Standardising #surveillance of #hepatitis E virus #infection in the #EU/EEA: a review of national practices and suggestions for the way forward (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 19 September 2019 / In Press, Journal Pre-proof

Standardising surveillance of hepatitis E virus infection in the EU/EEA: a review of national practices and suggestions for the way forward

Cornelia Adlhoch a, Zdenka Manďáková b, Steen Ethelberg c, Jevgenia Epštein d, Ruska Rimhanen-Finne e, Julie Figoni f, Sally A. Baylis g, Mirko Faber h, Kassiani Mellou i, Niamh Murphy j, Joanne O’Gorman j, Maria Elena Tosti k, Anna Rita Ciccaglione k, Agnetha Hofhuis l, Hans Zaaijer m, Heidi Lange n, Rita de Sousa o, Ana Avellón p, Lena Sundqvist q, Bengü Said r, Samreen Ijaz r

{a} European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73, Solna, Sweden; {b} National Institute of Public Health, Prague, Czech Republic; {c} Statens Serum Institut, Copenhagen, Denmark; {d} Health Board, Tallinn, Estonia; {e}
National Institute for Health and Welfare (THL), Helsinki, Finland; {f} Santé Publique France, Saint-Maurice, France; {g} Paul-Ehrlich-Institut (PEI), Langen, Germany; {h} Robert Koch-Institut, Berlin, Germany; {i} Hellenic Public Health Organization, Athens, Greece; {j} Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland; {k} Istituto Superiore di Sanità, Rome, Italy; {l} National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; {m}
Sanquin Blood Supply Foundation, Amsterdam, the Netherlands; {n} Norwegian Institute of Public Health, Oslo, Norway; {o} Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal; {p} Viral Hepatitis Reference and Research Laboratory National Center of Microbiology Carlos III Health Institute, Madrid, Spain; {q} The Public Health Agency of Sweden (Folkhalsomyndigheten), Stockholm, Sweden; {r} Public Health England, London, United Kingdom

Received 3 July 2019, Revised 5 September 2019, Accepted 11 September 2019, Available online 19 September 2019.

DOI: https://doi.org/10.1016/j.jcv.2019.09.005

 

Highlights

  • Experts suggest primary objectives for national HEV surveillance in EU/EEA countries:
    • to monitor the incidence of acute HEV cases
    • to monitor chronic HEV infections
    • to describe the epidemiology of acute and chronic HEV infections
  • Suggested secondary objectives for national HEV surveillance in EU/EEA countries:
    • to monitor HEV phylotypes/subtypes
    • to identify potential clusters/outbreaks
    • to collect information on possible routes of transmission
  • Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.

 

Abstract

Background

Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses.

Objective and study design

WHO’s European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC’s HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods.

Results

The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission.

Discussion

Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.

Keywords: Hepatitis E virus – EU/EEA – surveillance – testing

© 2019 Published by Elsevier B.V.

Keywords: Hepatitis E; EU.

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#Hepatitis E virus #infections in #Europe (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 8 September 2019 / In Press, Journal Pre-proof

Hepatitis E virus infections in Europe

Jacques Izopet a,b, Pauline Tremeaux d, Olivier Marion a,b, Marion Migueres a,b, Nicolas Capelli a,b, Sabine Chapuy-Regaud a,b, Jean-Michel Mansuy a, Florence Abravanel a,b, Nassim Kamar b,c, Sébastien Lhomme a, b

{a} CHU Toulouse, Hôpital Purpan, Laboratoire de virologie, National Reference Center for Hepatitis E, F-31300, France; {b} INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, Toulouse, F-31300, France; {c} CHU Toulouse, Hôpital Rangueil, Department of Nephrology, Dialysis and Organ Transplantation, F-31300, France; {d} APHP, Hôpital Cochin, Laboratoire de Virologie, F-75679, France

Received 2 August 2019, Accepted 6 September 2019, Available online 8 September 2019.

DOI: https://doi.org/10.1016/j.jcv.2019.09.004

 

Highlights

  • Following the introduction of robust serological and molecular tools, our understanding of the epidemiology and clinical consequences of HEV infection has improved conderably.
  • The increasing number of symptomatic cases reported in Europe is linked to greater clinical awareness and the optimisation of test algorithms.
  • HEV genotype 3, which is zoonotic, is the most prevalent genotype in Europe.
  • The three major clades and subgenotypes of HEV-3 differ geographically and changes in distribution over the time have been observed.
  • Although clinically silent in the vast majority of patients, severe acute HEV-3 hepatitis occur in patients with underlying chronic liver disease and chronic HEV-3 hepatitis occur in immunocompromised patients.
  • Extrahepatic manifestations of HEV infection, including neurological and renal manifestations, are increasingly recognised.

 

Abstract

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis worldwide. The systematic use of improved tools for diagnosing and genotyping has completely changed our understanding of the epidemiology and clinical consequences of HEV infection. Most cases of HEV in Europe arise from infected animals such as pigs, wild boar, deer and rabbits. Zoonotic HEV genotypes (HEV genotypes 3-8) are mainly food-borne or transmitted by direct contact, but recent data suggest that infection can also be water-borne or even iatrogenic throught contamined blood products.

HEV-3 is the most prevalent genotype in Europe but the geographic distributions of the 3 major clades and subgenotypes (HEV-3abjkchi, HEV-3efg, and HEV-3ra) differ. Most HEV-3 infections are asymptomatic but they can result in severe acute hepatitis in patients with chronic liver disease, chronic hepatitis in immunocompromised patients, and to extra-hepatic manifestations.

Despite more frequent reports of symptomatic hepatitis E cases across Europe, systems for monitoring HEV infections vary greatly. Severe HEV-associated illnesses, hospitalizations and deaths are probably underestimated. The seroprevalence and incidence of locally acquired hepatitis E varies between and within European countries and over time. The precise origin of these variations is uncertain but may be linked to environmental factors or the degree to which HEV contaminates the human food chain. Collaborative initiatives such as the establishment of the One Health platform for HEV sequences (HEVnet database) will be very useful for a better understanding of the epidemiology of HEV in Europe and the development of effective prevention strategies.

Keywords: Hepatitis E virus – Europe – Zoonosis – Hepatitis E

© 2019 Published by Elsevier B.V.

Keywords: Hepatitis E; European Region.

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Cross-sectional #Seroprevalence and #Genotype of #HepatitisE Virus in #Humans and #Swine in a High-density #Pig-farming Area in Central #China (Virol Sin., abstract)

[Source: Virologica Sinica, full page: (LINK). Abstract, edited.]

Cross-sectional Seroprevalence and Genotype of Hepatitis E Virus in Humans and Swine in a High-density Pig-farming Area in Central China

Authors: Yilin Shu, Yameng Chen, Sheng Zhou, Shoude Zhang, Qin Wan, Changcai Zhu, Zhijiang Zhang, Hailong Wu, Jianbo Zhan, Ling Zhang

RESEARCH ARTICLE / First Online: 01 July 2019

 

Abstract

Hepatitis E virus (HEV) infection is a common public health problem in developing countries. However, the current prevalence of HEV and the relationship of HEV genotype between swine and human within high-density pig-farming areas in central China are still inadequately understood. Here, cross-sectional serological and genotypic surveys of HEV among the 1232 general population, 273 workers occupationally exposed to swine, and 276 pigs in a high-density pig-breeding area, were undertaken by ELISA and nested RT-PCR methods. Anti-HEV IgG was detected in 26.22% of general population and 48.35% of occupational workers. The prevalence of swine serum HEV-Ag was 6.52%. The prevalence of anti-HEV IgG was significantly higher among the workers occupationally exposed to swine than among the general population. An increased HEV seropositivity risk among the general population was associated with either being a peasant or male and was very strongly associated with the increase of age. Among the occupationally exposed group, the prevalence of anti-HEV IgG antibodies increased with age and working years. Among the 30 HEV-IgM-positive people, the infection rates of clerks in the public, peasants, pork retailers, and pig farmers were higher than those of others. A phylogenetic analysis revealed that all the isolates belonged to subgenotype 4d, and four people and four pigs shared 97.04%–100% sequence homology. This study revealed a high HEV seroprevalence among the general population and workers occupationally exposed to swine in the Anlu City, and supports the notion that swine are a source of human HEV infection.

Keywords: Hepatitis E virus (HEV) – Seroepidemiological study – Zoonosis – Cross-sectional study – Genotype

Yilin Shu, Yameng Chen and Sheng Zhou authors contributed equally to this work.

Electronic supplementary material: The online version of this article ( https://doi.org/10.1007/s12250-019-00136-x) contains supplementary material, which is available to authorized users.

 

Notes

Acknowledgements

The authors would like to thank the Anlu animal husbandry and veterinary bureau for these supporting information on pig density at Anlu city in the central China in 2016. This work was partly supported by General Projects of Health and Family Planning Commission of Hubei Province of China no. WJ2017M174, and WJ2017M240 and Occupational Hazard and Identification Control of Hubei Provincial Key Laboratory Open Fund, no. OCHI2017G02.

Author Contributions

YS, JZ, LZ and HW designed the study. YS, YC, SZ and QW performed the experiments. YS, SZ, CZ and ZZ analyzed the data. HC, YS and LZ drafted the manuscript. All authors read and approved the final manuscript.

 

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Animal and Human Rights Statement

All institutional and national guidelines for the care and use of animals were followed. Additional informed consent was obtained from all patients for which identifying information is included in this article.

Keywords: Hepatitis E; Pigs; Human; China; Seroprevalence.

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#Seroprevalence of #Hepatitis E Virus #Infection in #Pigs from Southern #Bulgaria (Vector Borne Zoo Dis., abstract)

[Source: Vector-Borne and Zoonotic Diseases, full page: (LINK). Abstract, edited.]

Seroprevalence of Hepatitis E Virus Infection in Pigs from Southern Bulgaria

Ilia Tsachev, Magdalena Baymakova, Massimo Ciccozzi, Roman Pepovich, Todor Kundurzhiev, Plamen Marutsov, Kiril K. Dimitrov, Krasimira Gospodinova, Maria Pishmisheva, and Liliya Pekova

Published Online: 24 Apr 2019 / DOI: https://doi.org/10.1089/vbz.2018.2430

 

Abstract

Hepatitis E virus (HEV) has been isolated from humans and several animals’ species. During the last years, the knowledge of HEV infection dramatically changed and enriched. The aim of this study was to estimate the seroprevalence of HEV in industrial pigs in different districts of Southern Bulgaria. Three hundred sixty swine serum samples were tested for anti-HEV IgG antibodies. The samples were collected from four industrial farms from three districts of Southern Bulgaria. HEV-specific antibodies in porcine serum were detected by enzyme-linked immunosorbent assay (PrioCHECK HEV Ab porcine). The overall HEV seroprevalence was 60.3%. The seropositivity varied widely depending on age groups and investigated farms. The overall prevalence in weaners was 25%, in fattening pigs 75.8%, and in group of sows was found the highest HEV positivity of 80%. The occurrence of HEV positivity in sows and fattening pigs presented odds ratio (OR) = 17.200 (95% confidence interval [CI]: 8.8–33.7) and OR = 11.342 (95% CI: 6.1–21.0), respectively, compared to weaners. The study indicated that HEV is widespread in industrial farms in Bulgaria and presented high seroprevalence in pigs. The results found that HEV seropositivity showed age dependency. The National Health Authorities should raise awareness of HEV and its zoonotic potential.

Keywords: Hepatitis E; Pigs; Bulgaria.

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Monitoring #human #enteric #viruses in #wastewater and relevance to infections encountered in the clinical setting: a one-year experiment in central #France, 2014 to 2015 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Monitoring human enteric viruses in wastewater and relevance to infections encountered in the clinical setting: a one-year experiment in central France, 2014 to 2015

Maxime Bisseux1,2, Jonathan Colombet1, Audrey Mirand1,2, Anne-Marie Roque-Afonso3, Florence Abravanel4, Jacques Izopet4,Christine Archimbaud1,2, Hélène Peigue-Lafeuille1,2, Didier Debroas1, Jean-Luc Bailly1, Cécile Henquell1,2

Affiliations: 1 Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France; 2 CHU Clermont-Ferrand, Centre National de Référence Entérovirus et parechovirus – Laboratoire Associé, Laboratoire de Virologie, Clermont-Ferrand, France; 3 AP-HP, Hôpital Paul Brousse, Centre National de Référence Virus des hépatites à transmission entérique (hépatite A) – Laboratoire Associé, Laboratoire de Virologie, Villejuif, France; 4 CHU Toulouse, Centre National de Référence Virus des hépatites à transmission entérique (hépatite E) – Laboratoire Coordonnateur, Laboratoire de Virologie, Toulouse, France

Correspondence:  Maxime Bisseux

Citation style for this article: Bisseux Maxime, Colombet Jonathan, Mirand Audrey, Roque-Afonso Anne-Marie, Abravanel Florence, Izopet Jacques, Archimbaud Christine,Peigue-Lafeuille Hélène, Debroas Didier, Bailly Jean-Luc, Henquell Cécile. Monitoring human enteric viruses in wastewater and relevance to infections encountered in the clinical setting: a one-year experiment in central France, 2014 to 2015. Euro Surveill. 2018;23(7):pii=17-00237. https://doi.org/10.28071560-7917.ES.2018.23.7.17-00237

Received: 29 Mar 2017;   Accepted: 21 Sep 2017

 

Abstract

Background

Human enteric viruses are resistant in the environment and transmitted via the faecal-oral route. Viral shedding in wastewater gives the opportunity to track emerging pathogens and study the epidemiology of enteric infectious diseases in the community.

Aim:

The aim of this study was to monitor the circulation of enteric viruses in the population of the Clermont-Ferrand area (France) by analysis of urban wastewaters.

Methods:

Raw and treated wastewaters were collected between October 2014 and October 2015 and concentrated by a two-step protocol using tangential flow ultrafiltration and polyethylene glycol precipitation. Processed samples were analysed for molecular detection of adenovirus, norovirus, rotavirus, parechovirus, enterovirus (EV), hepatitis A (HAV) and E (HEV) viruses.

Results:

All wastewater samples (n = 54) contained viruses. On average, six and four virus species were detected in, respectively, raw and treated wastewater samples. EV-positive samples were tested for EV-D68 to assess its circulation in the community. EV-D68 was detected in seven of 27 raw samples. We collected data from clinical cases of EV-D68 (n = 17), HAV (n = 4) and HEV infection (n = 16) and compared wastewater-derived sequences with clinical sequences. We showed the silent circulation of EV-D68 in September 2015, the wide circulation of HAV despite few notifications of acute disease and the presence in wastewater of the major HEV subtypes involved in clinical local cases.

Conclusion:

The environmental surveillance overcomes the sampling bias intrinsic to the study of infections associated with hospitalisation and allows the detection in real time of viral sequences genetically close to those reported in clinical specimens.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Environmental Pollution; Enterovirus; Adenovirus; Norovirus; Rotavirus; Parechovirus; Hepatits A.

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#Hepatitis E virus-associated #meningoencephalitis in a #lung #transplant recipient diagnosed by clinical metagenomic sequencing (Open Forum Infect Dis., abstract)

[Source: Open Forum Infectious Diseases, full page: (LINK). Abstract, edited.]

Hepatitis E virus-associated meningoencephalitis in a lung transplant recipient diagnosed by clinical metagenomic sequencing

Jamie A. Murkey, Kara W. Chew, Margrit Carlson, Chelsea L. Shannon, Deepika Sirohi, Hannah A. Sample, Michael R. Wilson, Paul Vespa, Romney M. Humphries, Steve Miller …

Open Forum Infect Dis ofx121. DOI: https://doi.org/10.1093/ofid/ofx121

Published: 13 June 2017

 

Abstract

Hepatitis E virus (HEV) infection uncommonly causes chronic hepatitis and neurologic disease. We describe a case of genotype 3a HEV meningoencephalitis diagnosed by metagenomic next-generation sequencing, illustrating the power of an unbiased molecular approach to microbial testing and the first reported case of HEV infection presumably acquired through lung transplantation.

Hepatitis E virus, meningitis, encephalitis, lung transplant, metagenomic next-generation sequencing (mNGS)

Topic: lung transplantation – nervous system disorder – hepatitis, chronic – hepatitis e – genotype – hepatitis e virus – meningoencephalitis – infection – viruses – massively-parallel genome sequencing

Issue Section: Brief Report

Author notes

# these authors contributed equally to the article

Corresponding author: Charles Chiu, MD/PhD, 185 Berry Street, Box #0134, San Francisco, CA 94107; phone: (415) 420–4463; e-mail: charles.chiu@ucsf.edu

© The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: Hepatitis E; Meningoencephalitis.

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#Diagnostic #Challenges and #Clinical #Characteristics of #Hepatitis E Virus–Associated #GBS (JAMA Neurol., abstract)

[Source: JAMA Neurology, full page: (LINK). Abstract, edited.]

Original Investigation  / November 07, 2016

Diagnostic Challenges and Clinical Characteristics of Hepatitis E Virus–Associated Guillain-Barré Syndrome

Olivier Stevens, MD1; Kristl G. Claeys, MD, PhD1,2; Koen Poesen, PhD3,4 ; et al
Veroniek Saegeman, PhD3,4 ; Philip Van Damme, MD, PhD1,2,5

Author Affiliations: 1Department of Neurology, University Hospitals Leuven, Leuven, Belgium; 2Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium; 3Laboratory for Molecular Neurobiomarker Research, KU Leuven, Leuven, Belgium; 4 Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium; 5VIB, Vesalius Research Center, Leuven, Belgium

Copyright 2017 American Medical Association. All Rights Reserved.

JAMA Neurol. Published online November 7, 2016. doi:10.1001/jamaneurol.2016.3541

 

Key Points

  • Question  – What is the importance of, and what are the challenges in, diagnosing an acute hepatitis E virus (HEV) infection as a preceding infection in patients with Guillain-Barré syndrome or a variant of Guillain-Barré syndrome?
  • Findings  – This cohort study finds that acute hepatitis E virus infection is frequently associated with Guillain-Barré syndrome, presenting with a heterogeneous phenotype. Cross-reactivity with other pathogens must be taken into account to make a certain diagnosis of infection with hepatitis E virus.
  • Meaning  – In a classic or atypical presentation of Guillain-Barré syndrome, one should consider testing the patient for an associated hepatitis E virus infection but always in parallel with testing for other pathogens, since cross-reactivity is possible.

 

Abstract

Importance 

Hepatitis E virus (HEV) recently has been shown to be an antecedent infection in Guillain-Barré syndrome (GBS), but the clinical spectrum of HEV-associated GBS is not yet documented, and diagnosing acute HEV infection can be a challenge.

Objectives 

To determine the prevalence of HEV-associated GBS in a Belgian cohort, study the clinical spectrum of HEV-associated GBS, and discuss difficulties in diagnosing acute HEV infection.

Design, Setting, and Participants 

This single-center, retrospective cohort study was conducted between January 1, 2007, and November 1, 2015. All patients with GBS or a GBS variant who presented to the adult neurology department of the University Hospital Leuven were identified via a search of the electronic medical records. Hepatitis E virus IgM and IgG reactivity was determined. In a subgroup, polymerase chain reaction for HEV was performed.

Main Outcomes and Measures 

Hepatitis E virus IgM and IgG reactivity.

Results 

Of 73 eligible patients (mean [SD] age, 52 [18] years; 29 females and 44 males), 6 (8%) showed positive reactivity on IgM assays for HEV, indicating a possible acute HEV infection. Four of the 6 patients (67%) had increased alanine aminotransferase levels of more than 1.5 times the upper limit of normal, while 4 of 22 patients (18%) with increased alanine aminotransferase levels showed positive reactivity on HEV IgM assays. Serum samples of 2 of 6 patients with positive reactivity on HEV IgM assays also revealed positive test results for cytomegalovirus or Epstein-Barr virus, indicating possible cross-reactivity. Thus, 4 patients (6%) in our cohort had probable acute HEV infection. Two of these patients presented with an infrequent GBS variant.

Conclusions and Relevance 

Acute HEV infection was frequently associated with GBS in our cohort. Abnormal alanine aminotransferase levels at admission can indicate the presence of an associated HEV infection. When HEV testing is considered, it is important to test for other infectious agents in parallel, as cross-reactivity can occur. Further studies are required to guide neurologists in their workup of underlying triggers of GBS.

Keywords: Hepatitis E; GBS.

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