https://www.journal-of-hepatology.eu/article/S0168-8278(12)00924-5/pdf

The burden of liver disease in Europe. A review of available epidemiological data.

Chronic viral hepatitis B is the second major cause of both cirrhosis and liver cancer. Between 0.5% and 0.7% of the European population is affected by chronic hepatitis B, with the highest prevalence being recorded in Romania (5.6%) and Greece (3.4%) [5-12]. Throughout Europe, an average of only 23% of patients knew of hepatitis B at the time of their diagnosis [13]. Data suggest there has been a reduction in the yearly incidence of HBV, accompanied by a decline in prevalence related to the vaccination campaigns that have been mounted throughout Europe [12, 14]. Chronic hepatitis C is an important risk factor for hepatocellular carcinoma, which develops several decades after infection. Since the discovery of the virus in the late eighties, the number of new cases of infection has dropped substantially. Prevalence rates of hepatitis C virus (HCV) infection in the last

Report Title: The burden of liver disease in Europe: a review of available epidemiological data

Hepatitis E is endemic in many developing countries where it causes substantial morbidity. In industrialised countries, it is considered rare, and largely confined to travellers returning from endemic areas. However, there is now a growing body of evidence that challenges this notion. Autochthonous hepatitis E in developed countries is far more common than previously recognised, and might be more common than hepatitis A. Hepatitis E has a predilection for older men in whom it causes substantial morbidity and mortality. The disease has a poor prognosis in the context of pre-existing chronic liver disease, and is frequently misdiagnosed as drug-induced liver injury. The source and route of infection remain uncertain, but it might be a porcine zoonosis. Patients with unexplained hepatitis should be tested for hepatitis E, whatever their age or travel history.

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(08)70255-X.pdf

Hepatitis E: an emerging infection in developed countries

Background. The source and route of autochthonous hepatitis E virus (HEV) infections are not clearly established in industrialized countries despite evidence that it is a zoonosis in pigs. We investigated the role of figatellu, a traditional pig liver sausage widely eaten in France and commonly consumed raw, as a source of HEV infection. Methods. A case-control study was conducted of 3 patients who presented autochthonous hepatitis E and 15 members of their 3 different families. Anti-HEV immunoglobulin G and immunoglobulin M antibody testing was performed with commercial assays. HEV RNA was detected in serum samples of patients and in pig liver sausages by means of real-time polymerase chain reaction and sequenced by means of in-house sequencing assays. Genetic links between HEV sequences were analyzed. Results. Acute or recent HEV infection, defined by detection of anti-HEV immunoglobulin M antibodies and/or HEV RNA, was observed in 7 of 13 individuals who ate raw figatellu and 0 of 5 individuals who did not eat raw figatellu (P = .041). Moreover, HEV RNA of genotype 3 was recovered from 7 of 12 figatelli purchased in supermarkets, and statistically significant genetic links were found between these sequences and those recovered from patients who ate raw figatellu. Conclusion. Our findings strongly support the hypothesis of HEV infection through ingestion of raw figatellu.

Pig liver sausage as a source of hepatitis E virus transmission to humans.

https://www.gastrojournal.org/article/S0016-5085(11)00261-7/pdf

Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants.

Using a validated sensitive assay, we found hepatitis E virus (HEV) IgG in 52.5% of voluntary blood donors in southwestern France. This finding suggests HEV is highly endemic to this region. The high HEV prevalence may reflect local dietary practices, such as eating uncooked pork and game products.

http://www.eurobio.fr/images/Image/File/ETUDE%20DU%20CNR%20VHE.pdf

Hepatitis E virus antibodies in blood donors, France.

Cases of autochthonous acute hepatitis E occur in most industrialized countries and are frequent in the South West of France. The prevalence of anti-hepatitis E virus (HEV) IgG antibodies in blood donors in this area was determined. A total of 529 samples from rural and urban blood donors were tested. The overall prevalence was 16.6%, 19.1% of rural donors and 14.2% of urban donors had anti-HEV antibodies (P = 0.13). The antibodies were widely distributed among all age groups and the sex ratio of the anti-HEV positive blood donors was 1.12 (P = 0.57). Hunting was the only pastime or profession associated with a high prevalence of anti-HEV antibodies (P = 0.038). The frequency of anti-HEV antibodies in blood donors could reflect active autochthonous transmission in this area of France. As the risk factors for HEV infection in industrialized countries are still unknown, further studies are needed to clarify the epidemiology of HEV infection in the Midi-Pyrenees region. J. Med. Virol. 80:289–293, 2008. © 2007 Wiley-Liss, Inc.

High prevalence of anti-hepatitis E virus antibodies in blood donors from South West France.

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 391% and varied from 20% to 713% depending on the geographical area (p?<?0001) while IgM seroprevalence was 331% Anti-HEV IgG was significantly correlated with increasing age (p?<?0001), eating uncooked pork liver sausages (p?<?0001), offal (p?=?0003), or mussels (p?=?002) Anti-HEV IgM was associated with being male (p?=?001) and eating uncooked pork liver sausages (p?=?002) 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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Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011.

Introduction Locally acquired hepatitis E virus (HEV) infection is an emerging infection in developed countries. South West France has a high incidence of HEV and has reported a large number of chronic cases of HEV infection. We previously estimated the HEV seroprevalence in blood donors in Midi-Pyrenees to be 16.6%, very much higher than the rate seen in Northern France (3.2%). However, comparison between seroprevalence studies is difficult. There is no gold-standard for measuring HEV antibodies and commercial assays vary in performance. A recent study has suggested poor sensitivity in a commonly used HEV IgG assay, which underestimates seroprevalence by a factor of 4.51. Since this assay was used in our previous study of HEV seroprevalence in Midi-Pyrenees, we repeated the study using a more sensitive assay previously validated against sera from cases of HEV genotype 3 infection. Aim To re-examine the seroprevalence of anti-HEV IgG using a sensitive, validated assay. Method Sera from 512 blood donors (aged 18–65 yrs) and 50 children (aged 2–4 yrs) were tested for anti-HEV IgG (Wantai, Beijing, China). Demographic data and putative risk factors for HEV acquisition were collected using a structured questionnaire. Results The HEV seroprevalence in blood donors was 52.5%. 63.1% of donors from rural areas and 42.9% of donors from urban ones were positive for anti-HEV IgG (p Conclusion HEV is highly endemic in South West France, and the seroprevalence approaches that found in many developing countries where HEV is endemic. Seroepidemiological studies of hepatitis E which use less sensitive assays may not produce a valid assessment of the relevant risk factors.

Henri Rech

Papers

Hepatitis E virus antibodies in blood donors, France.

High prevalence of anti-hepatitis E virus antibodies in blood donors from South West France.

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

P79 Hepatitis E virus is highly endemic in South West France