Transmission routes and risk factors for autochthonous hepatitis E virus infection in Europe: a systematic review

SUMMARYIncreasing numbers of non-travel-associated hepatitis E virus (HEV) infections have been reported in Europe in recent years. Our objective was to review the evidence on risk factors and transmission routes of autochthonous HEV infection and hepatitis E in Europe in order to develop recommendations for future research, prevention and control. A systematic literature review was performed to identify all primary reports and studies published during 1998–2008 on hepatitis E in humans and animals in Europe by searching Pubmed, reference lists of major articles and international conference proceedings. Each of the 106 included studies was categorized into one of three evidence levels (EL) based on study design and diagnostic methodology. The evidence was generally weak (73 were assigned to EL1, two to both EL1 and EL2, and 30 to EL2), further compounded by the use of poorly validated serological assays in some studies. Only one case-control study was assigned to EL3. Persons with autochthonous hepatitis E infection were on average older than the general population and predominantly male. There was no evidence for one main transmission route of HEV infection or risk factor for hepatitis E. However, zoonotic transmission seemed likely and person-to-person transmission too inefficient to cause clinical disease. Multiple routes of transmission probably exist and should be further investigated through analytical studies and reliable diagnostic kits. Based on current evidence that points to zoonotic transmission from pigs, thorough cooking of all porcine products, prevention of cross-contamination in the kitchen and improved education for occupationally exposed people (e.g. pig farmers, veterinarians and sewage workers) may help prevent HEV infection. Although evidence for parenteral transmission is limited, it is recommended that a risk assessment is undertaken.

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Seroprevalence and risk assessment of viral hepatitis E infection in a group of exposed persons from Republic of Moldova

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11397 ◽

2019 ◽

Vol 13 (05) ◽

pp. 461-464

Author(s):

Octavian Sajin ◽

Constantin Spînu ◽

Iurie Pînzaru ◽

Maria Isac ◽

Igor Spînu ◽

...

Keyword(s):

Risk Factors ◽

Occupational Exposure ◽

Viral Hepatitis ◽

Textile Industry ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Occupationally Exposed

Introduction: Viral hepatitis E is considered to be an important issue for public health in developing countries. The aim of the present study is to evaluate morbidity and risk factors in occupationally exposed groups such as people working on sausage production. Methodology: Seroprevalence of HEV (hepatitis E virus) and risk factors to infection were determined in a cross-sectional study of two groups of populations: people working on sausage production (n = 70) and persons without occupational exposure (people working in the textile industry n = 70) in Moldova, a country without reported cases of hepatitis E. Results: The seroprevalence of HEV was 14.3% (CI 95%, 13.1-15.5%) in the group of exposed, compared with no cases in the non-exposed group that indicates on no previous infectious contact with hepatitis E virus. Conclusions: The increased seroprevalence of HEV among persons with occupational exposure to swine meat suggest animal-to-human transmission of this infection.

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Hepatitis E Virus: No Evidence of Parenteral Transmission in Finland

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649950 ◽

1995 ◽

Vol 74 (05) ◽

pp. 1385-1386 ◽

Cited By ~ 2

Author(s):

Pirkko Pohjanpelto ◽

Freja Ebeling ◽

Vesa Rasi ◽

Hartmut Hampl

Keyword(s):

Hepatitis E Virus ◽

Hepatitis E ◽

Parenteral Transmission

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Infection dynamics and persistence of hepatitis E virus on pig farms – a review

Porcine Health Management ◽

10.1186/s40813-021-00189-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

M. Meester ◽

T. J. Tobias ◽

M. Bouwknegt ◽

N. E. Kusters ◽

J. A. Stegeman ◽

...

Keyword(s):

Risk Factors ◽

Hepatitis E Virus ◽

Risk Mitigation ◽

Transmission Rate ◽

Hepatitis E ◽

Main Body ◽

Genotype 3 ◽

Infection Dynamics ◽

Pig Farms ◽

Slaughter Pigs

Abstract Background Hepatitis E virus (HEV) genotype 3 and 4 is a zoonosis that causes hepatitis in humans. Humans can become infected by consumption of pork or contact with pigs. Pigs are the main reservoir of the virus worldwide and the virus is present on most pig farms. Main body Though HEV is present on most farms, the proportion of infected pigs at slaughter and thus the level of exposure to consumers differs between farms and countries. Understanding the cause of that difference is necessary to install effective measures to lower HEV in pigs at slaughter. Here, HEV studies are reviewed that include infection dynamics of HEV in pigs and on farms, risk factors for HEV farm prevalence, and that describe mechanisms and sources that could generate persistence on farms. Most pigs become infected after maternal immunity has waned, at the end of the nursing or beginning of the fattening phase. Risk factors increasing the likelihood of a high farm prevalence or proportion of actively infected slaughter pigs comprise of factors such as farm demographics, internal and external biosecurity and immunomodulating coinfections. On-farm persistence of HEV is plausible, because of a high transmission rate and a constant influx of susceptible pigs. Environmental sources of HEV that enhance persistence are contaminated manure storages, water and fomites. Conclusion As HEV is persistently present on most pig farms, current risk mitigation should focus on lowering transmission within farms, especially between farm compartments. Yet, one should be aware of the paradox of increasing the proportion of actively infected pigs at slaughter by reducing transmission insufficiently. Vaccination of pigs may aid HEV control in the future.

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Diet and Food Allergy as Risk Factors for Asthma in the Arabian Gulf Region: Current Evidence and Future Research Needs

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16203852 ◽

2019 ◽

Vol 16 (20) ◽

pp. 3852 ◽

Cited By ~ 3

Author(s):

Naser A. Alsharairi

Keyword(s):

Risk Factors ◽

Food Allergy ◽

Eastern Mediterranean ◽

Arabian Gulf ◽

Current Evidence ◽

Future Research ◽

Gulf Region ◽

Arabian Gulf Region ◽

Mediterranean Countries ◽

Increased Risk

Asthma is a chronic respiratory disease which is associated with higher levels of systemic inflammation. The causes of asthma remain poorly understood. Unhealthy diet and food allergy are potential risk factors for developing asthma. The prevalence of asthma in the Arabian Gulf region (AGR), and Kuwait, Saudi Arabia and Qatar in particular, is higher than in other Eastern Mediterranean countries. In the AGR, diets tend to be of low nutritional value due to high levels of total energy, cholesterol, sodium, added sugars and saturated fat, and low levels of fiber, fruit and vegetables. A few studies that include children and adults in the AGR have suggested a potential link between unhealthy diets/specific food allergens and increased risk of asthma, however, the association of food allergy with asthma is still a controversial issue. The aim of this commentary is to consider the evidence from the AGR regarding the effects of diet/food allergy on asthma risk that may be used to make recommendations for future research.

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579 – Exploring Risk Factors for Exposure to Hepatitis E Virus in Kidney Transplant Recipients from a Single Center in the United States

Gastroenterology ◽

10.1016/s0016-5085(19)40001-2 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-1207

Author(s):

Paul Wasuwanich ◽

Supharerk Thawillarp ◽

Wikrom Karnsakul

Keyword(s):

United States ◽

Risk Factors ◽

Kidney Transplant ◽

Hepatitis E Virus ◽

Hepatitis E ◽

The United States ◽

Transplant Recipients ◽

Single Center ◽

Kidney Transplant Recipients

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Hepatitis E Virus Infection Among Solid Organ Transplant Recipients at a North American Transplant Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw006 ◽

2016 ◽

Vol 3 (1) ◽

Cited By ~ 10

Author(s):

Paul K. Sue ◽

Nora Pisanic ◽

Christopher D. Heaney ◽

Michael Forman ◽

Alexandra Valsamakis ◽

...

Keyword(s):

Risk Factors ◽

North America ◽

Hepatitis E Virus ◽

Organ Transplant ◽

Hepatitis E ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Factors Associated ◽

Solid Organ Transplant Recipients

Abstract Background. Autochthonous hepatitis E virus (HEV) infection has been reported in over 200 solid organ transplant (SOT) recipients since 2006, yet little is known about the burden of HEV among SOT recipients in North America. We performed a retrospective, cross-sectional study to investigate the prevalence and risk factors associated with HEV infection among SOT recipients at our institution. Methods. Children and adults (n = 311) who received allografts between 1988 and 2012 at the Johns Hopkins Hospital were assessed for evidence of HEV infection by testing posttransplantation serum samples for HEV antibody by enzyme immunoassay and HEV RNA by reverse transcription quantitative polymerase chain reaction. Individuals with evidence of posttransplant HEV infection (presence of anti-HEV immunoglobulin [Ig]M antibody, anti-HEV IgG seroconversion, or HEV RNA) were compared with individuals without evidence of infection and assessed for risk factors associated with infection. Results. Twelve individuals (4%) developed posttransplant HEV infection. Posttransplant HEV infection was associated with an increased risk for graft rejection (odds ratio, 14.2; P = .03). No individuals developed chronic infection. Conclusions. Solid organ transplant recipients in the United States are at risk for posttransplant HEV infection. Further studies are needed to characterize environmental risk factors and the risk of HEV infection after SOT in North America.

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