Hepatitis E: An Emerging Infectious Disease in Germany?

Pischke, Sven; Heim, Albert; Bremer, Birgit; Raupach, R.; Horn-Wichmann, R.; Ganzenmueller, Tina; Klose, B.; Goudeva, L.; Wagner, F; Oehme, A.; Manns, Michael P.; Wedemeyer, Heiner

doi:10.1055/s-0031-1273394

Cited by 24 publications

(26 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It appears that, at least in the UK, Denmark, and Germany, seroprevalence rates have fallen compared to 20 years ago [26,49,50,51]. There appears to be a cohort effect, related to date of birth, suggesting that high seroprevalence rates seen in the elderly are due to a surge of infection in the 1950s and 1960s.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis E Seroprevalence in Europe: A Meta-Analysis

Hartl

Otto

Madden

et al. 2016

Viruses

196

182

View full text Add to dashboard Cite

There have been large numbers of studies on anti-HEV IgG seroprevalence in Europe, however, the results of these studies have produced high variability of seroprevalence rates, making interpretation increasingly problematic. Therefore, the aim of this study was to develop a clearer understanding of anti-HEV IgG seroprevalence in Europe and identify risk groups for HEV exposure by a meta-analysis of published studies. Methods: All European HEV-seroprevalence studies from 2003 to 2015 were reviewed. Data were stratified by assay, geographical location, and patient cohort (general population, patients with HIV, solid-organ transplant recipients, chronic liver disease patients, and individuals in contact with swine/wild animals). Data were pooled using a mixed-effects model. Results: Four hundred thirty-two studies were initially identified, of which 73 studies were included in the analysis. Seroprevalence estimates ranged from 0.6% to 52.5%, increased with age, but were unrelated to gender. General population seroprevalence varied depending on assays: Wantai (WT): 17%, Mikrogen (MG): 10%, MP-diagnostics (MP): 7%, DiaPro: 4%, Abbott 2%. The WT assay reported significantly higher seroprevalence rates across all cohorts (p < 0.001). Individuals in contact with swine/wild animals had significantly higher seroprevalence rates than the general population, irrespective of assay (p < 0.0001). There was no difference between any other cohorts. The highest seroprevalence was observed in France (WT: 32%, MP: 16%) the lowest in Italy (WT: 7.5%, MP 0.9%). Seroprevalence varied between and within countries. The observed heterogeneity was attributed to geographical region (23%), assay employed (23%) and study cohort (7%). Conclusion: Seroprevalcence rates primarily depend on the seroassy that is used, followed by the geographical region and study cohort. Seroprevalence is higher in individuals exposed to swine and/or wild animals, and increases with age.

show abstract

Section: Discussionmentioning

confidence: 99%

Hepatitis E Seroprevalence in Europe: A Meta-Analysis

Hartl

Otto

Madden

et al. 2016

Viruses

196

182

View full text Add to dashboard Cite

show abstract

“…In addition, anti-HEV IgG seroprevalence studies from France and the Netherlands found seroprevalence rates of more than 30% [8]. Nevertheless, anti-HEV-IgG seroprevalence has declined in various studies from different industrialized nations over the last 20 years [46,47,48,49]. This contrasts with the rapidly increasing number of reported HEV infections in several industrialized countries over the last decade.…”

Section: Acute Hepatitis E: An Emerging Disease In Western Countries?mentioning

confidence: 99%

“…The discrepancy between decreasing seroprevalence rates and increasing numbers of reported cases indicate that this phenomenon is based on an increased awareness for HEV infections [50]. Based on this assumption, the number of scientific articles on HEV infections has strongly increased since 2006, while i.e., the number of publications on hepatitis A has remained stable [4,47]. Hence, it seems that zoonotic HEV infection in industrialized countries is not emerging but until recently has been an underestimated disease that has, in fact, always been with us.…”

Section: Acute Hepatitis E: An Emerging Disease In Western Countries?mentioning

confidence: 99%

“…Early epidemiological studies, which found anti-HEV IgG seroprevalance rates of 1%–2% in Western countries [47], underestimated the disease burden of autochtonous hepatitis E due to limited sensitivity of the anti-HEV-assays [8]. Until now, the question of which assay should be used and who should be tested for HEV infection is controversial [8].…”

Section: Diagnosis Of Acute Hev Infectionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

View full text Add to dashboard Cite

The relevance of acute hepatitis E virus (HEV) infections has been underestimated for a long time. In the past, HEV infection had been interpreted falsely as a disease limited to the tropics until the relevance of autochthonous HEV infections in the Western world became overt. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections (predominantly genotype 3) in industrialized countries has risen within the last decade. The main source of infections in industrialized countries seems to be infected swine meat, while infections with the tropical HEV genotypes 1 and 2 usually are mainly transmitted fecal-orally by contaminated drinking water. In the vast majority of healthy individuals, acute HEV infection is either clinically silent or takes a benign self-limited course. In patients who develop a symptomatic HEV infection, a short prodromal phase with unspecific symptoms is followed by liver specific symptoms like jaundice, itching, uncoloured stool and darkened urine. Importantly, tropical HEV infections may lead to acute liver failure, especially in pregnant women, while autochthonous HEV infections may lead to acute-on-chronic liver failure in patients with underlying liver diseases. Immunosuppressed individuals, such as transplant recipients or human immunodeficiency virus (HIV)-infected patients, are at risk for developing chronic hepatitis E, which may lead to liver fibrosis and cirrhosis in the long term. Importantly, specific treatment options for hepatitis E are not approved by the regulation authorities, but off-label ribavirin treatment seems to be effective in the treatment of chronic HEV-infection and may reduce the disease severity in patients suffering from acute liver failure.

show abstract

“…In recent years from industrialized countries an increased number of autochthonous cases of hepatitis E has been reported. 1 Of note, hepatitis E may take a severe, chronic course in immunosuppressed individuals, as solid organ transplant recipients as well as in HIV-positive individuals. 2–4 Chronic hepatitis E has also been reported in a patient with idiopathic CD4 lymphocytopenia.…”

Section: Introductionmentioning

confidence: 99%

Absence of Chronic Hepatitis E in a German Cohort of Common Variable Immunodeficiency Patients

Pischke

Horn-Wichmann

Ernst

et al. 2012

Infectious Disease Reports

View full text Add to dashboard Cite

Cases of chronic or prolonged hepatitis E virus (HEV) infections have been described in solid organ transplant recipients, HIV infected patients and in patients with malignancies or idiopathic CD4+ T lymphopenia. It is unknown if HEV infection also takes chronic courses in patients with common variable immunodeficiency (CVID). We studied a cohort of 73 CVID patients recruited in a low endemic Central European country. None of the subjects tested positive for HEV RNA or anti-HEV IgG. Immunoglobulin transfusions (n=10) tested negative for HEV RNA but all were anti-HEV positive. To verify that such pooled blood products contain anti-HEV protective antibodies we measured the anti-HEV IgG optical density (OD) values in patients before and after transfusion. Anti-HEV OD values increased after infusion but did not reach the cut-off considered as positive. Thus, chronic HEV infections seem to be rare events in CVID patients in Germany. Commercially available immunoglobulin infusions contain anti HEV antibodies and may contribute to protection from HEV infection.

show abstract

Hepatitis E: An Emerging Infectious Disease in Germany?

Cited by 24 publications

References 10 publications

Hepatitis E Seroprevalence in Europe: A Meta-Analysis

Hepatitis E Seroprevalence in Europe: A Meta-Analysis

Acute Hepatitis E: Two Sides of the Same Coin

Absence of Chronic Hepatitis E in a German Cohort of Common Variable Immunodeficiency Patients

Contact Info

Product

Resources

About