Monitoring of hepatitis E virus in wastewater can identify clinically relevant variants

Hepatitis E virus (HEV) is prevalent worldwide and can lead to persistent infection causing severe morbidity. Further, antiviral treatment approaches can lead to the emergence of viral variants that may impede viral clearance. The frequency of these variants remains unknown in the human population as well as environment due to limited comprehensive data on HEV diversity.
In this study, we investigated the HEV prevalence and diversity of circulating variants in environmental samples from North-Rhine Westphalia, Germany. HEV prevalence could be determined with 73% of samples tested positive for viral RNA. Using ultra-deep sequencing we were able to assess the overall diversity in these samples and identified the presence of clinically relevant variants associated with drug resistance. In summary, monitoring variants from environmental samples could provide valuable insights into estimating HEV prevalence and identifying circulating variants that can impact treatment outcome.