A serious hepatitis E case in the city of Rieti (Lazio, Italy): correlation with a 2019 cluster suggests a resident hepatitis E virus strain; a case report.

Hepatitis E is generally considered a mild disease, but severe cases are also observed. In high-income countries, most hepatitis E cases are due to HEV genotype 3 and are linked mainly to the consumption of pork or wild boar meat, but data on the correlation of viral variants and hepatitis severity are still preliminary. We described a serious acute hepatitis E (Genotype 3e) case observed in the city of Rieti (Lazio region, Italy), and compared it with previous cases found in the same geographical area. Phylogenetic analysis of open reading frame 2 (ORF2) showed that the HEV strain of the patient in Rieti is closely related to those identified in the acute HEV hepatitis outbreak in 2019. Our data suggest the need to strengthen surveillance and prevention against HEV infection and investigation of pathogenicity linked to specific HEV variants.