Abstract
BackgroundNotified cases of hepatitis E have increased 40-fold in the past 10 years in Germany. Food safety is a major concern as hepatitis E virus (HEV) RNA has been detected in ready-to-eat retail-level food products. The objective of this case–control study was to assess risk factors for autochthonous symptomatic hepatitis E and explore reasons for delays in diagnosis. Methods: Demographic, clinical and exposure data from notified hepatitis E cases and individually matched population controls were collected in semi-standardised telephone interviews. Conditional logistic regression analysis was used to calculate matched odds ratios (mOR) and population attributable fractions (PAF). Results: In total, 270 cases and 1,159 controls were included (mean age 53 years, 61% men in both groups). Associated with disease were: consumption of undercooked pork liver, pork, wild boar meat, frankfurters, liver sausage and raw vegetables; contact with waste water (occupational) and various host factors (mORs between 1.9 and 34.1, p value < 0.03). PAF for frankfurters and liver sausage were 17.6%, and 23.6%, respectively. There were statistically significant differences in the clinical presentation and hospitalisation proportion of acute hepatitis E in men and women. Diagnosis was preceded by more invasive procedures in 29.2% of patients, suggesting that hepatitis E was not immediately considered as a common differential diagnosis. Conclusions: Our study suggests that there are indeed sex-specific differences in disease development and lends important epidemiological evidence to specific ready-to-eat pork products as a major source for autochthonous hepatitis E. A review of existing consumer recommendations and production methods may be indicated.
Highlights
Hepatitis E in western and central Europe is predominantly a zoonosis caused by infection with genotype 3 hepatitis E virus (HEV)
Food safety is a concern as cooking temperatures of 71 °C for 20 min are required to fully inactivate the virus [17] and HEV RNA has been detected in ready-to-eat food products, including raw sausage and liver sausage at retail level [18]
Symptoms related to the accumulation of bilirubin, e.g. jaundice, were more frequent among men, while gastrointestinal symptoms were more prevalent among women (Table 2)
Summary
Hepatitis E in western and central Europe is predominantly a zoonosis caused by infection with genotype 3 hepatitis E virus (HEV). Infection is most often asymptomatic, with clinical hepatitis more commonly reported among men over 50 years of age or persons with pre-existing liver disease, suggesting that host factors play an important role [12]. Food safety is a concern as cooking temperatures of 71 °C for 20 min are required to fully inactivate the virus [17] and HEV RNA has been detected in ready-to-eat food products, including raw sausage and liver sausage at retail level [18]. Food safety is a major concern as hepatitis E virus (HEV) RNA has been detected in ready-to-eat retail-level food products. The objective of this case–control study was to assess risk factors for autochthonous symptomatic hepatitis E and explore reasons for delays in diagnosis. A review of existing consumer recommendations and production methods may be indicated
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
