Evidence for the presence of autochthonous (locally acquired) cases of acute hepatitis E virus infections in Italy since the 80s

Stroffolini, Tommaso; Rapicetta, Maria; Chionne, Paola; Esvan, Rozenn; Madonna, Elisabetta; Lombardo, Flavia; Toccaceli, F.; Pisani, Giulio; Ciccaglione, Anna Rita; Bortolotti, Flavia

doi:10.1016/j.ejim.2015.03.012

Cited by 12 publications

(6 citation statements)

References 20 publications

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“…It is the converse in Switzerland, notwithstanding a steady increase in demand for molecular testing, the proportion of positive HEV samples has remained roughly constant over the years from 2011 to 2016 [ 14 ]. HEV circulation in Italy was demonstrated since the 1980s and sporadic autochthonous incident cases have been reported for several years [ 15 ]. Despite this, the real burden of HEV-related diseases is largely unknown in Italy.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016

et al. 2018

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Increasing numbers of hepatitis E cases are being reported in several European countries, including Italy, but the burden of hepatitis E virus (HEV) infection is largely unknown in the latter. To gain a better understanding of HEV epidemiology at national level in Italy, we piloted a strengthened and integrated human (epidemiological and virological) and environmental HEV surveillance system between 2012 and 2016. Over the 5-year period, 169 confirmed hepatitis E cases were identified, with a national annual incidence of 0.72 cases per 1,000,000. Of 65 HEV-RNA positive samples of sufficient quality for molecular analysis, 66% were genotype HEV3, 32% HEV1 and 1% HEV4. The most frequent risk factor reported by all HEV3 infected cases, was the consumption of undercooked pork and sausage. For the environmental surveillance, 679 urban sewage samples were collected from 53 wastewater treatment plants and HEV-RNA was detected in 38/679 of the samples. Among these, 25 (66%) were genotype HEV3 and the remaining were HEV1. We demonstrate that autochthonous transmission and environmental circulation of genotype HEV3 is adding to travel-related HEV transmission in Italy. We recommend the ‘One Health’ approach to integrated surveillance, and to include HEV-related messages within health information campaigns focussing on food security.

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Section: Discussionmentioning

confidence: 99%

Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016

et al. 2018

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“…These data contrast with experience of hepatitis E infection. Some patients previously labelled as having indeterminate ALF or drug induced liver injury may have had undetected acute hepatitis E infection as the possibility of infection with this virus was not recognised, and the means for testing was not available in the earlier years of our cohort study. These data reinforce the need for a high level of suspicion for hepatitis E in those presenting with ALI, and testing for hepatitis E should now be considered routine in the investigation of such patients.…”

Section: Discussionmentioning

confidence: 99%

Acute liver failure in Scotland: changes in aetiology and outcomes over time (the Scottish Look‐Back Study)

Donnelly

Davidson

Martin

et al. 2017

Aliment Pharmacol Ther

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“…Available data on HEV seropositivity in Italy are limited to Southern regions and suggest that 1·3–2·9% of people without hepatitis are HEV-seropositive [36], although a retrospective follow-up study (1978–1991) on acute nonA–nonB hepatitis cases at a single referral centre in Northern Italy showed autochthonous cases of acute HEV infections since the 1980s [37]. A recent Italian study on seropositivity to HEV among mainly young adults living in the city of Rome who underwent human immunodeficiency virus testing, showed an overall HEV seropositivity of 5·4% and a significant association with male homosexual intercourses, suggesting that besides the oro-faecal and zoonotic transmission, certain sexual practices may also contribute to HEV transmission [22], as well as blood transfusions and solid organ transplants [38].…”

Section: Discussionmentioning

confidence: 99%

Hepatitis E virus infection in North Italy: high seroprevalence in swine herds and increased risk for swine workers

et al. 2017

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We determined the hepatitis E virus (HEV) seroprevalence and detection rate in commercial swine herds in Italy's utmost pig-rich area, and assessed HEV seropositivity risk in humans as a function of occupational exposure to pigs, diet, foreign travel, medical history and hunting activities. During 2011-2014, 2700 sera from 300 swine herds were tested for anti-HEV IgG. HEV RNA was searched in 959 faecal pools from HEV-seropositive herds and in liver/bile/muscle samples from 179 pigs from HEV-positive herds. A cohort study of HEV seropositivity in swine workers (n = 149) was also performed using two comparison groups of people unexposed to swine: omnivores (n = 121) and vegetarians/vegans (n = 115). Herd-level seroprevalence was 75·6% and was highest in farrow-to-feeder herds (81·6%). Twenty-six out of 105 (24·8%) herds had HEV-positive faecal samples (25 HEV-3, one HEV-4). Only one bile sample tested positive. HEV seropositivity was 12·3% in swine workers, 0·9% in omnivores and 3·0% in vegetarians/vegans. Factors significantly associated with HEV seropositivity were occupational exposure to pigs, travel to Africa and increased swine workers' age. We concluded that HEV is widespread in Italian swine herds and HEV-4 circulation is alarming given its pathogenicity, with those occupationally exposed to pigs being at increased risk of HEV seropositivity.

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Evidence for the presence of autochthonous (locally acquired) cases of acute hepatitis E virus infections in Italy since the 80s

Cited by 12 publications

References 20 publications

Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016

Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016

Acute liver failure in Scotland: changes in aetiology and outcomes over time (the Scottish Look‐Back Study)

Hepatitis E virus infection in North Italy: high seroprevalence in swine herds and increased risk for swine workers

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