Abstract
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.
Highlights
Hepatitis E is a systemic disease predominantly affecting the liver and caused by infection with the hepatitis E virus (HEV)
In resource-poor countries, hepatitis E disease presents as large-scale waterborne epidemics of which a few have spread through person-to-person contact [2]
In the Western world, hepatitis E was traditionally considered a travel related disease, even though the perception has changed due to the increasing number of autochthonous cases reported in European Countries in recent years; at present it is recognised that HEV is endemic in the European Union/ European Economic Area (EU/EEA) [3]
Summary
Hepatitis E is a systemic disease predominantly affecting the liver and caused by infection with the hepatitis E virus (HEV). The burden of hepatitis E worldwide is unknown, it is estimated that one-third of the world population has been exposed to the virus at some time during their lives [1]. 20 million people are estimated to acquire HEV infections, with over 3 million developing symptomatic disease and almost 60,000 HEV-related deaths [2]. In the Western world, hepatitis E was traditionally considered a travel related disease, even though the perception has changed due to the increasing number of autochthonous cases reported in European Countries in recent years; at present it is recognised that HEV is endemic in the European Union/ European Economic Area (EU/EEA) [3]. Of the seven HEV genotypes known to infect humans (HEV1–4 and HEV7) and animals (HEV3–6), EU/EEA countries report mainly HEV3 autochthonous infections [4]
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