Transmission routes and risk factors for autochthonous hepatitis E virus infection in Europe: a systematic review

Abstract

SUMMARYIncreasing numbers of non-travel-associated hepatitis E virus (HEV) infections have been reported in Europe in recent years. Our objective was to review the evidence on risk factors and transmission routes of autochthonous HEV infection and hepatitis E in Europe in order to develop recommendations for future research, prevention and control. A systematic literature review was performed to identify all primary reports and studies published during 1998-2008 on hepatitis E in humans and animals in Europe by searching Pubmed, reference lists of major articles and international conference proceedings. Each of the 106 included studies was categorized into one of three evidence levels (EL) based on study design and diagnostic methodology. The evidence was generally weak (73 were assigned to EL1, two to both EL1 and EL2, and 30 to EL2), further compounded by the use of poorly validated serological assays in some studies. Only one casecontrol study was assigned to EL3. Persons with autochthonous hepatitis E infection were on average older than the general population and predominantly male. There was no evidence for one main transmission route of HEV infection or risk factor for hepatitis E. However, zoonotic transmission seemed likely and person-to-person transmission too inefficient to cause clinical disease. Multiple routes of transmission probably exist and should be further investigated through analytical studies and reliable diagnostic kits. Based on current evidence that points to zoonotic transmission from pigs, thorough cooking of all porcine products, prevention of crosscontamination in the kitchen and improved education for occupationally exposed people (e.g. pig farmers, veterinarians and sewage workers) may help prevent HEV infection. Although evidence for parenteral transmission is limited, it is recommended that a risk assessment is undertaken.

Preliminary study on the detection of hepatitis E virus (HEV) antibodies in pigs and wild boars in Poland

“…Studies of wildlife in Poland confirmed that HEV circulates in the wild boar population, which creates a potential risk of virus transmission to domestic animals and humans. Wild boars should be considered an important HEV reservoir with an increasing transmission potential related to their intensively growing population (11).…”

“…Hepatitis E virus (HEV), the aetiological agent of hepatitis E, is a member of the Orthohepesvirus genus within the Hepeviridae family and consists of genotypes 1, 2, 3, and 4 which infect humans and other mammals (1,11,20,23). It is a non-enveloped virus, 27-34 nm in diameter, whose genome contains a nonsegmented positive-sense RNA chain (10,23).…”

“…HEV genotypes 3 and 4 circulate in animals and humans and they are autochthonous in several industrialised countries of Europe, North America, and in Japan (10). Domestic pigs and wild boars are the main animal reservoir of these genotypes (15,18,23), but HEV antibodies have been detected in many other animal species: rats, cats, monkeys, dogs, cattle, sheep, goats, mongooses, rabbits, chickens, ferrets, bats, and deer (11,16,22,24).…”

“…Studies conducted in Italy, Spain, Hungary, and Germany have demonstrated the presence of this virus in wild boar populations (1). HEV genotype 3 strains are predominant in pigs in Europe (1,11), but infections with genotype 4 are detected in humans and swine in Eastern Asia and Europe. Furthermore, the results of experimental studies indicate that HEV genotypes 3 and 4 can cross the species barrier and so affect humans, swine, rhesus monkeys, and chimpanzees (10).…”

Hepatitis-E-Virus

“…So wurden vorsorglich einzelne ELISA-Teste, die eine hohe Rate an falsch-negativen Ergebnissen aufwiesen, vom Markt genommen und durch neue Teste ersetzt [163].…”