Nine-Year Nationwide Environmental Surveillance of Hepatitis E Virus in Urban Wastewaters in Italy (2011–2019)

Iaconelli, Marcello; Ferraro, Giusy Bonanno; Mancini, Pamela; Suffredini, Elisabetta; Veneri, Carolina; Ciccaglione, Anna Rita; Bruni, Roberto; Libera, S. Della; Bignami, Fabio; Brambilla, Massimo; Medici, Dario De; Brandtner, David; Schembri, Pietro; D’Amato, Stefania

doi:10.3390/ijerph17062059

Cited by 36 publications

(18 citation statements)

References 76 publications

(103 reference statements)

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“…Furthermore, by qRT-PCR, HEV RNA was detected in four fecal samples collected from ovine farms. These findings seem to indicate that circulation of HEV among sheep and goat populations in Italy is more frequent than expected and it is not limited to a geographical area (southern Italy), considered at high-risk for human infection [76][77][78], where sustained viral circulation was demonstrated in pig herds or among wild boars [58,79,80]. In our analysis, many of the positive flocks were close to each other (Figure 2), remaining confined within an area of approximately 29.8 km 2 in Piemonte and 14.9 km 2 in Valle d'Aosta.…”

Section: Discussionmentioning

confidence: 99%

Surveillance Study of Hepatitis E Virus (HEV) in Domestic and Wild Ruminants in Northwestern Italy

Palombieri

Robetto

Profio

et al. 2020

Animals

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In industrialized countries, increasing autochthonous infections of hepatitis E virus (HEV) are caused by zoonotic transmission of genotypes (Gts) 3 and 4, mainly through consumption of contaminated raw or undercooked pork meat. Although swine and wild boar are recognized as the main reservoir for Gt3 and Gt4, accumulating evidence indicates that other animal species, including domestic and wild ruminants, may harbor HEV. Herein, we screened molecularly and serologically serum and fecal samples from two domestic and four wild ruminant species collected in Valle d’Aosta and Piemonte regions (northwestern Italy. HEV antibodies were found in sheep (21.6%), goats (11.4%), red deer (2.6%), roe deer (3.1%), and in Alpine ibex (6.3%). Molecular screening was performed using different primer sets targeting highly conserved regions of hepeviruses and HEV RNA, although at low viral loads, was detected in four fecal specimens (3.0%, 4/134) collected from two HEV seropositive sheep herds. Taken together, the data obtained document the circulation of HEV in the geographical area assessed both in wild and domestic ruminants, but with the highest seroprevalence in sheep and goats. Consistently with results from other studies conducted in southern Italy, circulation of HEV among small domestic ruminants seems to occur more frequently than expected.

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Section: Discussionmentioning

confidence: 99%

Surveillance Study of Hepatitis E Virus (HEV) in Domestic and Wild Ruminants in Northwestern Italy

Palombieri

Robetto

Profio

et al. 2020

Animals

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“…It is interesting that there was high similarity (98.4%) between study sequence INMI1804_2018 and MN251650, a sequence identified in Italian wastewater [ 30 ]. This finding reinforces evidence, already described by other countries, that inadequate management of sewage treatment plants could represent a critical factor for environmental HEV transmission, including on cultivated land [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

et al. 2020

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Genotype 3 (GT3) is responsible for most European autochthonous hepatitis E virus (HEV) infections. This study analyzed circulating genotypes and GT3 subtypes in the Lazio region, Italy, between 2011 and 2019, as well as their pathogenic characteristics. Of the 64 evaluable HEV GT3 patient-derived sequences, identified subtypes included GT3f (n = 36), GT3e (n = 15), GT3c (n = 9), GT3a (n = 1) and three unsubtyped GT3 sequences. GT3c strains were similar to Dutch sequences (96.8–98.1% identity), GT3e strains showed high similarity (96.8%) with a United Kingdom sequence, while the most related sequences to GT3f Italian strains were isolated in France, Belgium and Japan. One sequence was closely related to another Italian strain isolated in raw sewage in 2016. The liver functioning test median values for 56 evaluable GT3 patients were: alanine aminotransferase (ALT), 461 (range 52–4835 U/L); aspartate aminotransferase (AST), 659 (range 64–6588 U/L); and total bilirubin, 3.49 (range 0.4–33 mg/dL). The median HEV RNA viral load for 26 evaluable GT3 patients was 42,240 IU/mL (range 5680–895,490 IU/mL). Of the 37 GT3 patients with available clinical information, no correlation was observed between HEV clinical manifestations and GT3 subtype. HEV symptoms were comparable among GT3c/e/f patients across most analyzed categories except for epigastric pain, which occurred more frequently in patients with HEV GT3e (75%) than in patients with GT3c (50%) or GT3f (19%) (p = 0.01). Additionally, patients with HEV GT3c exhibited significantly higher median international normalized ratio (INR) than patients with GT3e and GT3f (p = 0.033). The severity of GT3 acute hepatitis E was not linked to HEV RNA viral load or to the GT3 subtype.

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“…In the current ‘endgame’ of the Global Polio Eradication Program, sewage surveillance is used to detect any residual poliovirus circulation in endemic countries and provide early warning of import of poliovirus. Sewage surveillance has been studied for other enteric viruses [ 5 , 6 ] and for antimicrobial resistance [ 7 ].…”

Section: Introduction: the Concept Of Sewage Surveillancementioning

confidence: 99%

Implementation of environmental surveillance for SARS-CoV-2 virus to support public health decisions: Opportunities and challenges

Medema

Béen

Heijnen

et al. 2020

Current Opinion in Environmental Science & Health

291

338

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Analysing wastewater can be used to track infectious disease agents that are shed via stool and urine. Sewage surveillance of SARS-CoV-2 has been suggested as tool to determine the extent of COVID-19 in cities and serve as early warning for (re-)emergence of SARS-CoV-2 circulation in communities. The focus of this review is on the strength of evidence, opportunities and challenges for the application of sewage surveillance to inform public health decision making. Considerations for undertaking sampling programs are reviewed including sampling sites, strategies, sample transport, storage and quantification methods; together with the approach and evidence base for quantifying prevalence of infection from measured wastewater concentration. Published SARS-CoV-2 sewage surveillance studies (11 peer reviewed, and 10 pre-prints) were reviewed to demonstrate the current status of implementation to support public health decisions. Whilst being very promising, a number of areas were identified requiring additional research to further strengthen this approach and take full advantage of its potential. In particular, design of adequate sampling strategies, spatial and temporal resolution of sampling, sample storage, replicate sampling and analysis, controls for the molecular methods used for quantification of SARS-CoV-2 RNA in wastewater. The use of appropriate prevalence data and methods to correlate or even translate SARS-CoV-2 concentrations in wastewater to prevalence of virus shedders in the population is discussed.

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Nine-Year Nationwide Environmental Surveillance of Hepatitis E Virus in Urban Wastewaters in Italy (2011–2019)

Cited by 36 publications

References 76 publications

Surveillance Study of Hepatitis E Virus (HEV) in Domestic and Wild Ruminants in Northwestern Italy

Surveillance Study of Hepatitis E Virus (HEV) in Domestic and Wild Ruminants in Northwestern Italy

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

Implementation of environmental surveillance for SARS-CoV-2 virus to support public health decisions: Opportunities and challenges

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