Abstract
BackgroundHepatitis E, an acute zoonotic disease caused by the hepatitis E virus (HEV), has a relatively high burden in developing countries. The current research model on hepatitis E mainly uses experimental animal models (such as pigs, chickens, and rabbits) to explain the transmission of HEV. Few studies have developed a multi-host and multi-route transmission dynamic model (MHMRTDM) to explore the transmission feature of HEV. Hence, this study aimed to explore its transmission and evaluate the effectiveness of intervention using the dataset of Jiangsu Province.MethodsWe developed a dataset comprising all reported HEV cases in Jiangsu Province from 2005 to 2018. The MHMRTDM was developed according to the natural history of HEV cases among humans and pigs and the multi-transmission routes such as person-to-person, pig-to-person, and environment-to-person. We estimated the key parameter of the transmission using the principle of least root mean square to fit the curve of the MHMRTDM to the reported data. We developed models with single or combined countermeasures to assess the effectiveness of interventions, which include vaccination, shortening the infectious period, and cutting transmission routes. The indicator, total attack rate (TAR), was adopted to assess the effectiveness.ResultsFrom 2005 to 2018, 44 923 hepatitis E cases were reported in Jiangsu Province. The model fits the data well (R2 = 0.655, P < 0.001). The incidence of the disease in Jiangsu Province and its cities peaks are around March; however, transmissibility of the disease peaks in December and January. The model showed that the most effective intervention was interrupting the pig-to-person route during the incidence trough of September, thereby reducing the TAR by 98.11%, followed by vaccination (reducing the TAR by 76.25% when the vaccination coefficient is 100%) and shortening the infectious period (reducing the TAR by 50.05% when the infectious period is shortened to 15 days).ConclusionsHEV could be controlled by interrupting the pig-to-person route, shortening the infectious period, and vaccination. Among these interventions, the most effective was interrupting the pig-to-person route.Graphic
Highlights
Hepatitis E, an acute zoonotic disease caused by the hepatitis E virus (HEV), has a relatively high burden in developing countries
The peak incidence rate of hepatitis E in Jiangsu Province and other cities was around March; the peak transmissibility was in December and January (Table 3)
The results showed that shortening the period of infection can lower the incidence of HEV, representing another effective intervention and suggesting that we should aim for early detection, early diagnosis, and early treatment for controlling HEV transmission
Summary
Hepatitis E, an acute zoonotic disease caused by the hepatitis E virus (HEV), has a relatively high burden in developing countries. Hepatitis E is an acute zoonotic disease caused by hepatitis E virus (HEV). The virus is mainly transmitted through the faecal-oral route upon ingestion of contaminated water and food [1]. Among the four main genotypes of HEV, genotype 1 (HEV-1) and genotype 2 (HEV-2) are found in water and the external environment and only infect humans [5], whereas genotype 3 (HEV-3) and genotype 4 (HEV4) can simultaneously infect humans and animals, such as pigs [6]. Consumption of undercooked pork is one of the main causes of infection, and the rate of HEV infection caused by direct contact with pigs is high [7–10]. The main causes of infection in China are contact with infected pigs and humans, as well as environmental factors
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