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Jelicic P, Ferenc T, Mrzljak A, Jemersic L, Janev-Holcer N, Milosevic M, Bogdanic M, Barbic L, Kolaric B, Stevanovic V, Vujica M, Jurekovic Z, Pavicic Saric J, Vilibic M, Vilibic-Cavlek T. Insights into hepatitis E virus epidemiology in Croatia. World J Gastroenterol 2022; 28:5494-5505. [PMID: 36312833 PMCID: PMC9611701 DOI: 10.3748/wjg.v28.i37.5494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/15/2022] [Accepted: 09/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) is an emerging virus of global health concern. The seroprevalence rates differ greatly according to geographic region and population group.
AIM To analyze the seroprevalence of HEV in exposed (animal-related professions) and nonexposed populations, as well as solid organ and hematopoietic stem cell transplant patients.
METHODS Forestry workers (n = 93), hunters (n = 74), and veterinarians (n = 151) represented the exposed population. The general population (n = 126) and pregnant women (n = 118) constituted the control group. Transplant patients included liver transplant recipients (LTRs) (n = 83), kidney transplant recipients (KTRs) (n = 43), and hematopoietic stem cell transplant recipients (HSCRs) (n = 39). HEV immunoglobulin G antibodies were detected using the enzyme-linked immunosorbent assay and confirmed by the immunoblot test.
RESULTS The HEV seroprevalence significantly differed between groups: Veterinarians 15.2%, hunters 14.9%, forestry workers 6.5%, general population 7.1%, and pregnant women 1.7%. In transplant patients, the seropositivity was highest in LTRs (19.3%), while in KTRs and HSCRs, the seroprevalence was similar to the general population (6.9% and 5.1%, respectively). A significant increase in seropositivity with age was observed from 2.9% in individuals less than 30 years to 23.5% in those older than 60 years. Sociodemographic characteristics (sex, educational level, area of residence, and number of household members), eating habits (game meat, offal, and pork products consumption), and environmental and housing conditions (drinking water supply, type of water drainage/sewer, waste disposal, domestic animals) were not associated with HEV seropositivity. However, individuals who reported a pet ownership were more often seropositive compared to those who did not have pet animals (12.5% vs 7.0%).
CONCLUSION The results of this study showed that individuals in professional contact with animals and LTRs are at higher risk for HEV infection. In addition, age is a significant risk factor for HEV seropositivity.
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Affiliation(s)
- Pavle Jelicic
- Department of Environmental Health, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Thomas Ferenc
- Department of Radiology, Merkur University Hospital, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Lorena Jemersic
- Department of Virology, Croatian Veterinary Institute, Zagreb 10000, Croatia
| | - Natasa Janev-Holcer
- Department of Environmental Health, Croatian Institute of Public Health, Zagreb 10000, Croatia
- Department of Social Medicine and Epidemiology, Faculty of Medicine University of Rijeka, Rijeka 51000, Croatia
| | - Milan Milosevic
- Department of Occupational and Environmental Health, Andrija Stampar School of Public Health, Zagreb 10000, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, Zagreb 10000, Croatia
| | - Branko Kolaric
- Department of Gerontology and Social Medicine, Andrija Stampar Teaching Institute of Public Health, Zagreb 10000, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, Zagreb 10000, Croatia
| | - Mateja Vujica
- Institute of Emergency Medicine of Krapina-Zagorje County, Krapina 49000, Croatia
| | - Zeljka Jurekovic
- Department of Nephrology, Merkur University Hospital, Zagreb 10000, Croatia
| | | | - Maja Vilibic
- Department for Social Psychiatry, Psychotherapy and Psychodiagnostics, University Clinical Hospital Center “Sestre Milosrdnice”, Zagreb 10000, Croatia
| | - Tatjana Vilibic-Cavlek
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
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Vilibic-Cavlek T, Stevanovic V, Brlek-Gorski D, Ferencak I, Ferenc T, Ujevic-Bosnjak M, Tabain I, Janev-Holcer N, Perkovic I, Anticevic M, Bekavac B, Kaic B, Mrzljak A, Ganjto M, Zmak L, Mauric Maljkovic M, Jelicic P, Bucic L, Barbic L. Emerging Trends in the Epidemiology of COVID-19: The Croatian 'One Health' Perspective. Viruses 2021; 13:2354. [PMID: 34960623 PMCID: PMC8707935 DOI: 10.3390/v13122354] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023] Open
Abstract
During the four pandemic waves, a total of 560,504 cases and 10,178 deaths due to COVID-19 were reported in Croatia. The Alpha variant, dominant from March 2021 (>50% of positive samples), was rapidly replaced by Delta variants (>90%) by August 2021. Several seroprevalence studies were conducted in different populations (general population, children/adolescents, professional athletes, healthcare workers, veterinarians) and in immunocompromised patients (hemodialysis patients, liver/kidney transplant recipients). After the first pandemic wave, seroprevalence rates of neutralizing (NT) antibodies were reported to be 0.2-5.5%. Significantly higher seropositivity was detected during/after the second wave, 2.6-18.7%. Two studies conducted in pet animals (February-June 2020/July-December 2020) reported SARS-CoV-2 NT antibodies in 0.76% of cats and 0.31-14.69% of dogs, respectively. SARS-CoV-2 NT antibodies were not detected in wildlife. Environmental samples taken in the households of COVID-19 patients showed high-touch personal objects as most frequently contaminated (17.3%), followed by surfaces in patients' rooms (14.6%), kitchens (13.3%) and bathrooms (8.3%). SARS-CoV-2 RNA was also detected in 96.8% affluent water samples, while all effluent water samples tested negative. Detection of SARS-CoV-2 in humans, animals and the environment suggests that the 'One Health' approach is critical to controlling COVID-19 and future pandemics.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (I.F.); (I.T.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, 10000 Zagreb, Croatia;
| | - Diana Brlek-Gorski
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (D.B.-G.); (M.U.-B.); (N.J.-H.); (I.P.); (M.A.); (B.B.); (P.J.); (L.B.)
| | - Ivana Ferencak
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (I.F.); (I.T.)
| | - Thomas Ferenc
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia;
| | - Magdalena Ujevic-Bosnjak
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (D.B.-G.); (M.U.-B.); (N.J.-H.); (I.P.); (M.A.); (B.B.); (P.J.); (L.B.)
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (I.F.); (I.T.)
| | - Natasa Janev-Holcer
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (D.B.-G.); (M.U.-B.); (N.J.-H.); (I.P.); (M.A.); (B.B.); (P.J.); (L.B.)
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Ivana Perkovic
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (D.B.-G.); (M.U.-B.); (N.J.-H.); (I.P.); (M.A.); (B.B.); (P.J.); (L.B.)
| | - Mario Anticevic
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (D.B.-G.); (M.U.-B.); (N.J.-H.); (I.P.); (M.A.); (B.B.); (P.J.); (L.B.)
| | - Barbara Bekavac
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (D.B.-G.); (M.U.-B.); (N.J.-H.); (I.P.); (M.A.); (B.B.); (P.J.); (L.B.)
| | - Bernard Kaic
- Department of Epidemiology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Anna Mrzljak
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Marin Ganjto
- Zagreb Wastewater-Management and Operation Ltd., 10000 Zagreb, Croatia;
| | - Ljiljana Zmak
- Department for Tuberculosis, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Maja Mauric Maljkovic
- Department for Animal Breeding and Livestock Production, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Pavle Jelicic
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (D.B.-G.); (M.U.-B.); (N.J.-H.); (I.P.); (M.A.); (B.B.); (P.J.); (L.B.)
| | - Lovro Bucic
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (D.B.-G.); (M.U.-B.); (N.J.-H.); (I.P.); (M.A.); (B.B.); (P.J.); (L.B.)
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, 10000 Zagreb, Croatia;
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Vilibic-Cavlek T, Barbic L, Mrzljak A, Brnic D, Klobucar A, Ilic M, Janev-Holcer N, Bogdanic M, Jemersic L, Stevanovic V, Tabain I, Krcmar S, Vucelja M, Prpic J, Boljfetic M, Jelicic P, Madic J, Ferencak I, Savic V. Emerging and Neglected Viruses of Zoonotic Importance in Croatia. Pathogens 2021; 10:pathogens10010073. [PMID: 33467617 PMCID: PMC7829938 DOI: 10.3390/pathogens10010073] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Several arboviruses have emerged in Croatia in recent years. Tick-borne encephalitis is endemic in continental counties; however, new natural micro-foci have been detected. Two autochthonous dengue cases were reported in 2010. West Nile virus emerged in 2012, followed by emergence of Usutu virus in 2013. Although high seroprevalence rates of Toscana virus have been detected among residents of Croatian littoral, the virus remains neglected, with only a few clinical cases of neuroinvasive infections reported. Lymphocytic choriomeningitis virus is a neglected neuroinvasive rodent-borne virus. So far, there are no reports on human clinical cases; however, the seroprevalence studies indicate the virus presence in the Croatian mainland. Puumala and Dobrava hantaviruses are widely distributing rodent-borne viruses with sporadic and epidemic occurrence. Hepatitis E virus is an emerging food-borne virus in Croatia. After the emergence in 2012, cases were regularly recorded. Seropositivity varies greatly by region and population group. Rotaviruses represent a significant healthcare burden since rotavirus vaccination is not included in the Croatian national immunization program. Additionally, rotaviruses are widely distributed in the Croatian ecosystem. A novel coronavirus, SARS-CoV-2, emerged in February 2020 and spread rapidly throughout the country. This review focuses on emerging and neglected viruses of zoonotic importance detected in Croatia.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (I.T.); (I.F.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Correspondence:
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (J.M.)
| | - Anna Mrzljak
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Department of Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Dragan Brnic
- Department of Virology, Croatian Veterinary Institute, 10000 Zagreb, Croatia; (D.B.); (L.J.); (J.P.)
| | - Ana Klobucar
- Department of Epidemiology, Andrija Stampar Institute of Public Health, 10000 Zagreb, Croatia;
| | - Maja Ilic
- Department of Epidemiology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Natasa Janev-Holcer
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (N.J.-H.); (P.J.)
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (I.T.); (I.F.)
| | - Lorena Jemersic
- Department of Virology, Croatian Veterinary Institute, 10000 Zagreb, Croatia; (D.B.); (L.J.); (J.P.)
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (J.M.)
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (I.T.); (I.F.)
| | - Stjepan Krcmar
- Department of Biology, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Marko Vucelja
- Faculty of Forestry, University of Zagreb, 10000 Zagreb, Croatia; (M.V.); (M.B.)
| | - Jelena Prpic
- Department of Virology, Croatian Veterinary Institute, 10000 Zagreb, Croatia; (D.B.); (L.J.); (J.P.)
| | - Marko Boljfetic
- Faculty of Forestry, University of Zagreb, 10000 Zagreb, Croatia; (M.V.); (M.B.)
| | - Pavle Jelicic
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (N.J.-H.); (P.J.)
| | - Josip Madic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (J.M.)
| | - Ivana Ferencak
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (I.T.); (I.F.)
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia;
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