1887
Research Open Access
Like 0

Abstract

Background

In high-income countries, hepatitis E virus (HEV) infection is mainly a zoonosis. However, it is also transfusion-transmissible and some countries, but not Italy, have introduced HEV screening for blood donations.

Aim

We assessed HEV infection prevalence and risk factors in a nationwide sample of Italian blood donors.

Methods

We selected 107 blood establishments (BE) distributed in the 20 Italian regions by a stratified two-stage design and invited them to participate in the study. Donors were tested for anti-HEV IgG and IgM and HEV RNA. Sociodemographic data and risk factors were collected through a questionnaire.

Results

Overall, 60 BE from 60 provinces in 19 Italian regions joined the study. We assessed HEV markers in 7,172 blood donors, of whom 6,235 completed the questionnaire. Overall crude and adjusted anti-HEV IgG prevalences were 8.3% and 5.5%, respectively. Overall anti-HEV IgM prevalence was 0.5%, while no blood donor was HEV RNA-positive. Anti-HEV IgG prevalence varied widely among regions (range: 1.3%–27.20%) and hyperendemic prevalences (> 40%) were detected in some provinces in two regions. Older age (AOR = 1.81; 95% CI: 1.36–2.41), foreign nationality (AOR = 2.77; 95% CI: 1.06–7.24), eating raw pork liver sausages (AOR = 2.23; 95% CI: 1.55–3.20) and raw homemade sausages (AOR = 3.63; 95% CI: 2.50–5.24) were independent infection predictors.

Conclusion

Italian blood donors showed a low to moderate HEV seroprevalence. High levels in some regions and/or provinces were mainly attributable to eating habits. Prevention should include avoiding consumption of raw or undercooked meat and safe production of commercial pork products.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2022.27.22.2100516
2022-06-02
2024-11-22
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.22.2100516
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/27/22/eurosurv-27-22-8.html?itemId=/content/10.2807/1560-7917.ES.2022.27.22.2100516&mimeType=html&fmt=ahah

References

  1. Primadharsini PP, Nagashima S, Okamoto H. Genetic variability and evolution of hepatitis E virus. Viruses. 2019;11(5):456.  https://doi.org/10.3390/v11050456  PMID: 31109076 
  2. Lee GH, Tan BH, Teo EC, Lim SG, Dan YY, Wee A, et al. Chronic infection with camelid hepatitis E virus in a liver transplant recipient who regularly consumes camel meat and milk. Gastroenterology. 2016;150(2):355-7.e3.  https://doi.org/10.1053/j.gastro.2015.10.048  PMID: 26551551 
  3. Donnelly MC, Scobie L, Crossan CL, Dalton H, Hayes PC, Simpson KJ. Review article: hepatitis E-a concise review of virology, epidemiology, clinical presentation and therapy. Aliment Pharmacol Ther. 2017;46(2):126-41.  https://doi.org/10.1111/apt.14109  PMID: 28449246 
  4. Kamar N, Izopet J, Pavio N, Aggarwal R, Labrique A, Wedemeyer H, et al. Hepatitis E virus infection. Nat Rev Dis Primers. 2017;3(1):17086.  https://doi.org/10.1038/nrdp.2017.86  PMID: 29154369 
  5. Izopet J, Tremeaux P, Marion O, Migueres M, Capelli N, Chapuy-Regaud S, et al. Hepatitis E virus infections in Europe. J Clin Virol. 2019;120:20-6.  https://doi.org/10.1016/j.jcv.2019.09.004  PMID: 31536936 
  6. Hartl J, Otto B, Madden RG, Webb G, Woolson KL, Kriston L, et al. Hepatitis E seroprevalence in Europe: a meta-analysis. Viruses. 2016;8(8):E211.  https://doi.org/10.3390/v8080211  PMID: 27509518 
  7. Capai L, Falchi A, Charrel R. Meta-analysis of human IgG anti-HEV seroprevalence in industrialized countries and a review of literature. Viruses. 2019;11(1):84.  https://doi.org/10.3390/v11010084  PMID: 30669517 
  8. Spada E, Pupella S, Pisani G, Bruni R, Chionne P, Madonna E, et al. A nationwide retrospective study on prevalence of hepatitis E virus infection in Italian blood donors. Blood Transfus. 2018;16(5):413-21. PMID: 29757135 
  9. Boland F, Martinez A, Pomeroy L, O’Flaherty N. Blood donor screening for hepatitis E Virus in the European Union. Transfus Med Hemother. 2019;46(2):95-103.  https://doi.org/10.1159/000499121  PMID: 31191195 
  10. Galli C, Fomiatti L, Tagliacarne C, Velati C, Zanetti AR, Castaldi S, et al. Seroprevalence of hepatitis E virus among blood donors in northern Italy (Sondrio, Lombardy) determined by three different assays. Blood Transfus. 2017;15(6):502-5. PMID: 29059041 
  11. Lucarelli C, Spada E, Taliani G, Chionne P, Madonna E, Marcantonio C, et al. High prevalence of anti-hepatitis E virus antibodies among blood donors in central Italy, February to March 2014. Euro Surveill. 2016;21(30):30299.  https://doi.org/10.2807/1560-7917.ES.2016.21.30.30299  PMID: 27494608 
  12. Mansuy JM, Gallian P, Dimeglio C, Saune K, Arnaud C, Pelletier B, et al. A nationwide survey of hepatitis E viral infection in French blood donors. Hepatology. 2016;63(4):1145-54.  https://doi.org/10.1002/hep.28436  PMID: 27008201 
  13. Holm DK, Moessner BK, Engle RE, Zaaijer HL, Georgsen J, Purcell RH, et al. Declining prevalence of hepatitis E antibodies among Danish blood donors. Transfusion. 2015;55(7):1662-7.  https://doi.org/10.1111/trf.13028  PMID: 25819381 
  14. Capai L, Masse S, Gallian P, Souty C, Isnard C, Blanchon T, et al. Seroprevalence study of anti-HEV IgG among different adult populations in Corsica, France, 2019. Microorganisms. 2019;7(10):460.  https://doi.org/10.3390/microorganisms7100460  PMID: 31623185 
  15. Grabarczyk P, Sulkowska E, Gdowska J, Kopacz A, Liszewski G, Kubicka-Russel D, et al. Molecular and serological infection marker screening in blood donors indicates high endemicity of hepatitis E virus in Poland. Transfusion. 2018;58(5):1245-53.  https://doi.org/10.1111/trf.14531  PMID: 29492976 
  16. Slot E, Hogema BM, Riezebos-Brilman A, Kok TM, Molier M, Zaaijer HL. Silent hepatitis E virus infection in Dutch blood donors, 2011 to 2012. Euro Surveill. 2013;18(31):20550.  https://doi.org/10.2807/1560-7917.ES2013.18.31.20550  PMID: 23929229 
  17. Mooij SH, Hogema BM, Tulen AD, van Pelt W, Franz E, Zaaijer HL, et al. Risk factors for hepatitis E virus seropositivity in Dutch blood donors. BMC Infect Dis. 2018;18(1):173.  https://doi.org/10.1186/s12879-018-3078-9  PMID: 29653521 
  18. Niederhauser C, Widmer N, Hotz M, Tinguely C, Fontana S, Allemann G, et al. Current hepatitis E virus seroprevalence in Swiss blood donors and apparent decline from 1997 to 2016. Euro Surveill. 2018;23(35):1700616.  https://doi.org/10.2807/1560-7917.ES.2018.23.35.1700616  PMID: 30180927 
  19. Sauleda S, Ong E, Bes M, Janssen A, Cory R, Babizki M, et al. Seroprevalence of hepatitis E virus (HEV) and detection of HEV RNA with a transcription-mediated amplification assay in blood donors from Catalonia (Spain). Transfusion. 2015;55(5):972-9.  https://doi.org/10.1111/trf.12929  PMID: 25403913 
  20. Holm DK, Moessner BK, Engle RE, Zaaijer HL, Georgsen J, Purcell RH, et al. Declining prevalence of hepatitis E antibodies among Danish blood donors. Transfusion. 2015;55(7):1662-7.  https://doi.org/10.1111/trf.13028  PMID: 25819381 
  21. Lange H, Øverbø J, Borgen K, Dudman S, Hoddevik G, Urdahl AM, et al. Hepatitis E in Norway: seroprevalence in humans and swine. Epidemiol Infect. 2017;145(1):181-6.  https://doi.org/10.1017/S0950268816002144  PMID: 27671461 
  22. Bendall R, Ellis V, Ijaz S, Ali R, Dalton H. A comparison of two commercially available anti-HEV IgG kits and a re-evaluation of anti-HEV IgG seroprevalence data in developed countries. J Med Virol. 2010;82(5):799-805.  https://doi.org/10.1002/jmv.21656  PMID: 20336757 
  23. Beale MA, Tettmar K, Szypulska R, Tedder RS, Ijaz S. Is there evidence of recent hepatitis E virus infection in English and North Welsh blood donors? Vox Sang. 2011;100(3):340-2.  https://doi.org/10.1111/j.1423-0410.2010.01412.x  PMID: 21392024 
  24. Fischer C, Hofmann M, Danzer M, Hofer K, Kaar J, Gabriel C. Seroprevalence and Incidence of hepatitis E in blood donors in Upper Austria. PLoS One. 2015;10(3):e0119576.  https://doi.org/10.1371/journal.pone.0119576  PMID: 25751574 
  25. Thom K, Gilhooly P, McGowan K, Malloy K, Jarvis LM, Crossan C, et al. Hepatitis E virus (HEV) in Scotland: evidence of recent increase in viral circulation in humans. Euro Surveill. 2018;23(12):17-00174.  https://doi.org/10.2807/1560-7917.ES.2018.23.12.17-00174  PMID: 29589577 
  26. O’Riordan J, Boland F, Williams P, Donnellan J, Hogema BM, Ijaz S, et al. Hepatitis E virus infection in the Irish blood donor population. Transfusion. 2016;56(11):2868-76.  https://doi.org/10.1111/trf.13757  PMID: 27522065 
  27. Mansuy JM, Saune K, Rech H, Abravanel F, Mengelle C, L Homme S, et al. Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011. Euro Surveill. 2015;20(19):21127.  https://doi.org/10.2807/1560-7917.ES2015.20.19.21127  PMID: 25990359 
  28. Mansuy JM, Bendall R, Legrand-Abravanel F, Sauné K, Miédouge M, Ellis V, et al. Hepatitis E virus antibodies in blood donors, France. Emerg Infect Dis. 2011;17(12):2309-12.  https://doi.org/10.3201/eid1712.110371  PMID: 22172156 
  29. Marcantonio C, Pezzotti P, Bruni R, Taliani G, Chionne P, Madonna E, et al. Incidence of hepatitis E virus infection among blood donors in a high endemic area of Central Italy. J Viral Hepat. 2019;26(4):506-12. PMID: 30548124 
  30. Feng Y, Feng YM, Wang S, Xu F, Zhang X, Zhang C, et al. High seroprevalence of hepatitis E virus in the ethnic minority populations in Yunnan, China. PLoS One. 2018;13(5):e0197577.  https://doi.org/10.1371/journal.pone.0197577  PMID: 29787589 
  31. Colson P, Borentain P, Queyriaux B, Kaba M, Moal V, Gallian P, et al. Pig liver sausage as a source of hepatitis E virus transmission to humans. J Infect Dis. 2010;202(6):825-34.  https://doi.org/10.1086/655898  PMID: 20695796 
  32. Faber M, Askar M, Stark K. Case-control study on risk factors for acute hepatitis E in Germany, 2012 to 2014. Euro Surveill. 2018;23(19):17-00469.  https://doi.org/10.2807/1560-7917.ES.2018.23.19.17-00469  PMID: 29766841 
  33. Feurer C, Le Roux A, Rossel R, Barnaud E, Dumarest M, Garry P, et al. High load of hepatitis E viral RNA in pork livers but absence in pork muscle at French slaughterhouses. Int J Food Microbiol. 2018;264:25-30.  https://doi.org/10.1016/j.ijfoodmicro.2017.10.013  PMID: 29107193 
  34. Alfonsi V, Romanò L, Ciccaglione AR, La Rosa G, Bruni R, Zanetti A, et al. Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016. Euro Surveill. 2018;23(41):1700517.  https://doi.org/10.2807/1560-7917.ES.2018.23.41.1700517  PMID: 30326991 
  35. Ricci A, Allende A, Bolton D, Chemaly M, Davies R, Fernandez Escamez PS, et al. Public health risks associated with hepatitis E virus (HEV) as a food-borne pathogen. EFSA J. 2017;15(7):e04886. PMID: 32625551 
  36. Schielke A, Ibrahim V, Czogiel I, Faber M, Schrader C, Dremsek P, et al. Hepatitis E virus antibody prevalence in hunters from a district in Central Germany, 2013: a cross-sectional study providing evidence for the benefit of protective gloves during disembowelling of wild boars. BMC Infect Dis. 2015;15(1):440.  https://doi.org/10.1186/s12879-015-1199-y  PMID: 26493830 
  37. Baumann-Popczyk A, Popczyk B, Gołąb E, Rożej-Bielicka W, Sadkowska-Todys M. A cross-sectional study among Polish hunters: seroprevalence of hepatitis E and the analysis of factors contributing to HEV infections. Med Microbiol Immunol (Berl). 2017;206(5):367-78.  https://doi.org/10.1007/s00430-017-0515-0  PMID: 28776194 
  38. Italian Institute for Environmental Protection and Research (ISPRA). Cinghiali: tutti ne parlano e ormai sono quasi tendenza - Intervista ad esperto Ispra. [Wild boars: everyone is talking about them and by now they are almost a trend - Interview with an Ispra expert]. Rome: ISPRA. [Accessed:20 Nov 2021]. Available from: https://www.isprambiente.gov.it/it/archivio/notizie-e-novita-normative/notizie-ispra/2019/09/cinghiali-tutti-ne-parlano-e-ormai-sono-quasi-tendenza-intervista-a-esperto-ispra
  39. Jori F, Laval M, Maestrini O, Casabianca F, Charrier F, Pavio N. Assessment of domestic pigs, wild boars and feral hybrid pigs as reservoirs of hepatitis E virus in Corsica, France. Viruses. 2016;8(8):236.  https://doi.org/10.3390/v8080236  PMID: 27556478 
  40. Iacolina L, Pertoldi C, Amills M, Kusza S, Megens HJ, Bâlteanu VA, et al. Hotspots of recent hybridization between pigs and wild boars in Europe. Sci Rep. 2018;8(1):17372.  https://doi.org/10.1038/s41598-018-35865-8  PMID: 30478374 
  41. Iaconelli M, Bonanno Ferraro G, Mancini P, Suffredini E, Veneri C, Ciccaglione AR, et al. Nine-year nationwide environmental surveillance of hepatitis E virus in urban wastewaters in Italy (2011-2019). Int J Environ Res Public Health. 2020;17(6):2059.  https://doi.org/10.3390/ijerph17062059  PMID: 32244915 
  42. La Rosa G, Proroga YTR, De Medici D, Capuano F, Iaconelli M, Della Libera S, et al. First detection of hepatitis E virus in shellfish and in seawater from production areas in southern Italy. Food Environ Virol. 2018;10(1):127-31.  https://doi.org/10.1007/s12560-017-9319-z  PMID: 28956272 
  43. Kokkinos P, Kozyra I, Lazic S, Söderberg K, Vasickova P, Bouwknegt M, et al. Virological quality of irrigation water in leafy green vegetables and berry fruits production chains. Food Environ Virol. 2017;9(1):72-8.  https://doi.org/10.1007/s12560-016-9264-2  PMID: 27709435 
  44. Salvador D, Neto C, Benoliel MJ, Caeiro MF. Assessment of the presence of hepatitis E virus in surface water and drinking water in Portugal. Microorganisms. 2020;8(5):761.  https://doi.org/10.3390/microorganisms8050761  PMID: 32438739 
/content/10.2807/1560-7917.ES.2022.27.22.2100516
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error