A national survey of acute hepatitis E in France

Renou, Christophe; Moreau, Xavier; Pariente, Alexandre; Cadranel, Jean–François; Maringe, E.; Morin, Thierry; Causse, Xavier; Payen, Jean‐Louis; Izopet, Jacques; Nicand, Élisabeth; Bourlière, Marc; Pénaranda, Guillaume; Hardwigsen, Jean; Gerolami, René; Péron, Jean‐Marie; Pavio, Nicole

doi:10.1111/j.1365-2036.2008.03679.x

Cited by 94 publications

(88 citation statements)

References 17 publications

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“…Autochthonous cases of hepatitis E associated with drinking water from a private source have been previously described in France [23]. In the present study, seroprevalence among blood donors living in the Ariège and Aude was found particularly high.…”

Section: Figuresupporting

confidence: 48%

Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011

Mansuy¹,

Sauné

Rech³

et al. 2015

Eurosurveillance

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The apparent seroprevalence of hepatitis E Virus (HEV) varies greatly among developed countries depending on the geographical area and the sensitivity of immunoassays. We used a validated assay to determine the prevalence of HEV IgG and IgM antibodies among 3,353 blood donors living in southern France, who gave blood during the two first weeks of October 2011 and participated in the study. Demographic and epidemiological information was collected using a specific questionnaire. We also screened 591 samples for HEV RNA. Overall IgG seroprevalence was 39.1% and varied from 20% to 71.3% depending on the geographical area (p < 0.001) while IgM seroprevalence was 3.31%. Anti-HEV IgG was significantly correlated with increasing age (p < 0.001), eating uncooked pork liver sausages (p < 0.001), offal (p = 0.003), or mussels (p = 0.02). Anti-HEV IgM was associated with being male (p = 0.01) and eating uncooked pork liver sausages (p = 0.02). HEV RNA was detected in one of the 99 anti-HEV IgM-positive samples, but in none of the 492 anti-HEV IgM-negative samples. HEV is hyperendemic in southern France. Dietary and culinary habits alone cannot explain the epidemiology of HEV in this region, indicating that other modes of contamination should be investigated.

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Section: Figuresupporting

confidence: 48%

Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011

Mansuy¹,

Sauné

Rech³

et al. 2015

Eurosurveillance

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“…In most cases, acute hepatitis E in these regions is of autochthonous origin [6] . The most frequent risk factors for hepatitis E, reported in a French survey, were water consumption from a personal water supply, uncooked shellfish consumption, and the recent acquisition of a pet pig [7] . None of these risk factors were present in our patient.…”

Section: Discussionmentioning

confidence: 99%

Guillain-Barré syndrome following hepatitis E

Loly¹,

Rikir²,

Seivert³

et al. 2009

WJG

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Guillain-Barré syndrome (GBS) is often triggered by a preceding bacterial or viral infection. Occasionally, it has been observed in association with acute hepatitis A, B and C, and three cases have been previously described in India in which GBS was associated with acute hepatitis E. A molecular mimicry mechanism is supposed to be involved in the pathogenesis of GBS triggered by infectious agents, although the nature of the shared epitopes has not been characterized in most instances, including that in the case of hepatotropic viruses. We report a case of GBS following acute hepatitis E in a European individual. The presence of antiganglioside GM2 antibodies in this patient suggested molecular mimicry involving ganglioside GM2 in the pathogenesis of GBS associated with hepatitis E.

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“…Infection in pigs can be symptomatic [59][60][61] but most often infections remain clinically undetected [47,[62][63][64][65]. Close relatedness has been found between HEV gt3 nucleotide sequences from pigs and wild boar and those from human cases [6,32,41,51,60,61,63,64,[66][67][68][69][70][71]. HEV carried by a human case in the UK had 100 % aminoacid sequence homology to a UK pig HEV sequence but no transmission link between them could be defined [72].…”

Section: Potential For Zoonotic Transmission By Direct Animal Contactmentioning

confidence: 99%

“…Unpasteurized milk was associated with HEV infection in an EL2 seroepidemiological study [92]. In a risk factor EL2 analysis using a structured questionnaire, dried sausages and uncooked shellfish (mussels, oysters, or both) were considered risk factors associated with cases in The Netherlands and France, respectively, but these studies did not use controls [19,51]. In the EL3 case-control study in Germany, Wichmann et al found that eating any offal or wild boar was independently associated with autochthonous HEV infection [52].…”

Section: Potential For Foodborne Zoonotic Transmissionmentioning

confidence: 99%

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

2009

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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.

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A national survey of acute hepatitis E in France

Abstract: SUMMARY BackgroundFew data are available on the incidence, risk factors and contamination pathways involved in acute indigenous hepatitis E in developed countries.

Cited by 94 publications

References 17 publications

Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011

Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011

Guillain-Barré syndrome following hepatitis E

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

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