Hepatitis E Virus in Croatia in the “One-Health” Context

Abstract

Hepatitis E virus (HEV) is the most common cause of viral hepatitis globally. The first human case of autochthonous HEV infection in Croatia was reported in 2012, with the undefined zoonotic transmission of HEV genotype 3. This narrative review comprehensively addresses the current knowledge on the HEV epidemiology in humans and animals in Croatia. Published studies showed the presence of HEV antibodies in different population groups, such as chronic patients, healthcare professionals, voluntary blood donors and professionally exposed and pregnant women. The highest seroprevalence in humans was found in patients on hemodialysis in a study conducted in 2018 (27.9%). Apart from humans, different studies have confirmed the infection in pigs, wild boars and a mouse, indicating the interspecies transmission of HEV due to direct or indirect contact or as a foodborne infection. Continued periodical surveys in humans and animals are needed to identify the possible changes in the epidemiology of HEV infections.

Seroprevalence Trends and Molecular Epidemiology of Viral Hepatitis in Croatia

“…HEV infection usually presents as a self-limiting illness with low mortality (1–2%), but immunocompromised patients can develop more severe forms of the disease. The disease is prevalent in the developing countries of eastern and southern Asia, which hold more than 60% of all documented cases [ 23 ]. In these areas, the main route of transmission is fecal–oral through contaminated drinking water supplies, with human-specific genotypes HEV-1 and HEV-2 being the predominant cause of infection [ 19 ].…”

“…On these occasions, genotypes with zoonotic potential (HEV-3 and HEV-4) are the leading causes of the disease. The reported prevalence of HEV in Europe is between 0.6% and 52.5% [ 23 ].…”

Hepatitis E Virus (HEV) Infection in Hemodialysis Patients: A Multicenter Epidemiological Cohort Study in North-Eastern Greece

“…Additionally, in a study from Poland, raising and having contact with farm animals was associated with HEV infection among hunters [ 21 ]. Thus, several studies have proven that people working in agriculture or who are exposed to specific animals (deposits of HEV), such as pigs, wild boars and deers, have a greater risk of HEV infection [ 22 , 23 ], underlining the zoonotic risk of the infection in most European studies [ 24 , 25 , 26 ].…”

The concept of one health applied to the problem of zoonotic diseases

“…The genus Orthohepevirus A contains 7 genotypes (HEV-1 to HEV-7) that can infect wide range of mammals and/or human. 33 In both humans and animals, HEV-3 and HEV-4 can be identified and the predominant pathway of transmission follows that of zoonosis. Wild boar (Sus scrofa) and domestic pig (Sus scrofa domesticus) represent the most significant animal reservoirs for both HEV-3 and HEV-4.…”

“…This virus belong to the Hepeviridae family, which consist of two genera Piscihepevirus and Orthohepevirus (A–D species). The genus Orthohepevirus A contains 7 genotypes (HEV‐1 to HEV‐7) that can infect wide range of mammals and/or human 33 . In both humans and animals, HEV‐3 and HEV‐4 can be identified and the predominant pathway of transmission follows that of zoonosis.…”