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These are public hospitals specialized in infectious diseases offering care to the disadvantaged population of Greater Cairo. Until 2008, Greater Cairo included three governorates, Cairo, El Qalyoubia and Giza, the last two being partly rural. Details of the surveillance system have been described elsewhere [9]. Briefly, individuals older than 5?years of age with recent (Dinaciclib purchase least three times the upper limit of normal were invited to participate. After providing written informed consent (from one of the parents if Terminal deoxynucleotidyl transferase Abbott Laboratories, Diagnostics Division, Abbott Park, IL, USA), HBs antigen (AUSZYME MONOCLONAL?, third-generation EIA; Abbott Laboratories, Diagnostics Division) and anti-HBc IgM (CORZYME?, M rDNA; Abbott Laboratories, Diagnostics Division). In patients with non-A non-B hepatitis, anti-hepatitis C virus (HCV) antibody and HCV-RNA were assessed serologically (INNOTEST? HCV Ab IV; Innogenetics, Ghent, Belgium) and using PCR (nested reverse transcription PCR by in house assay using 5��-untranslated repeat primers). In patients with positive HCV antibodies and RNA, exacerbation of chronic hepatitis C by other infectious agents was ruled out using serological testing (anti-Epstein�CBarr virus (EBV) IgM (ETI-EBV-M reverse P001605; Dia Sorin, Vercelle, Italy), anti-cytomegalovirus (CMV) IgM (AXSYM?_system-CMV-IgM; Abbott Laboratories, Wiesbaden, Delknheim, Germany), and anti-Toxoplasma IgM (AXSYM? system-Toxo-IgM, Abbott Laboratories)). Real-time PCR for HEV-RNA was performed in patients with positive HCV antibodies and RNA as well as those with negative markers for acute hepatitis A, B and C: viral RNA was detected in blood samples by real-time PCR with a hydrolysis probe [10]. Birinapant cell line Serological analyses were performed with the EIAgen HEV IgG kit and EIAgen HEV IgM kit (Adaltis Ingen, Paris, France) as recommended by the manufacturer. Cases were defined as follows: recent (