Hepatitis E virus seroprevalence, seroincidence and seroreversion in the German adult population

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.

Time course of hepatitis E-specific antibodies in adults

Hepatitis E virus (HEV) is highly endemic in industrialized countries, but there is a lack of knowledge on individual and overall antibody concentration dynamics. The aim of this study was to characterize longitudinal concentration changes of anti-HEV immunoglobulin G (anti-HEV IgG) by enzyme immunoassay (EIA). In total, 199 serum samples collected from 45 subjects over 18 years were analysed. A wide range of anti-HEV IgG levels was found. Overall, anti-HEV IgG significantly decreased after an observation period of at least 5 years. One negative seroconversion was observed. Four individual profiles suggested single and even multiple HEV reinfections despite pre-existing HEV antibodies.

Hepatitis A Outbreak in Europe: Imported Frozen Berry Mix Suspected to be the Source of At least One Infection in Austria in 2013

We tested 19 sera from Austrian patients with acute hepatitis A. A serum from a 48-year-old female patient yielded HAV-nucleic acid that showed 99.7% homology to the HAV-sequence obtained from samples taken during the current outbreak in several European countries, which is associated with consumption of frozen berries. So far, Austria was considered not to be affected by this hepatitis A outbreak.

Lack of evidence for HEV infection in Baltic sea mussels (Mytilidae)

BACKGROUND AND AIMS

Hepatitis E virus (HEV), similar to hepatitis A virus (HAV), has been linked to cases associated with mussel consumption, and several studies have detected HEV in commercially available mussels. While extensive data exists on HEV contamination in mussels from tropical regions, the Mediterranean Sea, and the North Sea, there is a lack of information regarding the potential risk posed by common mussels (Mytilidae) from the Baltic Sea. Furthermore, no experimental studies have investigated the ability of Baltic Sea mussels to be infected with HEV.

MATERIAL AND METHODS

Healthcare workers (n = 447) from the University Medical Center Hamburg Eppendorf, Germany, were surveyed regarding their mussel consumption habits and tested for anti-HEV IgG using a commercially available assay. Commercially sourced Baltic Sea Mytilidae, obtained from local retailers, were tested for HEV using a validated PCR method. Additionally, 50 live Mytilidae were experimentally spiked with HEV, followed by dissection and separate PCR analysis of the gastrointestinal tract, gonads, and muscle tissue.

RESULTS

There was no significant difference in the likelihood of anti-HEV IgG positivity between individuals who frequently consumed mussels and those who did not. None of the 40 commercial mussel samples tested were positive for HEV. HEV RNA was detected in the gastrointestinal tract of experimentally exposed Mytilidae specimen but not in their gonads or muscle tissue. It was observed that HEV RNA persisted in the gastrointestinal tract for more than 14 days but not beyond 21 days.

DISCUSSION

This study provides no evidence of HEV contamination in commercially sourced Baltic Sea mussels, as all tested samples were negative for HEV RNA. Moreover, no significant association was observed between mussel consumption and anti-HEV IgG positivity among healthcare workers. Experimental exposure revealed that HEV RNA can persist in the gastrointestinal tract of Baltic Sea mussels for over 16 days but less than 24 days, while no viral presence was detected in the gonad or muscle tissue. These findings suggest a minimal risk of HEV transmission through mussels from the Baltic Sea but highlight the need for further studies to understand their role in HEV ecology.

Acute hepatitis E virus infection presenting as meningo-encephalitis

BACKGROUND

Acute hepatitis E infection (HEV), with its high incidence in Europe, should be considered as a differential diagnosis of acute viral hepatitis and can in some cases manifest with pronounced neurological symptoms.

CLINICAL CASE

We report on a 33-year-old female patient with severe arthralgia, myalgia, headache and psychomotor deterioration. Laboratory analyses showed elevated transaminases without signs of cholestasis. Acute hepatitis E virus infection was detected in serum. She reported fatigue and dysesthesias not responsive to analgesics. Cerebrospinal fluid (CSF) analysis revealed an inflammatory syndrome. HEV RNA was detected in the CSF. The infection remained mild, but dysesthesias persisted. Eight weeks after the first admission, the symptoms worsened again. Complete and sustained remission was achieved following intravenous corticosteroid treatment.

CONCLUSION

In patients with acute neurological symptoms and liver enzyme elevation, HEV infection should be considered. Neurologic symptoms such as fatigue, arthralgia, myalgia and dysesthesia along with psychomotor retardation should prompt CSF analysis.