Europe - Number of reported Hepatitis E cases has increased - Could be associated with pigproducts

[Gert van der Hoek]

Eurosurveillance, Volume 22, Issue 26, 29 June 2017
Surveillance and outbreak report

HEPATITIS E VIRUS INFECTION IN EUROPE: SURVEILLANCE AND DESCRIPTIVE EPIDEMIOLOGY OF CONFIRMED CASES, 2005 TO 2015





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.




In summary, EU/EEA countries are at different stages in their surveillance and testing capacity for HEV, and there is no standardised European case definition. For the time period 2005?2015, at least 22 countries were able to report on cases infected with HEV, either through formal surveillance or existing systems of laboratory notifications. WHO?s global health sector strategy on viral hepatitis asks countries to establish surveillance for viral hepatitis, particularly in blood donors [24].

Our study describes the availability of general hepatitis E surveillance in most EU/EEA countries. These data demonstrate a Europe-wide increase in reported cases, as well as a high number of reported HEV-related hospitalisations and a total of 28 deaths, between 2005 and 2015. They also provide a better understanding of the epidemiology and burden of HEV as an emerging cause of liver-related morbidity in EU/EEA countries.

[Gert van der Hoek]

Food poisoning warning: Hepatitis E found in European pig products

Sun, May 21, 2017

Cases of hepatitis E virus – which attacks the liver and in extreme cases can paralyse and kill – are rising, Dr Harry Dalton told a conference in Liverpool.

The gastroenterologist at Royal Cornwall Hospital Trust said the vast majority of cases can be tracked to European pig products such as hams and salamis.

HEV is particularly dangerous for the elderly, the pregnant and people with suppressed immune systems.

Public Health England said that confirmed or reported cases rose from 368 in 2010 to 1,244 last year.

Its scientists added there was “a trend towards more severe and prolonged illness”.

A joint Food Standards Agency and European Food Safety Authority workshop has found that there are up to 100,000 foodborne HEV infections a year in England alone – most of which are not recognised.

[Gert van der Hoek]

Vet Res. 2017 May 25;48(1):31. doi: 10.1186/s13567-017-0436-3.

From the epidemiology of hepatitis E virus (HEV) within the swine reservoir to public health risk mitigation strategies: a comprehensive review.

Salines M1,2, Andraud M3,4, Rose N3,4.

Abstract

Hepatitis E virus (HEV) is the causative agent of hepatitis E in humans, an emerging zoonosis mainly transmitted via food in developed countries and for which domestic pigs are recognised as the main reservoir. It therefore appears important to understand the features and drivers of HEV infection dynamics on pig farms in order to implement HEV surveillance programmes and to assess and manage public health risks.

The authors have reviewed the international scientific literature on the epidemiological characteristics of HEV in swine populations. Although prevalence estimates differed greatly from one study to another, all consistently reported high variability between farms, suggesting the existence of multifactorial conditions related to infection and within-farm transmission of the virus. Longitudinal studies and experimental trials have provided estimates of epidemiological parameters governing the transmission process (e.g. age at infection, transmission parameters, shedding period duration or lag time before the onset of an immune response).

Farming practices, passive immunity and co-infection with immunosuppressive agents were identified as the main factors influencing HEV infection dynamics, but further investigations are needed to clarify the different HEV infection patterns observed in pig herds as well as HEV transmission between farms.

Relevant surveillance programmes and control measures from farm to fork also have to be fostered to reduce the prevalence of contaminated pork products entering the food chain.

[Gert van der Hoek]

Public health risks associated with hepatitis E virus (HEV) as a food-borne pathogen


Abstract
Hepatitis E virus (HEV) is an important infection in humans in EU/EEA countries, and over the last 10 years more than 21,000 acute clinical cases with 28 fatalities have been notified with an overall 10-fold increase in reported HEV cases; the majority (80%) of cases were reported from France, Germany and the UK. However, as infection in humans is not notifiable in all Member States, and surveillance differs between countries, the number of reported cases is not comparable and the true number of cases would probably be higher.

Food-borne transmission of HEV appears to be a major route in Europe; pigs and wild boars are the main source of HEV. Outbreaks and sporadic cases have been identified in immune-competent persons as well as in recognised risk groups such as those with preexisting liver damage, immunosuppressive illness or receiving immunosuppressive treatments.

The opinion reviews current methods for the detection, identification, characterisation and tracing of HEV in food-producing animals and foods, reviews literature on HEV reservoirs and food-borne pathways, examines information on the epidemiology of HEV and its occurrence and persistence in foods, and investigates possible control measures along the food chain.

Presently, the only efficient control option for HEV infection from consumption of meat, liver and products derived from animal reservoirs is sufficient heat treatment. The development of validated quantitative and qualitative detection methods, including infectivity assays and consensus molecular typing protocols, is required for the development of quantitative microbial risk assessments and efficient control measures.

More research on the epidemiology and control of HEV in pig herds is required in order to minimise the proportion of pigs that remain viraemic or carry high levels of virus in intestinal contents at the time of slaughter.

Consumption of raw pig, wild boar and deer meat products should be avoided.

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