Cornelia Adlhoch1, Ana Avellon2, Sally A Baylis3, Anna R Ciccaglione4, Elisabeth Couturier5, Rita de Sousa6, Jevgenia Epštein7, Steen Ethelberg8, Mirko Faber9, Ágnes Fehér10, Samreen Ijaz11, Heidi Lange12, Zdenka Manďáková13, Kassiani Mellou14, Antons Mozalevskis15, Ruska Rimhanen-Finne16, Valentina Rizzi17, Bengü Said18, Lena Sundqvist19, Lelia Thornton20, Maria E Tosti21, Wilfrid van Pelt22, Esther Aspinall23, Dragoslav Domanovic24, Ettore Severi25, Johanna Takkinen26, Harry R Dalton27. 1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: cornelia.adlhoch@ecdc.europa.eu. 2. Spanish National Centre of Microbiology, Carlos III Institute of Health, Madrid, Spain. Electronic address: aavellon@isciii.es. 3. Paul-Ehrlich-Institut, Langen, Germany. Electronic address: Sally.Baylis@pei.de. 4. National Institute of Health (Istituto Superiore di Sanità - ISS), Rome, Italy. Electronic address: annarita.ciccaglione@iss.it. 5. Institut de veille sanitaire, Saint-Maurice, France. Electronic address: e.couturier@invs.sante.fr. 6. National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal. Electronic address: rita.sousa@insa.min-saude.pt. 7. Health Board, Tallinn, Estonia. Electronic address: Jevgenia.Epstein@terviseamet.ee. 8. Statens Serum Institut, Copenhagen, Denmark. Electronic address: SET@ssi.dk. 9. Robert Koch Institute, Berlin, Germany. Electronic address: FaberM@rki.de. 10. National Center for Epidemiology (NCE), Budapest, Hungary. Electronic address: feher.agnes@oek.antsz.hu. 11. National Infection Service, Public Health England, London, United Kingdom. Electronic address: Samreen.Ijaz@phe.gov.uk. 12. Norwegian Institute of Public Health, Oslo, Norway. Electronic address: Heidi.Lange@fhi.no. 13. National Institute of Public Health, Prague, Czech Republic. Electronic address: zdenka.mandakova@szu.cz. 14. Greek Center for Disease Prevention and Control, Athens, Greece. Electronic address: mellou@keelpno.gr. 15. World Health Organization (WHO), Regional Office for Europe, Copenhagen, Denmark. Electronic address: AMZ@euro.who.int. 16. National Institute for Health and Welfare (THL), Finland. Electronic address: ruska.rimhanen-finne@thl.fi. 17. European Food Safety Authority (EFSA), Parma, Italy. Electronic address: Valentina.RIZZI@efsa.europa.eu. 18. National Infection Service, Public Health England, London, United Kingdom. Electronic address: bengu.said@phe.gov.uk. 19. Public Health Agency of Sweden, Stockholm, Sweden. Electronic address: lena.sundqvist@folkhalsomyndigheten.se. 20. Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland. Electronic address: lelia.thornton@hse.ie. 21. National Institute of Health (Istituto Superiore di Sanità - ISS), Rome, Italy. Electronic address: mariaelena.tosti@iss.it. 22. National Institute for Public Health and the Environment, Bilthoven, Netherlands. Electronic address: Wilfrid.van.Pelt@rivm.nl. 23. National Health Services, Health Scotland, Glasgow, United Kingdom. Electronic address: esther.aspinall@nhs.net. 24. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: Dragoslav.Domanovic@ecdc.europa.eu. 25. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: Ettore.Severi@ecdc.europa.eu. 26. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: Johanna.Takkinen@ecdc.europa.eu. 27. European Centre for Environment and Human Health, University of Exeter, United Kingdom. Electronic address: harry.dalton@rcht.cornwall.nhs.uk.
Abstract
BACKGROUND: Hepatitis E virus (HEV) is endemic in EU/EEA countries, but the understanding of the burden of the infection in humans is inconsistent as the disease is not under EU surveillance but subject to national policies. STUDY: Countries were asked to nominate experts and to complete a standardised questionnaire about the epidemiological situation and surveillance of HEV in their respective EU/EEA country. This study reviewed surveillance systems for human cases of HEV in EU/EEA countries and nominated experts assessed the epidemiology in particular examining the recent increase in the number of autochthonous cases. RESULTS: Surveillance systems and case definitions across EU/EEA countries were shown to be highly variable and testing algorithms were unreliable. Large increases of autochthonous cases were reported from Western EU/EEA countries with lower case numbers seen in Northern and Southern European countries. Lack of clinical awareness and variability in testing strategies might account for the observed differences in hepatitis E incidence across EU/EEA countries. Infections were predominantly caused by HEV genotype 3, the most prevalent virus type in the animal reservoirs. CONCLUSION: Discussions from the expert group supported joint working across countries to better monitor the epidemiology and possible changes in risk of virus acquisition at a European level. There was agreement to share surveillance strategies and algorithms but also importantly the collation of HEV data from human and animal populations. These data collected at a European level would serve the 'One Health' approach to better informing on human exposure to HEV.
BACKGROUND: Hepatitis E virus (HEV) is endemic in EU/EEA countries, but the understanding of the burden of the infection in humans is inconsistent as the disease is not under EU surveillance but subject to national policies. STUDY: Countries were asked to nominate experts and to complete a standardised questionnaire about the epidemiological situation and surveillance of HEV in their respective EU/EEA country. This study reviewed surveillance systems for human cases of HEV in EU/EEA countries and nominated experts assessed the epidemiology in particular examining the recent increase in the number of autochthonous cases. RESULTS: Surveillance systems and case definitions across EU/EEA countries were shown to be highly variable and testing algorithms were unreliable. Large increases of autochthonous cases were reported from Western EU/EEA countries with lower case numbers seen in Northern and Southern European countries. Lack of clinical awareness and variability in testing strategies might account for the observed differences in hepatitis E incidence across EU/EEA countries. Infections were predominantly caused by HEV genotype 3, the most prevalent virus type in the animal reservoirs. CONCLUSION: Discussions from the expert group supported joint working across countries to better monitor the epidemiology and possible changes in risk of virus acquisition at a European level. There was agreement to share surveillance strategies and algorithms but also importantly the collation of HEV data from human and animal populations. These data collected at a European level would serve the 'One Health' approach to better informing on human exposure to HEV.
Authors: Michael J Ankcorn; Samreen Ijaz; John Poh; Ahmed M Elsharkawy; Erasmus Smit; Robert Cramb; Swathi Ravi; Kate Martin; Richard Tedder; James Neuberger Journal: Transplantation Date: 2018-07 Impact factor: 4.939