No evidence for zoonotic hepatitis E virus infection through dairy milk in Germany

Abstract

confounding. We find it unlikely that residual confounding can account for our relative risk estimate of 1.36.(1) Without confounder adjustment the hazard ratio was 1.50 (95% confidence interval 1.12-1.99), so the confounders we adjusted for were actually not strong confounders. This is also evident from the fact that the PPI users and nonusers were very similar, as shown in our article's Table 1. We disagree with Dr. Ali Khan's statement that in observational epidemiology relative risks below 2 are generally due to bias. We find that the review by Sørensen et al. offers a more balanced view of the pros and cons of observational and randomized studies.(2) Despite our differences of opinion, we agree with Dr. Ali Khan and colleagues on the most important and self-evident aspect: patients with a valid indication for PPIs can use them; others should not. Such practice would probably spare patients from many hepatic encephalopathy episodes, and any risk of hepatic encephalopathy attributable to PPI use would at least be countered by beneficial effects of PPIs. When we accomplish this, we can consider how to handle the excess hepatic encephalopathy risk for those patients who need PPIs. We have no evidence base for this situation, but it is a possibility that lactulose could be preemptively coadministered together with PPIs.(3) The way to obtain an evidence base seems to be a randomized PPI discontinuation trial for cirrhosis patients with a valid indication for PPIs. We believe that such a trial should be undertaken.

No link between male infertility and HEV genotype 3 infection

“…The authors of the present publication also previously described a significant detection rate of HEV-RNA in cow milk in the Kunming region, which later could not be confirmed by other studies from China and Europe 3–5. If these discrepancies are related to specific local HEV GT4 strains, local animal housing habits or are laboratory artefacts (pre- or post-analytical) needs still to be resolved.…”

Evidence for an unknown agent antigenically related to the hepatitis E virus in dairy cows in the United States

“…This report, although still lacking independent confirmation, raises serious concerns regarding milk and beef safety. On the contrary, reports from Germany and Belgium failed to identify the presence of HEV RNA in milk samples and dairies. Therefore, it is imperative to definitely determine the nature and extent of HEV infection in cattle.…”

“…However, independent confirmation of these reports is still lacking. For example, two recent studies failed to identify HEV RNA in milk or fecal samples of cows in Belgium or Germany . Therefore, the main objective of this study was to determine if cattle in the United States are infected with HEV.…”

“…For example, two recent studies failed to identify HEV RNA in milk or fecal samples of cows in Belgium 28 or Germany. 29…”

Evidence of increased Hepatitis E virus exposure in Lao villagers with contact to ruminants

“…In contrast, sporadic cases in both developed and developing countries are mostly associated with contact to animals infected with genotypes 3 and 4. Other sources of infection are contaminated animal products, such as raw meat (Meng, ) and possibly milk (Baechlein & Becher, ; Drobeniuc et al, ; Huang et al, ). Pigs are considered the main reservoir of zoonotic HEV (Meng, ), but several independent studies provided recent serological and molecular evidence of HEV circulation in cattle and goats (Arankalle et al, ; Di Martino et al, ; Dong et al, ; El‐Tras, Tayel, & El‐Kady, ; Fu et al, ; Geng et al, , ; Huang et al, ; Long et al, ; Sanford et al, ; Xu et al, ; Yan et al, ; Zhang et al, ).…”