High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India

Pischke, Sven; Schulze-zur-Wiesch, J; Lütgehetmann, Marc; Kreuels, Benno; Lueth, Stefan; Kapaun, Petra; Benten, Daniel; Schmiedel, Stefan; Sterneck, Martina; Lohse, Ansgar W.; Polywka, Susanne

doi:10.5604/16652681.1226815

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…For example, in a hepatitis E GT 1 outbreak in a German tourist group, five of 24 (20%) individuals developed clinical signs of acute hepatitis E [13], which is in line with an estimated manifestation index of 16% in tropical HEV-infection [56]. In contrast, individuals with HEV GT 3 or 4 infections might develop symptomatic hepatitis E in less than 2% [16,17].…”

Section: Tropical and Autochthonous Hev Infections May Lead To Difmentioning

confidence: 87%

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

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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.

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Section: Tropical and Autochthonous Hev Infections May Lead To Difmentioning

confidence: 87%

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

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“…In Am Timan, the additionally detected AJS cases might be due to other reasons (anemia, nutritional deficiencies or other) of which we were unable to elucidate the cause [ 22 ]. Another possible reason for the high proportion of negatives could be linked to RDT performance, where PCR is the gold standard unfeasible for the setting [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017

Spina

Lenglet

Beversluis³

et al. 2017

PLoS ONE

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BackgroundIn September 2016, three acutely jaundiced (AJS) pregnant women were admitted to Am Timan Hospital, eastern Chad. We described the outbreak and conducted a case test-negative study to identify risk factors for this genotype of HEV in an acute outbreak setting.MethodsActive case finding using a community based surveillance network identified suspected AJS cases. Pregnant or visibly ill AJS cases presenting at hospital were tested with Assure® IgM HEV rapid diagnostic tests (RDTs) and some with Polymerase Chain Reaction (PCR) in Amsterdam; confirmed cases were RDT-positive and controls were RDT-negative. All answered questions around: demographics, household makeup, area of residence, handwashing practices, water collection behaviour and clinical presentation. We calculated unadjusted odds ratios (ORs) and 95% confidence intervals (95% CI).ResultsBetween September and April 2017, 1443 AJS cases (1293 confirmed) were detected in the town(attack rate: 2%; estimated 65,000 population). PCR testing confirmed HEV genotype 1e.HEV RDTs were used for 250 AJS cases; 100 (40%) were confirmed. Risk factors for HEV infection, included: having at least two children under the age of 5 years (OR 2.1, 95%CI 1.1–4.3), having another household member with jaundice (OR 2.4, 95%CI 0.90–6.3) and, with borderline significance, living in the neighbourhoods of Riad (OR 3.8, 95%CI 1.0–1.8) or Ridina (OR 3.3, 95%CI 1.0–12.6). Cases were more likely to present with vomiting (OR 3.2, 9%CI 1.4–7.9) than controls; possibly due to selection bias. Cases were non-significantly less likely to report always washing hands before meals compared with controls (OR 0.33, 95%CI 0.1–1.1).DiscussionOur study suggests household factors and area of residence (possibly linked to access to water and sanitation) play a role in HEV transmission; which could inform future outbreak responses. Ongoing sero-prevalence studies will elucidate more aspects of transmission dynamics of this virus with genotype 1e.

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“…The genotypes 1 and 2 HEV strains are endemic to countries in Asia and Africa, and also in Mexico [7,12,13]. In addition to historical large explosive outbreaks in Asia [14][15][16], in recent years, genotype 1 HEV infections in humans were also reported from individuals in Israel [17], Italy [18], and Germany [19] who are usually associated with prior travel to endemic countries. Two recent large outbreaks associated with genotype 1 HEV infection have been reported from Niger [20], and Uganda [21,22].…”

Section: Epidemiologymentioning

confidence: 99%

Hepatitis E virus: reasons for emergence in humans

Sooryanarain

Meng

2019

Current Opinion in Virology

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Hepatitis E virus (HEV) infects both humans and other animal species. Recently, we have seen a steady increase in autochthonous cases of human HEV infection in certain areas especially in Europe, and large outbreaks in several African countries among the displaced population. This mini-review critically analyzes potential host, environmental, and viral factors that may be associated with the emergence of hepatitis E in humans. The existence of numerous HEV reservoir animals such as pig, deer and rabbit results in human exposure to infected animals via direct contact or through animal meat consumption. Contamination of drinking, irrigation and coastal water by animal and human wastes lead to emergence of endemic cases in industrialized countries and outbreaks in displaced communities especially in war-torn countries.

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High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India

Cited by 11 publications

References 14 publications

Acute Hepatitis E: Two Sides of the Same Coin

Acute Hepatitis E: Two Sides of the Same Coin

A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017

Hepatitis E virus: reasons for emergence in humans

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