TY - JOUR
T1 - Hepatitis E in Italy
T2 - 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016
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
AU - Capobianchi, Maria Rosaria
AU - Garbuglia, Anna Rosa
AU - Riccardo, Flavia
AU - Tosti, Maria Elena
AU - Collaborating Group, Group
PY - 2018/10/1
Y1 - 2018/10/1
N2 - 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.
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.
KW - epidemiology
KW - Hepatitis E
KW - Italy
KW - risk factors
KW - surveillance
KW - viral infections
UR - http://www.scopus.com/inward/record.url?scp=85055077397&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055077397&partnerID=8YFLogxK
U2 - 10.2807/1560-7917.ES.2018.23.41.1700517
DO - 10.2807/1560-7917.ES.2018.23.41.1700517
M3 - Article
C2 - 30326991
AN - SCOPUS:85055077397
VL - 23
JO - Eurosurveillance
JF - Eurosurveillance
SN - 1560-7917
IS - 41
ER -