Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016

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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.

Fingerprint

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

Keywords

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

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Virology

Cite this

@article{05008b7689c44ee68111781dbccda452,
title = "Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016",
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.",
keywords = "epidemiology, Hepatitis E, Italy, risk factors, surveillance, viral infections",
author = "Valeria Alfonsi and Luisa Roman{\`o} and Ciccaglione, {Anna Rita} and {La Rosa}, Giuseppina and Roberto Bruni and Alessandro Zanetti and {Della Libera}, Simonetta and Marcello Iaconelli and Patrizia Bagnarelli and Capobianchi, {Maria Rosaria} and Garbuglia, {Anna Rosa} and Flavia Riccardo and Tosti, {Maria Elena} and {Collaborating Group}, Group",
year = "2018",
month = "10",
day = "1",
doi = "10.2807/1560-7917.ES.2018.23.41.1700517",
language = "English",
volume = "23",
journal = "Eurosurveillance",
issn = "1560-7917",
publisher = "European Centre for Disease Prevention and Control (ECDC)",
number = "41",

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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

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U2 - 10.2807/1560-7917.ES.2018.23.41.1700517

DO - 10.2807/1560-7917.ES.2018.23.41.1700517

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JO - Eurosurveillance

JF - Eurosurveillance

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