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Hinrichs JB, Kreitlow A, Plötz M, Schotte U, Becher P, Gremmel N, Stephan R, Kemper N, Abdulmawjood A. Development of a Sensitive and Specific Quantitative RT-qPCR Method for the Detection of Hepatitis E Virus Genotype 3 in Porcine Liver and Foodstuff. Foods 2024; 13:467. [PMID: 38338602 PMCID: PMC10855453 DOI: 10.3390/foods13030467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
As an international and zoonotic cause of hepatitis, hepatitis E virus (HEV) poses a significant risk to public health. However, the frequency of occurrence and the degree of contamination of food of animal origin require further research. The aim of this study was to develop and validate a highly sensitive quantitative RT-qPCR assay for the detection and quantification of HEV contamination in porcine liver and food. The focus was on genotype 3, which is most common as a food contaminant in developed countries and Europe. The selected assay has its target sequence in the open reading frame 1 (ORF1) of the HEV genome and showed good results in inclusivity testing, especially for HEV genotype 3. The developed assay seems to show high efficiency and a low intercept when compared to other assays, while having a comparable limit of detection (LOD). In addition, a standard curve was generated using artificially spiked liver to provide more accurate quantitative results for contamination assessment and tracking in this matrix. Application of the assay to test 67 pig livers from different origins resulted in a positivity rate of 7.5%, which is consistent with the results of numerous other prevalence studies. Quantitative detection of the viral genome in the food chain, particularly in pig livers, is essential for understanding the presence and evolution of HEV contamination and thus ensures consumer safety.
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Affiliation(s)
- Jan Bernd Hinrichs
- Institute of Food Quality and Food Safety, University of Veterinary Medicine Hannover, 30173 Hannover, Germany; (J.B.H.); (A.K.); (M.P.)
| | - Antonia Kreitlow
- Institute of Food Quality and Food Safety, University of Veterinary Medicine Hannover, 30173 Hannover, Germany; (J.B.H.); (A.K.); (M.P.)
| | - Madeleine Plötz
- Institute of Food Quality and Food Safety, University of Veterinary Medicine Hannover, 30173 Hannover, Germany; (J.B.H.); (A.K.); (M.P.)
| | - Ulrich Schotte
- Department C Animal Health and Zoonoses, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany;
| | - Paul Becher
- Institute of Virology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (P.B.); (N.G.)
| | - Nele Gremmel
- Institute of Virology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (P.B.); (N.G.)
| | - Roger Stephan
- Vetsuisse Faculty, Institute for Food Safety and Hygiene, University of Zurich, 8057 Zurich, Switzerland;
| | - Nicole Kemper
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviors, University of Veterinary Medicine Hannover, 30173 Hannover, Germany;
| | - Amir Abdulmawjood
- Institute of Food Quality and Food Safety, University of Veterinary Medicine Hannover, 30173 Hannover, Germany; (J.B.H.); (A.K.); (M.P.)
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Bennett C, Hunt K, Butler F, Keaveney S, Fanning S, De Gascun C, Coughlan S, O'Gorman J. Detection of Hepatitis A RNA, Hepatitis E RNA, Human Adenovirus F DNA, and Norovirus RNA in Fresh and Frozen Berry Products at Point of Retail in Ireland. FOOD AND ENVIRONMENTAL VIROLOGY 2023; 15:246-254. [PMID: 37528267 PMCID: PMC10499670 DOI: 10.1007/s12560-023-09561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Abstract
Soft fruits are at particular risk of contamination with enteric viruses such as Hepatitis A virus (HAV), Hepatitis E Virus (HEV), Norovirus (NoV), Human Adenovirus (HAdV) and Sapovirus (SaV). The aim of this study was to investigate, for the first time, the presence of these biological agents in ready to eat (RTE) berries at point of retail in Ireland. A sampling strategy was designed in which RTE fresh and frozen strawberries and raspberries were purchased from five retailers between May and October 2018. Reverse Transcriptase Polymerase Chain Reaction (RT-qPCR) assays for HEV RNA, Nov RNA, SaV RNA, and human Adenovirus species F DNA (HAdV-F) were performed on 239 samples (25g portions). Viral nucleic acid was present in 6.7% (n = 16) of samples tested as follows: HAV RNA (n = 5), HAdV-F DNA (n = 5), HEV RNA (n = 3) and NoV GII RNA (n = 3). Sapovirus RNA was not detected in any product. No significant differences were found between berry type, fresh/frozen status, or supermarket source. This study suggests a risk that exists across all retail outlets however only low levels of nucleic acid ranging from 0 to 16 genome copies/g were present. Although these findings may reflect non-viable/non-infectious virus the continued provision of risk mitigation advice to consumers is warranted and further work is required to ensure control measures to reduce contamination are implemented and enforced.
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Affiliation(s)
- Charlene Bennett
- UCD-National Virus Reference Laboratory, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Kevin Hunt
- UCD-School of Biosystems and Food Engineering, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Francis Butler
- UCD-School of Biosystems and Food Engineering, University College Dublin, Belfield, Dublin, 4, Ireland
| | | | - Séamus Fanning
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy & Sports Science, Belfield, Dublin, 4, Ireland
| | - Cillian De Gascun
- UCD-National Virus Reference Laboratory, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Suzie Coughlan
- UCD-National Virus Reference Laboratory, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Joanne O'Gorman
- UCD-National Virus Reference Laboratory, University College Dublin, Belfield, Dublin, 4, Ireland
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3
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Golkocheva-Markova E, Ismailova C, Kevorkyan A, Raycheva R, Zhelyazkova S, Kotsev S, Pishmisheva M, Rangelova V, Stoyanova A, Yoncheva V, Tenev T, Gladnishka T, Trifonova I, Christova I, Dimitrov R, Bruni R, Ciccaglione AR. Age and Gender Trends in the Prevalence of Markers for Hepatitis E Virus Exposure in the Heterogeneous Bulgarian Population. Life (Basel) 2023; 13:1345. [PMID: 37374127 DOI: 10.3390/life13061345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The prevalence of hepatitis E virus (HEV) in the Bulgarian population remains underestimated. The aim of the present study was to evaluate age and gender trends in HEV prevalence in the heterogeneous Bulgarian population. Stored serum samples from blood donors and different patient sub-populations-kidney recipients (KR), patients with Guillain-Barre syndrome (GBS), Lyme disease (LD), patients with liver involvement and a clinical diagnosis other than viral hepatitis A and E (non-AE), hemodialysis (HD) and HIV-positive patients (HIV)-were retrospectively investigated for markers of past and recent/ongoing HEV infection. The estimated overall seroprevalence of past infection was 10.6%, ranging from 5.9% to 24.5% for the sub-populations evaluated, while the seroprevalence of recent/ongoing HEV infection was 7.5%, ranging from 2.1% to 20.4%. The analysis of the individual sub-populations showed a different prevalence with respect to sex. In regard to age, the cohort effect was preserved, as a multimodal pattern was observed only for the GBS sub-population. Molecular analysis revealed HEV 3f and 3e. The type of the population is one of the main factors on which the anti-HEV prevalence depends, highlighting the need for the development of guidelines related to the detection and diagnosis of HEV infection with regard to specific patient populations.
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Affiliation(s)
- Elitsa Golkocheva-Markova
- NRL Hepatitis Viruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Chiydem Ismailova
- NRL Hepatitis Viruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Ani Kevorkyan
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University, 4002 Plovdiv, Bulgaria
| | - Ralitsa Raycheva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University, 4002 Plovdiv, Bulgaria
| | - Sashka Zhelyazkova
- Clinic of Nervous Diseases, University Hospital "Alexandrovska", Medical University, 1431 Sofia, Bulgaria
| | - Stanislav Kotsev
- Department Infectious Diseases, Regional Hospital, 4400 Pazardzhik, Bulgaria
| | - Maria Pishmisheva
- Department Infectious Diseases, Regional Hospital, 4400 Pazardzhik, Bulgaria
| | - Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University, 4002 Plovdiv, Bulgaria
| | - Asya Stoyanova
- NRL Enteroviruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Viliana Yoncheva
- NRL Hepatitis Viruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Tencho Tenev
- NRL Hepatitis Viruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Teodora Gladnishka
- NRL of Vector-Borne Infections, Listeria and Leptospires, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Iva Trifonova
- NRL of Vector-Borne Infections, Listeria and Leptospires, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Iva Christova
- NRL of Vector-Borne Infections, Listeria and Leptospires, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Roumen Dimitrov
- Institute of Mathematics and Informatics, Bulgarian Academy of Sciences, 1000 Sofia, Bulgaria
| | - Roberto Bruni
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
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Schemmerer M, Wenzel JJ, Stark K, Faber M. Molecular epidemiology and genotype-specific disease severity of hepatitis E virus infections in Germany, 2010-2019. Emerg Microbes Infect 2022; 11:1754-1763. [PMID: 35713010 PMCID: PMC9295818 DOI: 10.1080/22221751.2022.2091479] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Zoonotic hepatitis E virus (HEV) is endemic in Europe. Genotype 3 (HEV-3) is predominant but information on subtype distribution, trends and clinical implications in Germany is scarce. We analysed 936 HEV RNA positive samples of human origin and corresponding national surveillance data from 2010 to 2019. Samples were referred to the National Consultant Laboratory and sequenced in at least one of four genomic regions. Sequences were analysed using bioinformatics methods and compared to the latest HEV reference set. 1,656 sequences were obtained from 300 female, 611 male and 25 of unknown sex aged 3–92 years (median 55 years). HEV-3c was predominant (67.3%) followed by HEV-3f, HEV-3e and HEV-3i(-like) with 14.3%, 9.7% and 4.0% (other subtypes ≤1.1%). The proportion of HEV-3 group 2 (3abchijklm) strains increased over time. Jaundice, upper abdominal pain, fever, hospitalization, and death due to HEV were significantly more often reported for patients infected with HEV-3 group 1 (3efg) compared to group 2. Larger spatio-temporal clusters of identical sequences were not observed. HEV-3 group 1 infections are more severe as compared to the predominant group 2. Detection of group 2 strains increased over the last years, possibly due to more frequent diagnosis of asymptomatic and mild courses. The diversity of strains and the space–time distribution is compatible with a foodborne zoonosis with supra-regional distribution of the infection vehicle (pork products).
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Affiliation(s)
- Mathias Schemmerer
- National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - Jürgen J Wenzel
- National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - Klaus Stark
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mirko Faber
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Unravelling microbial populations and volatile organic compounds of artisan fermented liver sausages manufactured in Central Italy. Food Res Int 2022; 154:111019. [DOI: 10.1016/j.foodres.2022.111019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 01/04/2023]
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6
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Damiris K, Aghaie Meybodi M, Niazi M, Pyrsopoulos N. Hepatitis E in immunocompromised individuals. World J Hepatol 2022; 14:482-494. [PMID: 35582299 PMCID: PMC9055194 DOI: 10.4254/wjh.v14.i3.482] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/15/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States. While there are eight identified genotypes to date, genotype 1 (HEV1), HEV2, HEV3, HEV4 are the most common to infect humans. HEV1 and HEV2 are most common in developing countries including Latina America, Africa and Asia, and are commonly transmitted through contaminated water supplies leading to regional outbreaks. In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat. The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing. In majority of cases, HEV infection is a self-limiting hepatitis requiring only symptomatic treatment. However, this is not the case in immunocompromised individuals, including those that have undergone solid organ or stem cell transplantation. In this subset of patients, chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death. The need for re-transplantation as a result of post-transplant hepatitis is of great concern. In addition, there have been many reported incidents of extrahepatic manifestations, for which the exact mechanisms remain to be elucidated. The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies, while attempting to minimize the risk of organ rejection. Subsequent treatment options include ribavirin, and pegylated interferon alpha in those who have demonstrated ribavirin resistance. Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden. Given this concern, vaccination has been approved in China with other investigations underway throughout the world. In this review we introduce the epidemiology, diagnosis, clinical manifestations, and treatment of HEV, with emphasis on immunocompromised individuals in the United States.
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Affiliation(s)
- Konstantinos Damiris
- Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
| | - Mohamad Aghaie Meybodi
- Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
| | - Mumtaz Niazi
- Department of Medicine - Gastroenterology and Hepatology, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
| | - Nikolaos Pyrsopoulos
- Department of Medicine - Gastroenterology and Hepatology, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
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7
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Withenshaw SM, Grierson SS, Smith RP. Study of Animal Mixing and the Dynamics of Hepatitis E Virus Infection on a Farrow-to-Finish Pig Farm. Animals (Basel) 2022; 12:ani12030272. [PMID: 35158596 PMCID: PMC8833537 DOI: 10.3390/ani12030272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 02/05/2023] Open
Abstract
In Europe, swine are a livestock reservoir for Hepatitis E virus genotype 3 (HEV-3). Consumption of food containing HEV-3 can cause zoonotic human infection, though risk is reduced by heat treatment. Implementing controls that limit infection in slaughter pigs may further reduce foodborne transmission risk but knowledge of infection dynamics on commercial farms is limited. This study addressed this knowledge gap and in particular investigated the influence of group mixing. Faeces were collected from grower (n = 212) and fattener (n = 262) pigs on a farrow-to-finish farm on four occasions. HEV RNA was detected on all occasions, and prevalence was higher in growers (85.8%) than fatteners (26.0%; p < 0.001). HEV-positive samples were also collected from the wider farm environment (n = 67; 64.7% prevalence), indicating potential sources for HEV re-circulation within the herd. Timing of infection in a cohort was also investigated. HEV was absent from all piglet faeces (n = 98) and first detected at weaner stage (25.7% prevalence), but only in groups weaned earlier or comprising pigs from many different litters. Farrowing sow faeces (n = 75) were HEV-negative but antibodies were detected in blood from two sows. Results suggest that multiple factors influence HEV infection dynamics on pig farms, and potential foci for further study into practical control solutions are highlighted.
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Affiliation(s)
- Susan M. Withenshaw
- Department of Epidemiological Sciences, Animal and Plant Health Agency, Weybridge KT15 3NB, UK;
- Correspondence:
| | - Sylvia S. Grierson
- Department of Virology, Animal and Plant Health Agency, Weybridge KT15 3NB, UK;
| | - Richard P. Smith
- Department of Epidemiological Sciences, Animal and Plant Health Agency, Weybridge KT15 3NB, UK;
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Dudareva S, Faber M, Zimmermann R, Bock CT, Offergeld R, Steffen G, Enkelmann J. [Epidemiology of viral hepatitis A to E in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:149-158. [PMID: 35029725 PMCID: PMC8758919 DOI: 10.1007/s00103-021-03478-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/08/2021] [Indexed: 12/18/2022]
Abstract
Viral hepatitis A to E describes various infectious inflammations of the liver parenchyma that are caused by the hepatitis viruses A to E (HAV, HBV, HCV, HDV, and HEV). Although the clinical pictures are similar, the pathogens belong to different virus families and differ in terms of pathogenesis, transmission routes, clinical course, prevention, and therapy options. In Germany, there is mandatory reporting according to the Infection Protection Act (IfSG) for direct or indirect laboratory evidence and for suspicion, illness, and death of viral hepatitis. The data are transmitted to the Robert Koch Institute.In this article, on the basis of published studies and notification data, we describe the epidemiology of hepatitis A to E as well as current challenges and prevention approaches. In particular, the latter contains the improvement of existing vaccination recommendations (hepatitis A and B); improvement of access to prevention, testing, and care including therapy with antiviral drugs (hepatitis B, C, and D) and the detection and prevention of foodborne infections and outbreaks; and improvements in the field of food safety (hepatitis A and E).
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Affiliation(s)
- Sandra Dudareva
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland.
| | - Mirko Faber
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Ruth Zimmermann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - C-Thomas Bock
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Ruth Offergeld
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Gyde Steffen
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Julia Enkelmann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
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9
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Smith I, Said B, Vaughan A, Haywood B, Ijaz S, Reynolds C, Brailsford S, Russell K, Morgan D. Case-Control Study of Risk Factors for Acquired Hepatitis E Virus Infections in Blood Donors, United Kingdom, 2018-2019. Emerg Infect Dis 2021; 27:1654-1661. [PMID: 34013866 PMCID: PMC8153866 DOI: 10.3201/eid2706.203964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in England. Substantial yearly increases of autochthonous infections were observed during 2003–2016 and again during 2017–2019. Previous studies associated acute HEV cases with consumption of processed pork products, we investigated risk factors for autochthonous HEV infections in the blood donor population in England. Study participants were 117 HEV RNA–positive blood donors and 564 HEV RNA–negative blood donors. No persons with positive results were vegetarian; 97.4% of persons with positive results reported eating pork products. Consuming bacon (OR 3.0, 95% CI 1.7–5.5; p<0.0001), cured pork meats (OR 3.5, 95% CI 2.2–5.4; p<0.0001), and pigs’ liver (OR 2.9, 95% CI 1.0–8.3; p = 0.04) were significantly associated with HEV infection. Our findings confirm previous links to pork products and suggest that appropriate animal husbandry is essential to reduce the risk for HEV infection.
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Treagus S, Wright C, Baker-Austin C, Longdon B, Lowther J. The Foodborne Transmission of Hepatitis E Virus to Humans. FOOD AND ENVIRONMENTAL VIROLOGY 2021; 13:127-145. [PMID: 33738770 PMCID: PMC8116281 DOI: 10.1007/s12560-021-09461-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/16/2021] [Indexed: 05/04/2023]
Abstract
Globally, Hepatitis E virus (HEV) causes over 20 million cases worldwide. HEV is an emerging and endemic pathogen within economically developed countries, chiefly resulting from infections with genotype 3 (G3) HEV. G3 HEV is known to be a zoonotic pathogen, with a broad host range. The primary source of HEV within more economically developed countries is considered to be pigs, and consumption of pork products is a significant risk factor and known transmission route for the virus to humans. However, other foods have also been implicated in the transmission of HEV to humans. This review consolidates the information available regarding transmission of HEV and looks to identify gaps where further research is required to better understand how HEV is transmitted to humans through food.
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Affiliation(s)
- Samantha Treagus
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Penryn Campus, Penryn, Cornwall, UK.
- Centre for Environment Fisheries and Aquaculture Science, Barrack Road, Weymouth, Dorset, DT4 8UB, UK.
| | | | - Craig Baker-Austin
- Centre for Environment Fisheries and Aquaculture Science, Barrack Road, Weymouth, Dorset, DT4 8UB, UK
| | - Ben Longdon
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Penryn Campus, Penryn, Cornwall, UK
| | - James Lowther
- Centre for Environment Fisheries and Aquaculture Science, Barrack Road, Weymouth, Dorset, DT4 8UB, UK
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11
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Crotta M, Lavazza A, Mateus A, Guitian J. Viraemic pigs entering the food chain are the most likely source of hepatitis E virus (HEV) in pork meat: Modelling the fate of HEV during slaughtering of pigs. Food Control 2021. [DOI: 10.1016/j.foodcont.2020.107662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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12
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Seroprevalence of Hepatitis E Virus in Moose ( Alces alces), Reindeer ( Rangifer tarandus), Red Deer ( Cervus elaphus), Roe Deer ( Capreolus capreolus), and Muskoxen ( Ovibos moschatus) from Norway. Viruses 2021; 13:v13020224. [PMID: 33535675 PMCID: PMC7912786 DOI: 10.3390/v13020224] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/18/2022] Open
Abstract
Hepatitis E virus (HEV), a major cause of viral hepatitis worldwide, is considered an emerging foodborne zoonosis in Europe. Pigs (Sus scrofa domestica) and wild boars (S. scrofa) are recognized as important HEV reservoirs. Additionally, HEV infection and exposure have been described in cervids. In Norway, HEV has been identified in pigs and humans; however, little is known regarding its presence in wild ungulates in the country. We used a species-independent double-antigen sandwich ELISA to detect antibodies against HEV in the sera of 715 wild ungulates from Norway, including 164 moose (Alces alces), 186 wild Eurasian tundra reindeer (Rangifer tarandus tarandus), 177 red deer (Cervus elaphus), 86 European roe deer (Capreolus capreolus), and 102 muskoxen (Ovibos moschatus). The overall seroprevalence was 12.3% (88/715). Wild reindeer had the highest seropositivity (23.1%, 43/186), followed by moose (19.5%, 32/164), muskoxen (5.9%, 6/102), and red deer (4%, 7/177). All roe deer were negative. According to our results, HEV is circulating in wild ungulates in Norway. The high seroprevalence observed in wild reindeer and moose indicates that these species may be potential reservoirs of HEV. To the authors’ knowledge, this is the first report of HEV exposure in reindeer from Europe and in muskoxen worldwide.
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13
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Villar LM, Milagres FAP, Marques JT, de Paula VS. Hepatitis E prevalence in indigenous communities from Western Brazilian Amazon. Liver Int 2021; 41:235-236. [PMID: 33155389 DOI: 10.1111/liv.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Livia Melo Villar
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Julia Trece Marques
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
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14
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Suin V, Klamer SE, Hutse V, Wautier M, Jacques M, Abady M, Lamoral S, Verburgh V, Thomas I, Brochier B, Subissi L, Van Gucht S. Epidemiology and genotype 3 subtype dynamics of hepatitis E virus in Belgium, 2010 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 30862337 PMCID: PMC6415497 DOI: 10.2807/1560-7917.es.2019.24.10.1800141] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BackgroundHepatitis E virus (HEV) is an emerging public health concern in high-income countries and can cause acute and chronic hepatitis. Reported numbers of indigenously acquired HEV infection have increased in the past decade in many European countries. Since 2010, the National Reference Centre (NRC) for Hepatitis Viruses has been testing samples of suspected hepatitis E cases in Belgium.AimIn this surveillance report, we present the epidemiological trends of symptomatic HEV infections in Belgium, from the distribution by age, sex and geography to the molecular characterisation of the viral strains.MethodSerum samples of suspected cases sent to the NRC between 2010 and 2017 were analysed for the presence of HEV-specific IgM and RNA. Virus was sequenced for genotyping and phylogenetic analysis in all samples containing sufficient viral RNA.ResultsThe NRC reported an increase in the number of samples from suspected cases (from 309 to 2,663 per year) and in the number of laboratory-confirmed hepatitis E cases (from 25 to 117 per year). Among 217 sequenced samples, 92.6% were genotype 3 (HEV-3), followed by 6.5% of genotype 1 and 0.9% of genotype 4. HEV-3 subtype viruses were mainly 3f, 3c and 3e. HEV-3f was the most common subtype until 2015, while HEV-3c became the most common subtype in 2016 and 2017.ConclusionThe increasing trend of HEV diagnoses in Belgium may be largely explained by increased awareness and testing.
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Affiliation(s)
- Vanessa Suin
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Sofieke E Klamer
- European Program for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden.,Epidemiology of Infectious Diseases, Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Veronik Hutse
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Magali Wautier
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Marjorie Jacques
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Mona Abady
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Sophie Lamoral
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Vera Verburgh
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Isabelle Thomas
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Bernard Brochier
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Lorenzo Subissi
- European Program for Public Health Microbiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden.,National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Steven Van Gucht
- National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium
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15
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Harvala H, Hewitt PE, Reynolds C, Pearson C, Haywood B, Tettmar KI, Ushiro-Lumb I, Brailsford SR, Tedder R, Ijaz S. Hepatitis E virus in blood donors in England, 2016 to 2017: from selective to universal screening. ACTA ACUST UNITED AC 2020; 24. [PMID: 30862338 PMCID: PMC6415500 DOI: 10.2807/1560-7917.es.2019.24.10.1800386] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction Hepatitis E virus (HEV), the most common cause of acute hepatitis in many European countries, is transmitted through consumption of processed pork but also via blood transfusion and transplantation. HEV infection can become persistent in immunocompromised individuals. Aim We aimed to determine the incidence and epidemiology of HEV infection in English blood donors since the introduction of donation screening in 2016. Methods Between March 2016 and December 2017, 1,838,747 blood donations were screened for HEV RNA. Donations containing HEV RNA were further tested for serological markers, RNA quantification and viral phylogeny. Demographics, travel and diet history were analysed for all infected donors. Results We identified 480 HEV RNA-positive blood donations during the 22-month period, most (319/480; 66%) donors were seronegative. Viral loads ranged from 1 to 3,230,000 IU/ml. All sequences belonged to genotype 3, except one which likely represents a new genotype. Most viraemic donors were over 45 years of age (279/480; 58%), donors aged between 17 and 24 years had a seven-times higher incidence of HEV infection than other donors between March and June 2016 (1:544 donations vs 1:3,830). HEV-infected blood donors were evenly distributed throughout England. Screening prevented 480 HEV RNA-positive blood donations from reaching clinical supply. Conclusion HEV screening of blood donations is a vital step in order to provide safer blood for all recipients, but especially for the immunosuppressed. The unusually high rates of HEV infection in young blood donors may provide some insight into specific risks associated with HEV infection in England.
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Affiliation(s)
- Heli Harvala
- University College London, London, United Kingdom.,Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Patricia E Hewitt
- Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Claire Reynolds
- Joint NHSBT/PHE Epidemiology Unit, Microbiology Services, NHS Blood and Transplant and Blood Safety, Hepatitis, Sexually Transmitted Infection and HIV Division, National Infections Service, Public Health England, London, United Kingdom
| | - Callum Pearson
- Joint NHSBT/PHE Epidemiology Unit, Microbiology Services, NHS Blood and Transplant and Blood Safety, Hepatitis, Sexually Transmitted Infection and HIV Division, National Infections Service, Public Health England, London, United Kingdom
| | - Becky Haywood
- Blood Borne Virus Unit, Virus Reference Department, Microbiology Services and National Infection Services, Public Health England, London, United Kingdom
| | - Kate I Tettmar
- Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Ines Ushiro-Lumb
- Blood Borne Virus Unit, Virus Reference Department, Microbiology Services and National Infection Services, Public Health England, London, United Kingdom.,Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Susan R Brailsford
- Joint NHSBT/PHE Epidemiology Unit, Microbiology Services, NHS Blood and Transplant and Blood Safety, Hepatitis, Sexually Transmitted Infection and HIV Division, National Infections Service, Public Health England, London, United Kingdom.,Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Richard Tedder
- Current affiliation: Imperial College London, London, United Kingdom.,Blood Borne Virus Unit, Virus Reference Department, Microbiology Services and National Infection Services, Public Health England, London, United Kingdom.,University College London, London, United Kingdom.,Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department, Microbiology Services and National Infection Services, Public Health England, London, United Kingdom
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16
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Riveiro-Barciela M, Rando-Segura A, Barreira-Díaz A, Bes M, P Ruzo S, Piron M, Quer J, Sauleda S, Rodríguez-Frías F, Esteban R, Buti M. Unexpected long-lasting anti-HEV IgM positivity: Is HEV antigen a better serological marker for hepatitis E infection diagnosis? J Viral Hepat 2020; 27:747-753. [PMID: 32106351 DOI: 10.1111/jvh.13285] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023]
Abstract
Hepatitis E virus (HEV) is the leading cause of acute hepatitis worldwide. The minimum criterion for diagnosis of acute infection is detection of anti-HEV antibodies, although there are scant data on IgM duration. Our aim was to assess the persistence of HEV markers after acute self-limited hepatitis E. HEV serological tests (IgM by Mikrogen and Wantai and HEV-Ag) and HEV RNA were carried out in two cohorts: (a) patients with prior acute hepatitis E (ALT >10 x ULN plus positive IgM ± HEV RNA) currently self-limited and (b) 50 blood donors with positive HEV RNA. Among 25 cases of prior acute hepatitis E, after a median follow-up of 34 months, all presented undetectable HEV RNA. However, anti-HEV IgM remained detectable in 14 (56%) by Mikrogen, 6 (24%) by Wantai and none for HEV-Ag. Anti-HEV IgM tested positive in 80%-100% within the second year and 17%-42% over 3 years later, by Wantai and Mikrogen, respectively. Among HEV RNA-positive donors, 12 (25%) tested positive for either IgM by Mikrogen or Wantai, 9 (18%) for both and 18 (36%) for HEV-Ag. HEV-Ag positivity was more likely as HEV RNA was higher (14% if <2.2 log IU/mL; 64% if RNA ≥ 3.7). Overall, HEV-Ag performed best, with a positive predictive value of 100% and diagnostic accuracy of 57%. Anti-HEV IgM exhibited unexpectedly long persistence after a self-limited acute hepatitis E. HEV-Ag had the best performance and could be especially useful in settings where HEV RNA is not available.
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Affiliation(s)
- Mar Riveiro-Barciela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autonoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ana Barreira-Díaz
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marta Bes
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Servei Català de la Salut, Barcelona, Spain
| | - Sofía P Ruzo
- Lab. Malalties Hepàtiques-Hepatitis Virals, Vall d'Hebron Institut Recerca-Hospital Universitari Vall d'Hebron (VHIR-HUVH), Barcelona, Spain
| | - Maria Piron
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Servei Català de la Salut, Barcelona, Spain
| | - Josep Quer
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Lab. Malalties Hepàtiques-Hepatitis Virals, Vall d'Hebron Institut Recerca-Hospital Universitari Vall d'Hebron (VHIR-HUVH), Barcelona, Spain
| | - Silvia Sauleda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Servei Català de la Salut, Barcelona, Spain
| | - Francisco Rodríguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Liver Pathology Unit (Biochemistry and Microbiology departments, Clinical Laboratories), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rafael Esteban
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autonoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - María Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autonoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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17
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Maponga TG, Lopes T, Cable R, Pistorius C, Preiser W, Andersson MI. Prevalence and risks of hepatitis E virus infection in blood donors from the Western Cape, South Africa. Vox Sang 2020; 115:695-702. [PMID: 32597542 DOI: 10.1111/vox.12966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transfusion-transmitted hepatitis E virus (HEV) infection is a potential risk to recipients of blood transfusions. Infection with HEV poses a high risk to immunocompromised recipients with an increased likelihood of developing chronic infection. The aims of this study were to determine the prevalence of past and active HEV infections in donors from the Western Cape and to identify the risk factors associated with infection. MATERIALS AND METHODS We prospectively tested 10 250 blood donors for HEV infection. A risk factor sub-study investigated 250 donors who completed a questionnaire, and plasma samples were tested for HEV IgG antibodies and pooled for HEV RNA detection. The demographic and risk factors associated with HEV infection were assessed. The molecular study tested 10 000 individual donations using a commercial assay to detect viraemia. HEV viral load and genotype were also determined. RESULTS The overall anti-HEV IgG seroprevalence was 42·8% (107/250) among donors participating in the risk factor sub-study. The likelihood of past HEV infection was higher with an increase in age. Of the 10 000 donor samples individually tested for HEV RNA, one sample was positive with a viral load of 7·9 x 104 IU/ml and belonged to HEV genotype 3. CONCLUSION We found a high seroprevalence of anti-HEV IgG but a low HEV RNA prevalence among donors in the Western Cape, South Africa. The study provides evidence for a potential risk of HEV contamination in the blood supply in South Africa. A cost-benefit analysis is needed before considering the introduction of routine donor screening in our setting.
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Affiliation(s)
- Tongai G Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Tatum Lopes
- Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | | | | | - Wolfgang Preiser
- Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Tygerberg Business Unit, National Health Laboratory Service, Cape Town, South Africa
| | - Monique I Andersson
- Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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18
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Ledesma J, Williams D, Stanford FA, Hewitt PE, Zuckerman M, Bansal S, Dhawan A, Mbisa JL, Tedder R, Ijaz S. Resolution by deep sequencing of a dual hepatitis E virus infection transmitted via blood components. J Gen Virol 2020; 100:1491-1500. [PMID: 31592753 DOI: 10.1099/jgv.0.001302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hepatitis E virus (HEV) is a zoonotic infection, with consumption of processed pork products thought to be the major route of transmission in England. The clinical features of HEV infection range from asymptomatic infection to mild hepatitis to fulminant liver failure. Persistent, chronic hepatitis is increasingly recognized in immunocompromised patients. Infection via HEV-containing blood components and organs has been reported and measures to reduce this transmission risk were introduced into the blood service in England in 2016. We report here the sequence and phylogenetic findings from investigations into a transmission event from an HEV-infected donor to two recipients. Phylogenetic analysis of HEV genome sequence fragments obtained by Sanger sequencing showed that, whilst most of the sequences from both recipients' samples grouped with the sequence from the blood donor sample, the relationship of five sequences from recipient 2 were unresolved. Analysis of Illumina short-read deep sequence data demonstrated the presence of two divergent viral populations in the donor's sample that were also present in samples from both recipients. A clear phylogenetic relationship was established, indicating a probable transmission of both populations from the donor to each of the immunocompromised recipients. This study demonstrates the value of the application of new sequencing technologies combined with bioinformatic data analysis when Sanger sequencing is not able to clarify a proper phylogenetic relationship in the investigation of transmission events.
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Affiliation(s)
- Juan Ledesma
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, London, UK.,Antiviral Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - David Williams
- Bioinformatics, Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Felicia Adelina Stanford
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK
| | | | - Mark Zuckerman
- South London Specialist Virology Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Sanjay Bansal
- Paediatric Liver, GI and Nutrition Centre and Mowat Labs, King's College Hospital, London, UK
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre and Mowat Labs, King's College Hospital, London, UK
| | - Jean Lutamyo Mbisa
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, London, UK.,Antiviral Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Richard Tedder
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, London, UK
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19
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Oeser C, Vaughan A, Said B, Ijaz S, Tedder R, Haywood B, Warburton F, Charlett A, Elson R, Morgan D. Epidemiology of Hepatitis E in England and Wales: A 10-Year Retrospective Surveillance Study, 2008-2017. J Infect Dis 2020; 220:802-810. [PMID: 31107958 DOI: 10.1093/infdis/jiz207] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/23/2019] [Indexed: 01/01/2023] Open
Abstract
Indigenous, foodborne transmission of hepatitis E virus genotype 3 (HEV G3) has become recognized as an emerging problem in industrialized countries. Although mostly asymptomatic, HEV G3 infection has a range of outcomes, including mild illness, severe acute hepatitis, and, of particular concern, chronic progressive hepatitis in immunocompromised patients. Public Health England has monitored cases of acute HEV infection in England and Wales since 2003. Between 2010 and 2017, enhanced surveillance using 2 linked laboratory databases and questionnaires on clinical features and risk factors was conducted. There was a year-on-year increase in the number of infections from 2008 (183) through 2016 (1243). Then, in 2017, the number of infections declined (to 912). As reported previously, HEV G3 group 2 (also known as "G3 abcdhij") is the predominant cause of acute infections, and older men are most at risk. Consumption of pork and pork products was significantly higher among patients than in the general population, but other previously reported associations, such as consumption of shellfish, were not observed. Ongoing surveillance is required to monitor future trends and changes in the epidemiology of the virus. The changing methods of animal husbandry and processing and distribution of animal products needs to be further investigated.
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Affiliation(s)
- Clarissa Oeser
- Emerging Infections and Zoonoses, Public Health England, London.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Aisling Vaughan
- Emerging Infections and Zoonoses, Public Health England, London.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Bengü Said
- Emerging Infections and Zoonoses, Public Health England, London
| | - Samreen Ijaz
- Blood Borne Viruses Unit, Public Health England, London
| | | | - Becky Haywood
- Blood Borne Viruses Unit, Public Health England, London
| | - Fiona Warburton
- Statistics, Modelling, and Economics Department, Public Health England, London
| | - Andre Charlett
- Statistics, Modelling, and Economics Department, Public Health England, London
| | - Richard Elson
- Gastrointestinal Infections, National Infection Service, Public Health England, London
| | - Dilys Morgan
- Emerging Infections and Zoonoses, Public Health England, London
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20
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Seth A, Sherman KE. Hepatitis E: What We Think We Know. Clin Liver Dis (Hoboken) 2020; 15:S37-S44. [PMID: 32140212 PMCID: PMC7050948 DOI: 10.1002/cld.858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Aradhna Seth
- Division of Digestive DiseaseUniversity of Cincinnati College of MedicineCincinnatiOH
| | - Kenneth E. Sherman
- Division of Digestive DiseaseUniversity of Cincinnati College of MedicineCincinnatiOH
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21
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Adlhoch C, Manďáková Z, Ethelberg S, Epštein J, Rimhanen-Finne R, Figoni J, Baylis SA, Faber M, Mellou K, Murphy N, O'Gorman J, Tosti ME, Ciccaglione AR, Hofhuis A, Zaaijer H, Lange H, de Sousa R, Avellón A, Sundqvist L, Said B, Ijaz S. Standardising surveillance of hepatitis E virus infection in the EU/EEA: A review of national practices and suggestions for the way forward. J Clin Virol 2019; 120:63-67. [PMID: 31590112 PMCID: PMC6899520 DOI: 10.1016/j.jcv.2019.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses. OBJECTIVE AND STUDY DESIGN WHO's European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC's HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods. RESULTS The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission. DISCUSSION Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.
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Affiliation(s)
- Cornelia Adlhoch
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73, Solna, Sweden.
| | | | | | | | | | | | | | | | | | - Niamh Murphy
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.
| | - Joanne O'Gorman
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.
| | | | | | - Agnetha Hofhuis
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Hans Zaaijer
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands.
| | - Heidi Lange
- Norwegian Institute of Public Health, Oslo, Norway.
| | - Rita de Sousa
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.
| | - Ana Avellón
- Viral Hepatitis Reference and Research Laboratory National Center of Microbiology Carlos III Health Institute, Madrid, Spain.
| | - Lena Sundqvist
- The Public Health Agency of Sweden (Folkhälsomyndigheten), Stockholm, Sweden.
| | - Bengü Said
- Public Health England, London, United Kingdom.
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22
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Heo NY. [Hepatitis E Virus: Epidemiology, Diagnosis, and Management]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 74:130-136. [PMID: 31554028 DOI: 10.4166/kjg.2019.74.3.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/08/2023]
Abstract
The HEV is a known cause of water-borne outbreaks of acute non-A non-B hepatitis in developing countries, which affects young people and may result in high mortality in pregnant women. In recent decades, however, HEV genotypes 3 and 4 have been known as a cause of sporadic zoonotic infections in older males from swine HEV worldwide. Most acute HEV infections are self-limited. On the other hand, in immunosuppressed patients, including solid organ transplant recipients, chronic HEV infections may exist and progress to liver cirrhosis or decompensation. Therefore, physicians need to recognize HEV as a major pathogen for acute and chronic hepatitis of unknown causes and investigate this disease.
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Affiliation(s)
- Nae-Yun Heo
- Division of Gastroenterology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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23
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Abstract
Notified cases of hepatitis E have increased 40-fold in the past 10 years in Germany. Food safety is a major concern as hepatitis E virus (HEV) RNA has been detected in ready-to-eat retail-level food products. The objective of this case–control study was to assess risk factors for autochthonous symptomatic hepatitis E and explore reasons for delays in diagnosis. Methods: Demographic, clinical and exposure data from notified hepatitis E cases and individually matched population controls were collected in semi-standardised telephone interviews. Conditional logistic regression analysis was used to calculate matched odds ratios (mOR) and population attributable fractions (PAF). Results: In total, 270 cases and 1,159 controls were included (mean age 53 years, 61% men in both groups). Associated with disease were: consumption of undercooked pork liver, pork, wild boar meat, frankfurters, liver sausage and raw vegetables; contact with waste water (occupational) and various host factors (mORs between 1.9 and 34.1, p value < 0.03). PAF for frankfurters and liver sausage were 17.6%, and 23.6%, respectively. There were statistically significant differences in the clinical presentation and hospitalisation proportion of acute hepatitis E in men and women. Diagnosis was preceded by more invasive procedures in 29.2% of patients, suggesting that hepatitis E was not immediately considered as a common differential diagnosis. Conclusions: Our study suggests that there are indeed sex-specific differences in disease development and lends important epidemiological evidence to specific ready-to-eat pork products as a major source for autochthonous hepatitis E. A review of existing consumer recommendations and production methods may be indicated.
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Affiliation(s)
- Mirko Faber
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mona Askar
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Stark
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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24
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von Felden J, Alric L, Pischke S, Aitken C, Schlabe S, Spengler U, Giordani MT, Schnitzler P, Bettinger D, Thimme R, Xhaard A, Binder M, Ayuk F, Lohse AW, Cornelissen JJ, de Man RA, Mallet V. The burden of hepatitis E among patients with haematological malignancies: A retrospective European cohort study. J Hepatol 2019; 71:465-472. [PMID: 31108159 DOI: 10.1016/j.jhep.2019.04.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The burden of hepatitis E virus (HEV) infection among patients with haematological malignancy has only been scarcely reported. Therefore, we aimed to describe this burden in patients with haematological malignancies, including those receiving allogeneic haematopoietic stem cell transplantation. METHODS We conducted a retrospective, multicentre cohort study across 11 European centres and collected clinical characteristics of 50 patients with haematological malignancy and RNA-positive, clinically overt hepatitis E between April 2014 and March 2017. The primary endpoint was HEV-associated mortality; the secondary endpoint was HEV-associated liver-related morbidity. RESULTS The most frequent underlying haematological malignancies were aggressive non-Hodgkin lymphoma (NHL) (34%), indolent NHL (iNHL) (24%), and acute leukaemia (36%). Twenty-one (42%) patients had received allogeneic haematopoietic stem cell transplantation (alloHSCT). Death with ongoing hepatitis E occurred in 8 (16%) patients, including 1 patient with iNHL and 1 patient >100 days after alloHSCT in complete remission, and was associated with male sex (p = 0.040), cirrhosis (p = 0.006) and alloHSCT (p = 0.056). Blood-borne transmission of hepatitis E was demonstrated in 5 (10%) patients, and associated with liver-related mortality in 2 patients. Hepatitis E progressed to chronic hepatitis in 17 (34%) patients overall, and in 10 (47.6%) and 6 (50%) alloHSCT and iNHL patients, respectively. Hepatitis E was associated with acute or acute-on-chronic liver failure in 4 (8%) patients with 75% mortality. Ribavirin was administered to 24 (48%) patients, with an HEV clearance rate of 79.2%. Ribavirin treatment was associated with lower mortality (p = 0.037) and by trend with lower rates of chronicity (p = 0.407) when initiated <24 and <12 weeks after diagnosis of hepatitis E, respectively. Immunosuppressive treatment reductions were associated with mortality in 2 patients (28.6%). CONCLUSION Hepatitis E is associated with mortality and liver-related morbidity in patients with haematological malignancy. Blood-borne transmission contributes to the burden. Ribavirin should be initiated early, whereas reduction of immunosuppressive treatment requires caution. LAY SUMMARY Little is known about the burden of hepatitis E among patients with haematological malignancy. We conducted a retrospective European cohort study among 50 patients with haematological malignancy, including haematopoietic stem cell transplant recipients, with clinically significant HEV infection and found that hepatitis E is associated with hepatic and extrahepatic mortality, including among patients with indolent disease or among stem cell transplant recipients in complete remission. Hepatitis E virus infection evolved to chronic hepatitis in 5 (45.5%) patients exposed to a rituximab-containing regimen and 10 (47.6%) stem cell transplant recipients. Reducing immunosuppressive therapy because of hepatitis E was associated with mortality, while early ribavirin treatment was safe and effective.
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Affiliation(s)
- Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Divisions of Liver Diseases and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, Toulouse, France; UMR 152, IRD Toulouse 3 University, France
| | - Sven Pischke
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg site, Hamburg, Germany
| | - Celia Aitken
- Virology, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Stefan Schlabe
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Maria Teresa Giordani
- Infectious Diseases and Tropical Medicine Unit, San Bortolo Hospital, Vicenza, Italy
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, University of Heidelberg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Germany; Berta-Ottenstein-Program, Faculty of Medicine, University of Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Germany
| | - Alienor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Mascha Binder
- Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan J Cornelissen
- Department of Haematology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Vincent Mallet
- Hepatology Service, Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, Paris, France; Institut National de la Santé et de la Recherche Médicale unité 1223, Institut Pasteur, Paris, France.
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Tulen AD, Vennema H, van Pelt W, Franz E, Hofhuis A. A case-control study into risk factors for acute hepatitis E in the Netherlands, 2015–2017. J Infect 2019; 78:373-381. [DOI: 10.1016/j.jinf.2019.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
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Monitoring of pork liver and meat products on the Dutch market for the presence of HEV RNA. Int J Food Microbiol 2019; 296:58-64. [DOI: 10.1016/j.ijfoodmicro.2019.02.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 01/05/2023]
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Mulder AC, Kroneman A, Franz E, Vennema H, Tulen AD, Takkinen J, Hofhuis A, Adlhoch C. HEVnet: a One Health, collaborative, interdisciplinary network and sequence data repository for enhanced hepatitis E virus molecular typing, characterisation and epidemiological investigations. Euro Surveill 2019; 24:1800407. [PMID: 30862334 PMCID: PMC6415499 DOI: 10.2807/1560-7917.es.2019.24.10.1800407] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/08/2019] [Indexed: 12/27/2022] Open
Abstract
Hepatitis E virus (HEV) is a common cause of acute hepatitis worldwide. In Europe, HEV is a zoonosis transmitted via contaminated pork meat or other pork food products. Genotype 3 is the most prevalent HEV type in the animal reservoir, as well as in humans. Despite an increased incidence of hepatitis E across Europe, much remains unknown about its spread, sources and transmission routes. A One Health approach is crucial to better understand the (molecular) epidemiology of HEV. HEVnet was established in April 2017 as a network and database for sharing sequences and accompanying metadata collected from human, animal, food and environmental sources. HEVnet members working in the public health, veterinary health, food, environmental and blood safety sectors have submitted 1,615 HEV sequences from nine countries as at January 2019. Most are from humans (89%), and sequences of animal (5%), food (6%) or environmental (0.3%) origin are rare. Metadata for human sequences capture mostly sex (93%), year of birth (92%) and sampling (100%); data on region of sampling (37%) and clinical information (hospitalisation 27%, symptoms 20% or mortality 8%) are limited. HEVnet aims to expand into a global network capable of performing cross-sectoral and supranational studies, with a joint repository of molecular and epidemiological data on HEV.
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Affiliation(s)
- Annemieke Christine Mulder
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Annelies Kroneman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Eelco Franz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Harry Vennema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Anna D Tulen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Johanna Takkinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Agnetha Hofhuis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- These authors contributed equally to this article and share last authorship
| | - Cornelia Adlhoch
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- These authors contributed equally to this article and share last authorship
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Tan J, Chen Y, Wang L, Chan TC, Amer S, Xu X, Cai J, Li W, Zheng X, Zhou M, Qin S, Zhao N, Miao Z, Liu S. Acute sporadic hepatitis E in the Zhejiang coastal area of China: a 14-year hospital-based surveillance study. Virol J 2019; 16:16. [PMID: 30717759 PMCID: PMC6360671 DOI: 10.1186/s12985-019-1119-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To examine the epidemiological trends and changes of hepatitis E virus (HEV) infection and the potential risk factors for severe infection in the Zhejiang eastern coastal area of China. METHODS We analyzed statutory hepatitis E cases notifications and inpatient data held by the national surveillance and hospital information systems in Wenzhou, Taizhou, Ningbo, and Zhoushan cities of the Zhejiang eastern coastal area of China. RESULTS Nine thousand four hundred sixteen hepatitis E cases were reported from 2004 to 2017, with an average incidence of 2.94 per 100,000. The overall death rate was 0.06% (6/9416). A gradual decline of hepatitis E cases was found in the coastal areas since 2007, while a rise was identified in the non-coastal areas. Annual incidence in non-coastal cities was much higher than that in coastal cities (4.345 vs. 2.945 per 100,000, relative risk = 1.5, P value < 0.001). The mean age was 52 years old and 50.55 years with a male-to-female ratio of 2.32:1 and 2.21:1 in coastal and noncoastal areas respectively (all P > 0.05). Hepatitis E cases prevalence increased with age, highest among men in their 70s (9.02 vs. 11.33 per 100,000) and women in their 60s (3.94 vs. 4.66 per 100,000) groups for both coastal and noncoastal areas respectively. A clear seasonal pattern was observed, with a peak in March (0.4429 per 100,000) in coastal areas. 202 inpatients were documented, of which 50.50% (102/202) were severe cases. Male individuals with alcohol consumption, alcohol hepatic diseases, and superinfection were the three independent highest risks for severe infections (all with P value < 0.05). CONCLUSIONS This is to our knowledge the largest epidemiological study of hepatitis E cases in the eastern coastal area of Zhejiang province of China. The patterns of infection across the coastal areas were similar to those of the non-coastal areas, but the incidence was substantially lower and decreased gradually since 2007.
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Affiliation(s)
- Jun Tan
- Department of Hepatology, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, China
| | - Yijuan Chen
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, (310051), Zhejiang Province, China
| | - Lin Wang
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Said Amer
- Department of Zoology, Faculty of Science, Kafr El Sheikh University, Kafr El Sheikh, Egypt
| | - Xiaobin Xu
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | - Jian Cai
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, (310051), Zhejiang Province, China
| | - Wei Li
- Department of Hepatology, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, China
| | - Xiaoqing Zheng
- Department of Hepatology, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, China
| | - Mi Zhou
- The Medical School of Ningbo University, Ningbo, Zhejiang Province, China
| | - Shuwen Qin
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, (310051), Zhejiang Province, China
| | - Na Zhao
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Ziping Miao
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, (310051), Zhejiang Province, China.
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, (310051), Zhejiang Province, China.
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29
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Lund BM. Provision of microbiologically safe food for vulnerable people in hospitals, care homes and in the community. Food Control 2019. [DOI: 10.1016/j.foodcont.2018.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Affiliation(s)
- James L. Smith
- Eastern Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, Wyndmoor, Pennsylvania
| | - Pina M. Fratamico
- Eastern Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, Wyndmoor, Pennsylvania
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Summary of the British Transplantation Society UK Guidelines for Hepatitis E and Solid Organ Transplantation. Transplantation 2018; 102:15-20. [PMID: 28795981 DOI: 10.1097/tp.0000000000001908] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The incidence and prevalence of hepatitis E virus (HEV) infection has increased in many developed countries over the last decade, predominantly due to infection with genotype 3 (G3) HEV. Infection with HEV G3 is important in transplant recipients because it can persist in immunosuppressed individuals, leading, if untreated, to the development of chronic hepatitis and significant liver fibrosis. The British Transplantation Society (BTS) has developed Guidelines for "Hepatitis E and Solid Organ Transplantation" to inform clinical teams and patients about hepatitis E, to help increase the recognition of persistent hepatitis E infection, and to provide clear guidance on its management. This guideline was published on the BTS website in June 2017 and aims to review the evidence relating to the diagnosis and management of persistent hepatitis E in solid organ transplant recipients and the methods of prevention of HEV infection. In line with previous guidelines published by the BTS, the guideline has used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system to rate the strength of evidence and recommendations. This article includes a summary overview of hepatitis E and transplantation with key references, and the statements of recommendation contained within the guideline. It is recommended that the full guideline document is consulted for complete details of the relevant references and evidence base. This may be accessed at https://bts.org.uk/guidelines-standards/.
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Smith DB, Simmonds P. Classification and Genomic Diversity of Enterically Transmitted Hepatitis Viruses. Cold Spring Harb Perspect Med 2018; 8:a031880. [PMID: 29530950 PMCID: PMC6120691 DOI: 10.1101/cshperspect.a031880] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hepatitis A virus (HAV) and hepatitis E virus (HEV) are significant human pathogens and are responsible for a substantial proportion of cases of severe acute hepatitis worldwide. Genetically, both viruses are heterogeneous and are classified into several genotypes that differ in their geographical distribution and risk group association. There is, however, little evidence that variants of HAV or HEV differ antigenically or in their propensity to cause severe disease. Genetically more divergent but primarily hepatotropic variants of both HAV and HEV have been found in several mammalian species, those of HAV being classified into eight species within the genus Hepatovirus in the virus family Picornaviridae. HEV is classified as a member of the species Orthohepevirus A in the virus family Hepeviridae, a species that additionally contains viruses infecting pigs, rabbits, and a variety of other mammalian species. Other species (Orthohepevirus B-D) infect a wide range of other mammalian species including rodents and bats.
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Affiliation(s)
- Donald B Smith
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh EH9 3JT, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom
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King NJ, Hewitt J, Perchec-Merien AM. Hiding in Plain Sight? It's Time to Investigate Other Possible Transmission Routes for Hepatitis E Virus (HEV) in Developed Countries. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:225-252. [PMID: 29623595 DOI: 10.1007/s12560-018-9342-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
Historically in developed countries, reported hepatitis E cases were typically travellers returning from countries where hepatitis E virus (HEV) is endemic, but now there are increasing numbers of non-travel-related ("autochthonous") cases being reported. Data for HEV in New Zealand remain limited and the transmission routes unproven. We critically reviewed the scientific evidence supporting HEV transmission routes in other developed countries to inform how people in New Zealand may be exposed to this virus. A substantial body of indirect evidence shows domesticated pigs are a source of zoonotic human HEV infection, but there is an information bias towards this established reservoir. The increasing range of animals in which HEV has been detected makes it important to consider other possible animal reservoirs of HEV genotypes that can or could infect humans. Foodborne transmission of HEV from swine and deer products has been proven, and a large body of indirect evidence (e.g. food surveys, epidemiological studies and phylogenetic analyses) support pig products as vehicles of HEV infection. Scarce data from other foods suggest we are neglecting other potential sources of foodborne HEV infection. Moreover, other transmission routes are scarcely investigated in developed countries; the role of infected food handlers, person-to-person transmission via the faecal-oral route, and waterborne transmission from recreational contact or drinking untreated or inadequately treated water. People have become symptomatic after receiving transfusions of HEV-contaminated blood, but it is unclear how important this is in the overall hepatitis E disease burden. There is need for broader research efforts to support establishing risk-based controls.
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Affiliation(s)
- Nicola J King
- Institute of Environmental Science and Research, 34 Kenepuru Drive, Kenepuru, Porirua, 5022, New Zealand
| | - Joanne Hewitt
- Institute of Environmental Science and Research, 34 Kenepuru Drive, Kenepuru, Porirua, 5022, New Zealand.
| | - Anne-Marie Perchec-Merien
- New Zealand Ministry for Primary Industries, Pastoral House, 25 The Terrace, Wellington, New Zealand
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Kantala T, Maunula L. Hepatitis E virus: zoonotic and foodborne transmission in developed countries. Future Virol 2018. [DOI: 10.2217/fvl-2018-0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hepatitis E virus (HEV), together with hepatitis A virus, transmits via the fecal–oral route. The number of domestic hepatitis E cases among Europeans has grown alarmingly during the past 5 years. Surveillance studies suggest that the number of foodborne HEV infections is increasing most rapidly. Zoonotic HEV genotype HEV-3 is prevalent among pigs and wild boars in Europe and many developed countries, whereas zoonotic genotype HEV-4 is more common in pigs in some Asian countries. This review presents the most recent data about possible foodborne transmission of HEV via pigs and other production animals and about the presence of HEV in high-risk foods, such as ready-to-eat meat products. Possible solutions about how to tackle this problem are discussed here.
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Affiliation(s)
- Tuija Kantala
- Department of Food Hygiene & Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, FI-00014, Helsinki, Finland
- Finnish Food Safety Authority Evira, Mustialankatu 3, FI-00790 Helsinki, Finland
| | - Leena Maunula
- Department of Food Hygiene & Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, FI-00014, Helsinki, Finland
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Soothill G, Hessey S, Erotocritou M, Griffiths P, Ijaz S, Thorburn D, Ankcorn M, Irish D. Diagnostic utility of hepatitis E virus antigen-specific ELISA versus PCR testing in a cohort of post liver transplant patients in a large university hospital. J Clin Virol 2018; 106:44-48. [DOI: 10.1016/j.jcv.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/08/2018] [Accepted: 07/20/2018] [Indexed: 01/28/2023]
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Reekie I, Irish D, Ijaz S, Fox T, Bharucha T, Griffiths P, Thorburn D, Harber M, MacKinnon S, Sekhar M. Hepatitis E infection in stem cell and solid organ transplantpatients: A cross-sectional study: The importance of HEV RNA screening in peri-transplant period. J Clin Virol 2018; 107:1-5. [PMID: 30099145 DOI: 10.1016/j.jcv.2018.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/19/2018] [Accepted: 07/27/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hepatitis E Virus (HEV) is a common cause of acute viral hepatitis worldwide. Typically associated with a self-limiting illness, infection may persist in immunosuppressed populations with significant morbidity and mortality. Based on clinical data published world-wide, UK blood safety guidance recommends the universal screening for HEV RNA of blood donors and donors of tissue, organs and stem cells. OBJECTIVES This cross-sectional study aimed to determine the point prevalence of HEV viraemia and clinical course of viraemic patients in the peri-transplant period in solid organ transplant (SOT) and haematopoietic stem cell transplant (HSCT) recipients transplanted over a 3-year period (2013-2015). STUDY DESIGN Nucleic acid extracts of whole blood from patients undergoing SOT or HSCT were tested by an in-house real-time reverse-transcriptase polymerase chain reaction assay for HEV RNA. Samples were tested at baseline (time of transplant), 30, 60 and 90 days post-transplant. RESULTS 870 patients (259 HSCT, 262 liver and 349 kidney transplant) were included with 2554 samples meeting the inclusion criteria. No kidney transplant patients had HEV viraemia at time of testing. One HSCT and three liver transplant patients were found to be HEV RNA positive. Overall this represented 0.46% of the patients testing positive for HEV viraemia. CONCLUSIONS Prevalence of HEV viraemia in SOT and HSCT patients in U.K. although higher than in the general population is low at baseline and remains low throughout the early post-transplant phase. Clearance of viraemia can be maintained despite ongoing immunosuppression. Prospective U.K. studies are necessary to inform screening policies in this population.
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Affiliation(s)
- Ian Reekie
- Royal Free Hospital NHS Foundation Trust, London, UK.
| | - Dianne Irish
- Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Thomas Fox
- Royal Free Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Mark Harber
- Royal Free Hospital NHS Foundation Trust, London, UK
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Randazzo W, Vásquez-García A, Bracho MA, Alcaraz MJ, Aznar R, Sánchez G. Hepatitis E virus in lettuce and water samples: A method-comparison study. Int J Food Microbiol 2018; 277:34-40. [PMID: 29680694 DOI: 10.1016/j.ijfoodmicro.2018.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/02/2018] [Accepted: 04/02/2018] [Indexed: 12/27/2022]
Abstract
The hepatitis E virus (HEV), which is an increasing cause of acute viral hepatitis in Europe, is a zoonotic virus that is mainly transmitted through contaminated water, consumption of raw or undercooked meat from pigs or wild boar, blood transfusion, and organ transplantation. Although the role of HEV transmission through contaminated produce has not been confirmed, the presence of HEV has been reported in irrigation waters and in vegetables. The present study used a World Health Organization (WHO) international standard and clinical samples to evaluate the performance characteristics of three RT-qPCR assays for detection and quantification of HEV. Two of the evaluated assays provided good analytical sensitivity, as 250 international units (IU) per ml could be detected. Then, experiments focused on evaluating the elution conditions suitable for HEV release from vegetables, with the method proposed by the ISO 15216:2017 selected for evaluation in three types of fresh vegetables. The concentration method proposed by the ISO 15216:2017 combined with the RT-qPCR described by Schlosser et al. (2014) resulted in average HEV recoveries of 1.29%, 0.46%, and 3.95% in lettuce, spinach, and pepper, respectively, with an average detection limit of 1.47 × 105 IU/25 g. In naturally contaminated samples, HEV was detected in sewage only (10/14), while no detection was reported in lettuce (0/36) or in irrigation water samples (0/24).
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Affiliation(s)
- Walter Randazzo
- Department of Microbiology and Ecology, University of Valencia, Av. Dr. Moliner, 50, 46100 Burjassot, Valencia, Spain; Department of Preservation and Food Safety Technologies, IATA-CSIC, Av. Agustín Escardino 7, 46980 Paterna, Valencia, Spain
| | - Andrea Vásquez-García
- Faculty of Animal Science and Food Engineering, University of São Paulo, Av. Duque de Caxias Norte, 225, 13635-900 Pirassununga, São Paulo, Brazil
| | - Maria A Bracho
- Joint Research Unit in Infection and Public Health, FISABIO-Public Health - University of Valencia, Av. Catalunya, 21, 46020, Valencia, Spain; CIBER Epidemiología y Salud Pública, Valencia, Spain
| | - María Jesús Alcaraz
- Microbiology Service, Hospital Clínico Universitario, Av. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Rosa Aznar
- Department of Microbiology and Ecology, University of Valencia, Av. Dr. Moliner, 50, 46100 Burjassot, Valencia, Spain; Department of Preservation and Food Safety Technologies, IATA-CSIC, Av. Agustín Escardino 7, 46980 Paterna, Valencia, Spain
| | - Gloria Sánchez
- Department of Preservation and Food Safety Technologies, IATA-CSIC, Av. Agustín Escardino 7, 46980 Paterna, Valencia, Spain.
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Detection of hepatitis E virus genotype 3 in pigs from subsistence farms in the state of Mato Grosso, Brazil. Comp Immunol Microbiol Infect Dis 2018; 58:11-16. [PMID: 30245045 DOI: 10.1016/j.cimid.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 05/28/2018] [Accepted: 06/10/2018] [Indexed: 12/27/2022]
Abstract
Hepatitis E is a zoonotic disease, recognized as an important global public health concern. In this study, molecular detection of the ORF1 and ORF2 genomic regions of the hepatitis E virus (HEV) was carried out in fecal and serum samples from pigs in subsistence farms of Mato Grosso, Brazil. Fragments of the ORF2 region were amplified in 8% (12/150) of fecal samples, with 53.3% (8/15) of farms having positive results. Of the 12 positive samples, fragments of the ORF1 region were amplified in 33.3% (4/12) of these. Molecular characterization confirmed the phylogenetic groupings as HEV subtypes 3d, 3 h, and 3i. The results revealed that meat from pigs that was originally meant for personal consumption is being traded in marketplaces in metropolitan Cuiabá, thereby creating a source of transmission to consumers in Mato Grosso. The environmental conditions must be taken into account when investigating the presence and transmission of HEV.
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Faber M, Willrich N, Schemmerer M, Rauh C, Kuhnert R, Stark K, Wenzel JJ. Hepatitis E virus seroprevalence, seroincidence and seroreversion in the German adult population. J Viral Hepat 2018; 25:752-758. [PMID: 29377436 DOI: 10.1111/jvh.12868] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/18/2017] [Indexed: 01/26/2023]
Abstract
A steep rise in Hepatitis E diagnoses is currently being observed in Germany and other European countries. The objective of this study was (i) to assess whether this trend mirrors an increase in infection pressure or is caused by increased attention and testing and (ii) estimate individual and population-based Hepatitis E Virus (HEV) seroconversion and seroreversion rates for Germany. We measured anti-HEV IgG prevalence in 10 407 adults participating in two linked, population-representative serosurveys (total n = 12 971) conducted in 1998 and 2010. In this period, we found a moderate but statistically significant decline of overall anti-HEV IgG prevalence from 18.6% to 15.3%. At both time points, seroprevalence increased with age and peaked in persons born between 1935 and 1959 suggesting a past period of increased infection pressure. Paired samples of individuals participating in 1998 and 2010 (n = 2564) revealed respective seroconversion and seroreversion rates of 6.2% and 22.6% among seronegative and seropositive individuals during 12 years, or 5.2 and 2.9 per 1000 inhabitants per year. This corresponds to a total of 417 242 [95%CI: 344 363-495 971] new seroconversions per year in the German population. While anti-HEV seroprevalence has decreased in the last decade, infection pressure and seroincidence remains high in Germany. Continuously rising numbers of Hepatitis E diagnoses in Europe are likely due to an increased awareness of clinicians and indicate that still there is a gap between incident and diagnosed cases. Studies on the true burden of the disease, specific risk factors and sources of autochthonous infections as well as targeted prevention measures are urgently needed.
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Affiliation(s)
- M Faber
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - N Willrich
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - M Schemmerer
- Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - C Rauh
- Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - R Kuhnert
- Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany
| | - K Stark
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - J J Wenzel
- Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
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O'Hara Z, Crossan C, Craft J, Scobie L. First Report of the Presence of Hepatitis E Virus in Scottish-Harvested Shellfish Purchased at Retail Level. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:217-221. [PMID: 29442296 PMCID: PMC5951870 DOI: 10.1007/s12560-018-9337-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/19/2018] [Indexed: 05/21/2023]
Abstract
Shellfish samples (n = 310) purchased from local supermarkets were analysed for the presence of hepatitis E virus (HEV) by nested RT-PCR and real-time qRT-PCR. Overall, 2.9% of samples tested positive for the presence of HEV. Phylogenetic analysis of HEV sequences revealed all as being genotype 3 HEV. This is the first report of the detection of HEV in commercially sold shellfish in Scotland. These findings may encourage further research that will help address the gaps in the knowledge in respect to foodborne transmission of HEV in Scotland and the rest of the United Kingdom.
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Affiliation(s)
- Zoe O'Hara
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - Claire Crossan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - John Craft
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Linda Scobie
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
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Mooij SH, Hogema BM, Tulen AD, van Pelt W, Franz E, Zaaijer HL, Molier M, Hofhuis A. Risk factors for hepatitis E virus seropositivity in Dutch blood donors. BMC Infect Dis 2018; 18:173. [PMID: 29653521 PMCID: PMC5899381 DOI: 10.1186/s12879-018-3078-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/03/2018] [Indexed: 12/11/2022] Open
Abstract
Background A marked increase of hepatitis E cases has recently been observed in the Netherlands. Causes of the (re-)emergence of hepatitis E virus (HEV) and exact sources and routes of transmission of HEV infection are currently unknown. We aimed to identify risk factors for HEV seropositivity. Methods Using the Wantai EIA, 2100 plasma samples of blood donors from all over the Netherlands aged 18-70 years were tested for anti-HEV IgG antibodies. A questionnaire on socio-demographic characteristics, health, and potential risk factors for HEV exposure was sent to these participants. Results The overall IgG-seroprevalence was 31% (648/2100) and increased with age. Several food products were independently associated with IgG-seropositivity in a multivariate analysis adjusting for age and gender among 1562 participants who completed the questionnaire: traditional Dutch dry raw sausages called “cervelaat”, “fijnkost”, “salami” and “salametti” which are generally made from raw pork and beef (aOR 1.5; 95%CI 1.2-1.9), frequent consumption of bovine steak (aOR 1.3; 95%CI 1.0-1.7), and frequent consumption of smoked beef (aOR 1.3 95%CI 1.0-1.7). Although not frequently reported, contact with contaminated water was also a risk factor for seropositivity (aOR 2.5; 95%CI 1.5-4.4). Lower seroprevalence was associated with eating raspberries, going out for dinner, and contact with wild animals and dogs. Conclusion Several pork food products, mainly dry raw sausages, and contact with contaminated water were associated with past HEV infection in the Netherlands. Further investigation is needed into the prevalence and infectivity of HEV in these risk factor food products, as well as investigation of the production methods and possible origin of HEV-contamination within these sausages, e.g. very small amounts of pork liver, pig-derived blood products as food additive, or the pork muscle tissue.
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Affiliation(s)
- Sofie H Mooij
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands
| | - Boris M Hogema
- Sanquin Research, Department of Blood-borne Infections, Amsterdam, the Netherlands
| | - Anna D Tulen
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands.
| | - Wilfrid van Pelt
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands
| | - Eelco Franz
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands
| | - Hans L Zaaijer
- Sanquin Research, Department of Blood-borne Infections, Amsterdam, the Netherlands
| | - Michel Molier
- Sanquin Research, Department of Blood-borne Infections, Amsterdam, the Netherlands
| | - Agnetha Hofhuis
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands
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Prevalence and Clinical Correlates of Chronic Hepatitis E Infection in German Renal Transplant Recipients With Elevated Liver Enzymes. Transplant Direct 2018; 4:e341. [PMID: 29464202 PMCID: PMC5811270 DOI: 10.1097/txd.0000000000000758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/04/2017] [Accepted: 10/24/2017] [Indexed: 12/11/2022] Open
Abstract
Supplemental digital content is available in the text. Background Elevated liver enzymes are frequently observed in renal transplant recipients and warrant further exploration. In immunosuppressed patients, hepatitis E virus (HEV) infection may cause chronic hepatitis, cirrhosis, and extrahepatic manifestations such as renal injury. Methods We performed a retrospective cross-sectional study investigating the prevalence, clinical correlates, and outcome of chronic HEV infection in a cohort of renal transplant recipients with elevated liver enzymes. Results Over a period of 30 months, 140 of 1469 renal transplant recipients had elevated liver enzymes, of which serum samples from 98 patients were available to determine HEV status. Seventeen patients were detected with HEV infection, of which 16 developed chronic HEV infection, while 1 patient controlled viremia (prevalence of chronic infection of 16.3%, with a minimum prevalence of 1.1% in the whole cohort). Increased liver stiffness was indicated by an average FibroScan result of 11.2 kPa in these patients. All 16 patients with chronic HEV infection were treated with ribavirin for a mean duration of 3 months. Five patients developed a viral rebound and received a second treatment course, of which 2 controlled HEV replication. Six months after the end of therapy, HEV clearance was achieved in 81.3% of the patients. One patient developed ribavirin resistance. Hemolytic anemia after ribavirin treatment was frequent, requiring blood transfusion in 3 patients. Four patients developed de novo glomerulonephritis, of which 2 were possibly associated with HEV infection. Conclusions This retrospective study showed that prevalence of chronic HEV infection was high in our renal transplant patient cohort and was associated with significant liver impairment and the occurrence of renal injury. Ribavirin treatment was effective and should be initiated early to avoid complications, but the risk of severe hemolytic anemia makes strict monitoring essential.
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Ainley LI, Hewitt PE. Haematology patients and the risk of transfusion transmitted infection. Br J Haematol 2018; 180:473-483. [DOI: 10.1111/bjh.15030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Louise I. Ainley
- Department of Haematology; Imperial College Healthcare NHS Trust; London UK
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Hepatitis E virus subtype 3f strains isolated from Japanese hepatitis patients with no history of travel to endemic areas – The origin analyzed by molecular evolution. Virology 2018; 513:146-152. [PMID: 29078116 DOI: 10.1016/j.virol.2017.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/26/2022]
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Using data linkage to improve surveillance methods for acute hepatitis E infections in England and Wales 2010–2016. Epidemiol Infect 2017; 145:2886-2889. [DOI: 10.1017/s0950268817002047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYIndigenous, foodborne transmission of hepatitis E has been increasing across industrialised countries. Public Health England has conducted enhanced surveillance in England and Wales since 2003.This report gives an account of acute infections from 2010 to 2016 and describes modification made to the methods of surveillance to account for changes in reporting behaviours and improve ascertainment.
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Aspinall EJ, Couturier E, Faber M, Said B, Ijaz S, Tavoschi L, Takkinen J, Adlhoch C. Hepatitis E virus infection in Europe: surveillance and descriptive epidemiology of confirmed cases, 2005 to 2015. ACTA ACUST UNITED AC 2017; 22. [PMID: 28681720 PMCID: PMC6518348 DOI: 10.2807/1560-7917.es.2017.22.26.30561] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/28/2017] [Indexed: 12/31/2022]
Abstract
Hepatitis E virus (HEV) is an under-recognised cause of acute hepatitis in high-income countries. The purpose of this study was to provide an overview of testing, diagnosis, surveillance activities, and data on confirmed cases in the European Union/European Economic Area (EU/EEA). A semi-structured survey was developed and sent to 31 EU/EEA countries in February 2016, 30 responded. Twenty of these countries reported that they have specific surveillance systems for HEV infection. Applied specific case definition for HEV infection varied widely across countries. The number of reported cases has increased from 514 cases per year in 2005 to 5,617 in 2015, with most infections being locally acquired. This increase could not be explained by additional countries implementing surveillance for HEV infections over time. Hospitalisations increased from less than 100 in 2005 to more than 1,100 in 2015 and 28 fatal cases were reported over the study period. EU/EEA countries are at different stages in their surveillance, testing schemes and policy response to the emergence of HEV infection in humans. The available data demonstrated a Europe-wide increase in cases. Standardised case definitions and testing policies would allow a better understanding of the epidemiology of HEV as an emerging cause of liver-related morbidity.
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Affiliation(s)
- Esther J Aspinall
- NHS National Services Scotland, Glasgow, United Kingdom.,Glasgow Caledonian University, Glasgow, United Kingdom
| | | | | | - Bengü Said
- National Infection Service, Public Health England, London, United Kingdom
| | - Samreen Ijaz
- National Infection Service, Public Health England, London, United Kingdom
| | - Lara Tavoschi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Johanna Takkinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Cornelia Adlhoch
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- Country experts are listed at the end of the article
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Cook N, D'Agostino M, Johne R. Potential Approaches to Assess the Infectivity of Hepatitis E Virus in Pork Products: A Review. FOOD AND ENVIRONMENTAL VIROLOGY 2017; 9:243-255. [PMID: 28470455 DOI: 10.1007/s12560-017-9303-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/26/2017] [Indexed: 05/04/2023]
Abstract
The zoonotic transmission of hepatitis E, caused by the hepatitis E virus (HEV), is an emerging issue. HEV appears common in pigs (although infected pigs do not show clinical signs), and evidence suggests that a number of hepatitis E cases have been associated with the consumption of undercooked pork meat and products. Little information is available on whether cooking can eliminate HEV, since there is currently no robust method for measuring its infectivity. HEV infectivity can be clearly demonstrated by monitoring for signs of infection (e.g., shedding of virus) in an animal model. However, this approach has several disadvantages, such as lack of reproducibility and unsuitability for performing large numbers of tests, high costs, and not least ethical considerations. Growth in cell culture can unambiguously show that a virus is infectious and has the potential for replication, without the disadvantages of using animals. Large numbers of tests can also be performed, which can make the results more amenable to statistical interpretation. However, no HEV cell culture system has been shown to be applicable to all HEV strains, none has been standardized, and few studies have demonstrated their use for measurement of HEV infectivity in food samples. Nonetheless, cell culture remains the most promising approach, and the main recommendation of this review is that there should be an extensive research effort to develop and validate a cell culture-based method for assessing HEV infectivity in pork products. Systems comprising promising cell lines and HEV strains which can grow well in cell culture should be tested to select an assay for effective and reliable measurement of HEV infectivity over a wide range of virus concentrations. The assay should then be harnessed to a procedure which can extract HEV from pork products, to produce a method suitable for further use. The method can then be used to determine the effect of heat or other elimination processes on HEV in pork meat and products, or to assess whether HEV detected in any surveyed foodstuffs is infectious and therefore poses a risk to public health.
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Affiliation(s)
- Nigel Cook
- Fera Science Ltd., Sand Hutton, York, YO41 1LZ, UK.
- Jorvik Food and Environmental Virology Ltd., York, UK.
| | - Martin D'Agostino
- Fera Science Ltd., Sand Hutton, York, YO41 1LZ, UK
- Campden BRI, Chipping Campden, UK
| | - Reimar Johne
- German Federal Institute for Risk Assessment, Berlin, Germany
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Full-length genome of a novel genotype 3 hepatitis E virus strain obtained from domestic pigs in Japan. Virus Res 2017; 240:147-153. [DOI: 10.1016/j.virusres.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 12/27/2022]
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Pork products associated with human infection caused by an emerging phylotype of hepatitis E virus in England and Wales. Epidemiol Infect 2017; 145:2417-2423. [PMID: 28756783 DOI: 10.1017/s0950268817001388] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Since 2010, human hepatitis E infections have increased in England and Wales. Most cases are locally acquired and caused by hepatitis E virus genotype 3 (HEV G3). HEV G3 is linked to the consumption of pork products. The increase is associated with the emergence of a new phylotype, HEV G3-group 2 (G3-2, also known as G3abcdhij). Sixty individuals with confirmed hepatitis E infection and no history of travel outside the UK were recruited: 19 were infected with HEV G3-group 1 (G3-1 or G3efg) and 41 with G3-2. Epidemiological data relating to usual shopping habits and consumption of ham and sausages were analysed together with typing data to identify any associations with HEV phylotype. Study participants who purchased ham and/or sausage from a major supermarket were more likely to have HEV G3-2 infection (Relative risks 1·85, P = 0·06, CI 0·97-3·53). The HEV G3-2 phylotype has not been detected in indigenous UK pigs and it is suggested that human infections could be the result of consumption of products made from pork originating outside the UK. This does not infer blame on the supermarket but the epidemiology of HEV is dynamic and reflects complex animal husbandry practices which need to be explored further.
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Ankcorn MJ, Tedder RS. Hepatitis E: the current state of play. Transfus Med 2017; 27:84-95. [PMID: 28382704 DOI: 10.1111/tme.12405] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/08/2016] [Accepted: 02/22/2017] [Indexed: 12/16/2022]
Abstract
The hepatitis E virus (HEV) is a major cause of acute hepatitis globally. Genotypes 1 and 2 (G1 and G2) are obligate human pathogens transmitted faeco-orally, leading to epidemics in developing countries. In contrast, genotypes 3 and 4 (G3 and G4) have a wider host range, including humans, but are primarily porcine viruses and are transmitted from animals to humans as a food-borne zoonosis when meat from an infected animal is consumed. HEV is increasingly recognised as a problem in developed countries, including countries in Europe. G3 HEV is now the most common cause of acute viral hepatitis in the UK and cases continue to rise. The majority of these infections are acquired within the UK and thought to be from insufficiently cooked meat, predominantly processed pork meat. Previously thought to only cause self-limiting disease, HEV infection can persist in immunosuppressed patients, which may lead to chronic hepatitis and the rapid development of cirrhosis. Of particular interest to the transfusion community has been the possibility of transfusion-transmitted HEV, which has been reported from countries classically considered HEV-endemic but also non-endemic countries in Europe and Japan. This has prompted some countries to introduce screening for HEV in blood donations.
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Affiliation(s)
- M J Ankcorn
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK.,Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
| | - R S Tedder
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK.,Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
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