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.
Original languageEnglish
JournalEurosurveillance
Volume23
Issue number41
DOIs
Publication statusPublished - Oct 1 2018

Fingerprint

Hepatitis E
Hepatitis E virus
Italy
Genotype
RNA
Infectious Disease Transmission
Food Supply
Environmental Monitoring
Virus Diseases
Waste Water
Sewage
Health Promotion
Epidemiology
Incidence

Keywords

  • epidemiology
  • Hepatitis E
  • Italy
  • risk factors
  • surveillance
  • viral infections

Cite this

Hepatitis E in Italy. / Alfonsi, Valeria; Romanò, Luisa; Ciccaglione, Anna Rita; La Rosa, Giuseppina; Bruni, Roberto; Zanetti, Alessandro; Della Libera, Simonetta; Iaconelli, Marcello; Bagnarelli, Patrizia; Capobianchi, Maria Rosaria; Garbuglia, Anna Rosa; Riccardo, Flavia; Tosti, Maria Elena; Collaborating Group, Group.

In: Eurosurveillance, Vol. 23, No. 41, 01.10.2018.

Research output: Contribution to journalArticle

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AU - Alfonsi, Valeria

AU - Romanò, Luisa

AU - Ciccaglione, Anna Rita

AU - La Rosa, Giuseppina

AU - Bruni, Roberto

AU - Zanetti, Alessandro

AU - Della Libera, Simonetta

AU - Iaconelli, Marcello

AU - Bagnarelli, Patrizia

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AU - Riccardo, Flavia

AU - Tosti, Maria Elena

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AB - 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.

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