来，急性病毒性肝炎发展高居我市法定报告传染病前列，成为危害人民健康和影响经济发展的重要社会问题。我们对急性病毒性肝炎病例进行性别、费用、职业等分析，为临床诊治、综合防治工作以及卫生决策提供科学依据。

2007 年2 月23 日接到报告，有3 例戊肝病人住院且属
同一单位。根据流行病学调查患者临床表现及实验室检验分
析，证实为一起戊肝暴发。现将此次暴发调查处理情况报告
如下。