Unexpected high prevalence of IgG-antibodies to hepatitis E virus in Swedish pig farmers and controls

Olsén, Björn; Axelsson-Olsson, Diana; Thelin, Anders; Weiland, Ola

doi:10.1080/00365540500321470

Cited by 117 publications

(96 citation statements)

References 22 publications

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“…There have also been increasing numbers of reports on high seroprevalence in Europe and the US. Antibodies againts HEV (anti-HEV) were found in 17% of blood donors in the UK and in France, in 21-33% of blood donors and 50% of farmers in Denmark and 5 to 9% of the general population and 13% of veterinarians in Sweden [11,[15][16][17][18]. These data indicate that there is a high prevalence of hepatitis E infections also in Europe, albeit most infections are subclinical and most of them may be zoonotic.…”

Section: Introductionmentioning

confidence: 84%

Endemic hepatitis E in two Nordic countries

et al. 2009

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Antibodies against hepatitis E virus (anti-HEV) were found in 248 Swedish and Danish patients between 1993 and 2007. Most patients were symptomatic and tested for anti-HEV due to travel abroad. Among patients with known country of infection, most were infected in Asia, mainly on the Indian subcontinent. However, 29 patients were infected in Europe, nine of these had HEV IgM and/or HEV RNA in serum. In sera from 65 of 141 tested patients HEV RNA could be detected, and 63 strains could be typed by limited sequencing within ORF2. HEV RNA was found in sera from 71% of the patients with HEV IgM and IgG and in 18% of the patients with only detectable HEV IgG. It was also found up to three weeks after the onset of disease in 67% of the patients with known date of onset. Patients infected in Europe were infected by genotype 3, and were older than those infected by genotype 1 (mean age 55.3 vs 30 years, p<0.001). Since it is known that genotype 3 can infect domestic pigs, HEV strains from 18 piglets in 17 herds in Sweden and Denmark were sequenced. Phylogenetic analyses of the genotype 3 strains showed geographical clades and high similarity between strains from patients and pigs from the same area. There are thus autochthonous hepatitis E cases in Scandinavia, and there are probably many undiagnosed ones. Patients with hepatitis of unknown etiology should therefore be investigated for anti-HEV even if they have not been outside Europe, since infections acquired from pigs or other animals should be taken into consideration.

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Section: Introductionmentioning

confidence: 84%

Endemic hepatitis E in two Nordic countries

et al. 2009

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“…However, the virus can also infect a considerable proportion of the human population, but only a minority appear to develop symptoms [3][4][5][6][7][8]. The key to understanding HEV transmission in Europe may lie in determining how the virus that circulates among pigs is transmitted to humans in sufficiently high doses to cause infection or overt disease.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, unexpectedly high anti-HEV immunoglobulin G (IgG) seroprevalence among the general population has been reported from some industrialized countries, although the rates varied considerably between reports, ranging from 2 . 3 to 33 % [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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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“…The reasons for this high seroprevalence could be due to subclinical infection, exposure to animals, serological cross reactivity with other agents or false positive results. In particular, individuals coming in contact with swine, like veterinarians, pig breeders and slaughter house personnel have been found to have statistically significant higher rates of hepatitis E seropositivity in developed countries [18][19][20][21][22] .…”

Section: Virology Epidemiology and Transmissionmentioning

confidence: 99%

Chronic hepatitis E: A brief review

Murali

Kotwal

Chawla

2015

WJH

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Hepatitis E viral infection has traditionally been considered an acute, self-limited, water borne disease similar to hepatitis A, endemic to developing countries. However, over the past decade, zoonotic transmission and progression to chronicity in human patients has been identified, resulting in persistently elevated transaminase levels, progressive liver injury and cirrhosis. In addition to liver injury, neurological, renal and rheumatological manifestations have also been reported. Chronic hepatitis E occurs mainly in immunosuppressed individuals such as transplant recipients, human immunodeficiency virus patients with low CD4 counts and in patients with hematological malignancies receiving chemotherapy. Diagnosis is established by persistent elevation of hepatitis E virus RNA in the stool or serum. This population often requires treatment with antiviral agents, particularly ribavirin, as spontaneous clearance with reduction in immunosuppression occurs only in about a third of the patients. The purpose of this review, is to further discuss the clinical presentation, and recent advances in diagnosis, treatment and prophylaxis of chronic hepatitis E.

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Unexpected high prevalence of IgG-antibodies to hepatitis E virus in Swedish pig farmers and controls

Cited by 117 publications

References 22 publications

Endemic hepatitis E in two Nordic countries

Endemic hepatitis E in two Nordic countries

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

Chronic hepatitis E: A brief review

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