Case-control study on risk factors for acute hepatitis E in Germany, 2012 to 2014

Abstract

BackgroundNotified 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.

Incidence of hepatitis E virus infection among blood donors in a high endemic area of Central Italy

“…The results of our exposure analysis are important because they are consistent with others’ and our previous findings, stressing the role of certain dietary habits in determining the spread of HEV infection in some geographic areas …”

“…37,38 The results of our exposure analysis are important because they are consistent with others' and our previous findings, stressing the role of certain dietary habits in determining the spread of HEV infection in some geographic areas. [1][2][3][4]6,13,17,22,[39][40][41] Apart from the dietary role of wild boar meat in human infection, this wild animal species may contribute to HEV environment contamination and transmission to other animals, such as free-living pigs, due to the frequent development of prolonged infection with high viral load and long-duration shedding. 24,42 In fact, we demonstrated that the areas with the highest uncontrolled expansion of wild boar and free-living pig population in Sardinia, exactly matched with those of highest HEV prevalence in blood donors in that region.…”

A comparison of hepatitis E and A in a teaching hospital in Northwestern Romania. Acute hepatitis E – a mild disease?

“…In Europe, transmission occurs through consumption of contaminated and undercooked pork or other meat products [13,14] but other transmission routes have also been demonstrated (blood transfusions [15,16]). Vegetable products are rarely associated with HEV in Europe, probably due to tight regulation of pig manure use in farming [13,17]. Genotypes 3 and 4 may lead to chronic disease in immunocompromised patients [5,18] yet, the majority of individuals are asymptomatic [19].…”

“…Risk factors for clinical manifestations include: male gender, age over 50 and preexisting liver disease [13,23]. Acute-on-chronic liver failure has considerable fatality and may benefit from antiviral treatment (ribavirin, interferon).…”

Prevalence of hepatitis E virus infection in liver donors in Spain

“…Although the prevalence in our study is low, this finding suggests that there is a potential risk of HEV transmission through liver transplantation in our setting. The main route of HEV transmission in developed countries is the consumption of contaminated raw or undercooked food, mainly pork and meat products derived from infected wild animals [4]. For transplant recipients, other routes of transmission are associated with intra-hospital procedures.…”