Familial Hepatitis E Outbreak Linked to Wild Boar Meat Consumption

Rivero‐Juárez, Antonio; Frías, Mario; Martínez-Peinado, Antonio; Risalde, María Á.; Rodriguez-Cano, Diego; Camacho, Ángela; García‐Bocanegra, Ignacio; Cuenca-López, Francisca; Gómez-Villamandos, J.C.; Rivero, Antonio

doi:10.1111/zph.12343

Cited by 73 publications

(66 citation statements)

References 13 publications

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“…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 …”

Section: Discussionsupporting

confidence: 91%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Marcantonio¹,

Pezzotti²,

Bruni³

et al. 2019

Journal of Viral Hepatitis

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Summary In Europe, autochthonous hepatitis E virus (HEV) infection is mainly a foodborne zoonosis, but it is also transmitted by blood transfusion. Despite the numerous prevalence surveys, only a few studies have investigated HEV incidence. We aimed to determine HEV incidence and risk factors among blood donors in a hyperendemic area in Central Italy. Of 296 blood donors who had tested HEV negative in two previous seroprevalence surveys in L'Aquila, 198 agreed to undergo at least another blood sampling for estimating HEV incidence nearly 2 years after the prevalence surveys. Ten newly acquired infections were detected, yielding an overall incidence of 2.1/100 person‐years (95%CI: 1.0‐3.9), with an estimated participant's cumulative probability of becoming HEV infected of 6.5% (95%CI: 3.5‐12.0) at 4 years after enrolment. Seven newly infected blood donors were IgG positive only, two were IgM positive (one also IgG positive) and one was HEV RNA positive only, harbouring subtype 3c. Incident infection was most strongly associated with eating game meat, raw‐dried pork liver sausage and raw‐dried wild boar sausage. None of these exposures was statistically significant, even if eating raw‐dried wild boar sausage approached significance (P = 0.06). The HEV incidence we found was considerable compared with other similar studies. The nearly significant association of incident infection with wild boar and other game meat consumption was in agreement with the 3c subtype isolation in the viremic donor. However, beyond eating habits, also other exposure sources are likely important in hyperendemic areas, where incidence and risk exposure studies need to be undertaken for effectively preventing HEV transmission.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

Marcantonio¹,

Pezzotti²,

Bruni³

et al. 2019

Journal of Viral Hepatitis

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“…We observed a high nucleotide identity with a human strain detected in Italy linked to consumption of figatelli (raw pork liver sausages) (Garbuglia et al., ). Human HEV infection after ingestion of uncooked liver and meat of wild boars was reported in Japan and Spain, respectively (Li et al., ; Rivero‐Juarez et al., ). In Italy, one human case (Giordani, Fabris, Brunetti, Goblirsch, & Romanò, ) was supposed to be linked to wild boar meat consumption because the patient had never travelled outside Italy and declared to have consumed wild boar meat.…”

Section: Discussionmentioning

confidence: 99%

Molecular survey of HEV infection in wild boar population in Italy

Sabato

Ostanello

Grossi

et al. 2018

Transbound Emerg Dis

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Hepatitis E virus (HEV) is an RNA virus causing an acute generally self-limited disease in humans. An increasing number of autochthonous cases linked to zoonotic transmission of HEV genotype 3 have been reported over the last 10 years in Europe. Pigs and wild boars are considered the main reservoirs. The principal route of transmission in Europe is food-borne, linked by direct or indirect evidence to the consumption of raw or undercooked pork products and wild boar meat. In this study, we sampled 92 wild boar (Sus scrofa) livers during active surveillance in five municipalities in Central Italy throughout the hunting season 2016-2017. HEV RNA was detected in 52.2% of liver sampled with prevalence ranging from 0.0% to 65.7%. HEV-positive wild boars were detected in all but one area of hunting. Phylogenetic analysis showed that strains clustered within the two subtypes HEV-3c and HEV-3f and displayed a wide range of phylogenetic diversity. Several strains were circulating in the areas investigated; animals possibly belonging to the same family group hunted by the same team were infected with a unique strain (100% nucleotide identity). As wild animals are a proven source of HEV transmission to humans and pigs, the high prevalence observed (mean 52.2%) poses a question on the risk of consuming raw or undercooked wild boar meat, and thus, this subject deserves further investigations.

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“…Even in commercial raw porcine liver samples, viral RNA could be detected (Wenzel et al, 2011). So far no human infections could be assigned to consumption of pig or wild boar-derived meat in Germany, but autochthonous infections with HEV have been already attributed to ingestion of pig liver sausage in France (Colson et al, 2010) and of meat from wild boar in Spain (Rivero-Juarez et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Hepatitis E virus in wild rabbits and European brown hares in Germany

Hammerschmidt

Schwaiger

Dähnert

et al. 2017

Zoonoses and Public Health

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Recently, a change of hepatitis E from being a typical travel-associated disease to an autochthonous zoonosis in Germany was observed. An increasing number of autochthonous infections with the hepatitis E Virus (HEV) have been recognized in developed countries. Venison from wild boar is already known to be a potential source of infection, if not prepared properly by the consumer. In Germany, certain wild animals are known to be a reservoir for HEV. However, current information is missing about European brown hares (Lepus europaeus) and wild rabbits (Oryctolagus cuniculus). Thus, a total of 833 hunting-harvested animals (European brown hares n = 669; wild rabbits n = 164) were tested for the occurrence of HEV RNA and HEV antibodies. For this, liver and blood specimens were taken after hunts in six German federal states. HEV antibodies were found by ELISA in 2.2% (624/14) of European brown hares, but no HEV RNA was detectable by nested real-time RT-PCR. In contrast, a seroprevalence of 37.3% (126/47) was observed for wild rabbits, and 17.1% (164/28) of the samples were HEV RNA positive. Genomic analysis revealed that these partial sequences clustered within the rabbit clade of HEV-3 genotype. In addition, one rabbit sequence segregated into subtype 3g of HEV-3. Highest seroprevalences for hares and rabbits were detected in the federal states of Bavaria and of Schleswig-Holstein, respectively. Comparing urban, rural and insular areas, the highest seroprevalence was shown for wild rabbits in rural areas and for European brown hares on the northern island Fehmarn. This study provides evidence that European brown hares and wild rabbits from Germany can be infected with HEV. The different prevalences indicate that wild rabbits are a potential reservoir for HEV in Germany, whereas European brown hares seem to be only of minor importance for the epidemiology of HEV.

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Familial Hepatitis E Outbreak Linked to Wild Boar Meat Consumption

Cited by 73 publications

References 13 publications

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

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

Molecular survey of HEV infection in wild boar population in Italy

Hepatitis E virus in wild rabbits and European brown hares in Germany

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