1887
Surveillance Open Access
Like 0

Abstract

Background

Hepatitis E, a viral hepatitis caused mainly by the ingestion of raw or undercooked food, is not a notifiable disease in Spain.

Aim

To analyse the temporal trends, epidemiological characteristics and factors associated with severe disease from hepatitis E hospitalisations in Spain from 1997 to 2019.

Methods

Hospitalisation records were obtained from the Spanish National Hospital Discharge Database. Temporal trends and seasonality were analysed by Poisson regression in years 1997–2015 and 2016–19, given changes in hospital discharge databases. Multivariate logistic regression was used to identify factors associated with severe disease.

Results

Hepatitis E hospitalisation incidence increased from 0.22 cases per 1,000,000 inhabitants in 1997 to a maximum of 2.95 in 2018. Seasonality was observed during 2016–19 period, with more cases in the second and third quarters of the year. The incidence was higher in men vs women, and in the population aged over 40 years. Factors independently associated with death were age ≥ 50 years (adjusted odds ratio (aOR): 2.43), chronic liver disease (aOR: 4.29), HIV infection (aOR: 3.00) and hepatitis B/C (aOR: 2.11).

Conclusions

Hepatitis E hospitalisations have increased in Spain in recent years, being more severe in cases with older age, chronic hepatic diseases and HIV infection. A greater incidence in men over 40 years and a possible seasonality were observed. Further studies are needed to assess the seasonality, geographical distribution and impact of the disease to guide public health actions for prevention and control.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2024.29.43.2400118
2024-10-24
2024-10-28
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.43.2400118
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/29/43/eurosurv-29-43-1.html?itemId=/content/10.2807/1560-7917.ES.2024.29.43.2400118&mimeType=html&fmt=ahah

References

  1. Kamar N, Dalton HR, Abravanel F, Izopet J. Hepatitis E virus infection. Clin Microbiol Rev. 2014;27(1):116-38.  https://doi.org/10.1128/CMR.00057-13  PMID: 24396139 
  2. Kamar N, Marion O, Abravanel F, Izopet J, Dalton HR. Extrahepatic manifestations of hepatitis E virus. Liver Int. 2016;36(4):467-72.  https://doi.org/10.1111/liv.13037  PMID: 27005692 
  3. Fousekis FS, Mitselos IV, Christodoulou DK. Extrahepatic manifestations of hepatitis E virus: An overview. Clin Mol Hepatol. 2020;26(1):16-23.  https://doi.org/10.3350/cmh.2019.0082  PMID: 31601068 
  4. Aslan AT, Balaban HY. Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment. World J Gastroenterol. 2020;26(37):5543-60.  https://doi.org/10.3748/wjg.v26.i37.5543  PMID: 33071523 
  5. 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 
  6. Aspinall EJ, Couturier E, Faber M, Said B, Ijaz S, Tavoschi L, et al. Hepatitis E virus infection in Europe: surveillance and descriptive epidemiology of confirmed cases, 2005 to 2015. Euro Surveill. 2017;22(26):30561.  https://doi.org/10.2807/1560-7917.ES.2017.22.26.30561  PMID: 28681720 
  7. European Centre for Disease Prevention and Control (ECDC). Hepatitis E in the EU/EEA, 2005-2015. Stockholm: ECDC; 2017. Available from: https://www.ecdc.europa.eu/en/publications-data/hepatitis-e-eueea-2005-2015
  8. Ministerio de Sanidad, Servicios Sociales e Igualdad. Informe de hospitalización - CMBD – Registro de altas. Informe resumen 2014. [Hospitalisation report – CMBD – Discharge record. Summary report 2014]. Madrid. Ministerio de Sanidad, Servicios Sociales e Igualdad; 2016. Available from: https://www.sanidad.gob.es/estadEstudios/estadisticas/docs/CMBD_H__2014.pdf
  9. Boletín Oficial del Estado (BOE). Real Decreto 69/2015, de 6 de febrero, por el que se regula el Registro de Actividad de Atención Sanitaria Especializada. [Royal Decree 69/2015 of 6 February 2015, which regulates the Register of Specialized Health Care]. Madrid: Boletín Oficial del Estado (BOE); 2015. Spanish. Available from: https://www.boe.es/eli/es/rd/2015/02/06/69/con
  10. Centers for Disease Control and Prevention (CDC). International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Atlanta: CDC; 2004. Available from: https://archive.cdc.gov/www_cdc_gov/nchs/icd/icd9cm.htm
  11. World Health Organization (WHO). International Classification of Diseases (ICD-10-ES). 10th revision. Geneva: WHO; 2016. Available from: https://icd.who.int/browse10/2019/en#!
  12. National Statistics Institute (INE). Demografía y población. Estadística del Padrón continuo. Madrid: Ministry of Economic Affairs and Digital Transformation. [Accessed: 24 Feb 2022]. Available from: https://www.ine.es
  13. Suin V, Klamer SE, Hutse V, Wautier M, Jacques M, Abady M, et al. Epidemiology and genotype 3 subtype dynamics of hepatitis E virus in Belgium, 2010 to 2017. Euro Surveill. 2019;24(10):1800141.  https://doi.org/10.2807/1560-7917.ES.2019.24.10.1800141  PMID: 30862337 
  14. Oeser C, Vaughan A, Said B, Ijaz S, Tedder R, Haywood B, et al. Epidemiology of hepatitis E in England and Wales: a 10-year retrospective surveillance study, 2008-2017. J Infect Dis. 2019;220(5):802-10.  https://doi.org/10.1093/infdis/jiz207  PMID: 31107958 
  15. Limia Sánchez A, Olmedo Lucerón C. 2º Estudio de Seroprevalencia en España, 2017-2018. [2nd Seroprevalence Study in Spain, 2017-2018.] Rev Esp Salud Publica. 2021;95:e202103059. Spanish. PMID: 33734212 
  16. Jing W, Liu J, Liu M. The global trends and regional differences in incidence of HEV infection from 1990 to 2017 and implications for HEV prevention. Liver Int. 2021;41(1):58-69.  https://doi.org/10.1111/liv.14686  PMID: 33025620 
  17. European Association for the Study of the Liver.EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol. 2018;68(6):1256-71.  https://doi.org/10.1016/j.jhep.2018.03.005  PMID: 29609832 
  18. Portal Estadístico. Área de Inteligencia de Gestión. Consulta Interactiva del Sistema Nacional de Salud. Registro de Actividad de Atención Especializada – RAE-CMBD. Diagnósticos Hospitalización. [Statistical Portal. Area of Management Intelligence. Interactive consultation of the National Health System. Register of Specialized Health Care – RAE-CMBD. Hospitalisation Diagnoses]. Madrid. Ministerio de Sanidad. [Accessed: 25 Sep 2024]. Available from: https://pestadistico.inteligenciadegestion.sanidad.gob.es/publicoSNS/C/rae-cmbd/rae-cmbd/diagnosticos-hospitalizacion/diagnosticos-hospitalizacion
  19. Healy K, Freij U, Ellerstad M, Aulin LBS, Brückle L, Hillmering H, et al. Evaluating the prevalence of Hepatitis E virus infection in a large cohort of European blood donors, 2015-2018. J Viral Hepat. 2022;29(9):835-9.  https://doi.org/10.1111/jvh.13682  PMID: 35499211 
  20. Dalton HR, Stableforth W, Thurairajah P, Hazeldine S, Remnarace R, Usama W, et al. Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease. Eur J Gastroenterol Hepatol. 2008;20(8):784-90.  https://doi.org/10.1097/MEG.0b013e3282f5195a  PMID: 18617784 
  21. Woolson KL, Forbes A, Vine L, Beynon L, McElhinney L, Panayi V, et al. Extra-hepatic manifestations of autochthonous hepatitis E infection. Aliment Pharmacol Ther. 2014;40(11-12):1282-91.  https://doi.org/10.1111/apt.12986  PMID: 25303615 
  22. Abravanel F, Pique J, Couturier E, Nicot F, Dimeglio C, Lhomme S, et al. Acute hepatitis E in French patients and neurological manifestations. J Infect. 2018;77(3):220-6.  https://doi.org/10.1016/j.jinf.2018.06.007  PMID: 29966614 
  23. Pérez-García F, Vázquez-Morón S, Burgueño-García I, Muñoz-Gómez MJ, Zea-Sevilla MA, Calero M, et al. Hepatitis E virus seroprevalence is associated with neurodegenerative disorders in older people with dementia: a case-control study. J Infect Dis. 2023;227(7):873-7.  https://doi.org/10.1093/infdis/jiac268  PMID: 35759220 
  24. Lopez-Lopez P, Frias M, Camacho A, Rivero A, Rivero-Juarez A. Human immunodeficiency virus infected patients are not at higher risk for hepatitis E virus infection: a systematic review and meta-analysis. Microorganisms. 2019;7(12):618.  https://doi.org/10.3390/microorganisms7120618  PMID: 31779204 
  25. Hassing RJ, van der Eijk AA, Lopes VB, Snijdewind IJ, de Man RA, Pas SD, et al. Hepatitis E prevalence among HIV infected patients with elevated liver enzymes in the Netherlands. J Clin Virol. 2014;60(4):408-10.  https://doi.org/10.1016/j.jcv.2014.05.009  PMID: 24929755 
  26. Keane F, Gompels M, Bendall R, Drayton R, Jennings L, Black J, et al. Hepatitis E virus coinfection in patients with HIV infection. HIV Med. 2012;13(1):83-8.  https://doi.org/10.1111/j.1468-1293.2011.00942.x  PMID: 21819531 
  27. Alberts CJ, Schim van der Loeff MF, Sadik S, Zuure FR, Beune EJAJ, Prins M, et al. Hepatitis E virus seroprevalence and determinants in various study populations in the Netherlands. PLoS One. 2018;13(12):e0208522.  https://doi.org/10.1371/journal.pone.0208522  PMID: 30557324 
  28. Wasuwanich P, Ingviya T, Thawillarp S, Teshale EH, Kamili S, Crino JP, et al. Hepatitis E-associated hospitalizations in the United States: 2010-2015 and 2015-2017. J Viral Hepat. 2021;28(4):672-81.  https://doi.org/10.1111/jvh.13458  PMID: 33306246 
  29. Dalton HR, Hazeldine S, Banks M, Ijaz S, Bendall R. Locally acquired hepatitis E in chronic liver disease. Lancet. 2007;369(9569):1260.  https://doi.org/10.1016/S0140-6736(07)60595-9  PMID: 17434400 
  30. Choi JW, Son HJ, Lee SS, Jeon H, Cho JK, Kim HJ, et al. Acute hepatitis E virus superinfection increases mortality in patients with cirrhosis. BMC Infect Dis. 2022;22(1):62.  https://doi.org/10.1186/s12879-022-07050-w  PMID: 35042464 
  31. Qiu LX, Huang Y, Quan JL, Bi ZF, Zhong GH, Wang JY, et al. Prognosis of hepatitis E infection in patients with chronic liver disease: A meta-analysis. J Viral Hepat. 2023;30(2):101-7.  https://doi.org/10.1111/jvh.13754  PMID: 36177994 
  32. Nasir M, Wu GY. HEV and HBV Dual Infection: A Review. J Clin Transl Hepatol. 2020;8(3):313-21.  https://doi.org/10.14218/JCTH.2020.00030  PMID: 33083255 
  33. Severi E, Georgalis L, Pijnacker R, Veneti L, Turiac IA, Chiesa F, et al. Severity of the clinical presentation of hepatitis A in five European countries from 1995 to 2014. Int J Infect Dis. 2022;118:34-43.  https://doi.org/10.1016/j.ijid.2022.01.053  PMID: 35134558 
  34. von Felden J, Alric L, Pischke S, Aitken C, Schlabe S, Spengler U, et al. The burden of hepatitis E among patients with haematological malignancies: A retrospective European cohort study. J Hepatol. 2019;71(3):465-72.  https://doi.org/10.1016/j.jhep.2019.04.022  PMID: 31108159 
  35. Pas SD, de Man RA, Mulders C, Balk AHMM, van Hal PTW, Weimar W, et al. Hepatitis E virus infection among solid organ transplant recipients, the Netherlands. Emerg Infect Dis. 2012;18(5):869-72.  https://doi.org/10.3201/eid1805.111712  PMID: 22516170 
  36. Krumbholz A, Joel S, Dremsek P, Neubert A, Johne R, Dürrwald R, et al. Seroprevalence of hepatitis E virus (HEV) in humans living in high pig density areas of Germany. Med Microbiol Immunol. 2014;203(4):273-82.  https://doi.org/10.1007/s00430-014-0336-3  PMID: 24744181 
  37. Kogias D, Skeva A, Smyrlis A, Mourvati E, Kantartzi K, Romanidou G, et al. Hepatitis E virus (HEV) infection in hemodialysis patients: a multicenter epidemiological cohort study in North-Eastern Greece. Pathogens. 2023;12(5):667.  https://doi.org/10.3390/pathogens12050667  PMID: 37242337 
  38. Carpentier A, Chaussade H, Rigaud E, Rodriguez J, Berthault C, Boué F, et al. High hepatitis E virus seroprevalence in forestry workers and in wild boars in France. J Clin Microbiol. 2012;50(9):2888-93.  https://doi.org/10.1128/JCM.00989-12  PMID: 22718947 
  39. Smith I, Said B, Vaughan A, Haywood B, Ijaz S, Reynolds C, et al. Case-control study of risk factors for acquired hepatitis E virus infections in blood donors, United Kingdom, 2018-2019. Emerg Infect Dis. 2021;27(6):1654-61.  https://doi.org/10.3201/eid2706.203964  PMID: 34013866 
/content/10.2807/1560-7917.ES.2024.29.43.2400118
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