Eurosurveillance - Volume 29, Issue 43, 24 October 2024

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

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

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.

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).

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.

The first wave of the COVID-19 pandemic in 2020 was largely mitigated by limiting contacts in the general population. In early 2022, most contact-reducing measures were lifted.

To assess whether the population has reverted to pre-pandemic contact behaviour and how this would affect transmission potential of a newly emerging pathogen.

We compared two studies on contact behaviour in the Netherlands: the PIENTER Corona study, conducted during and after the pandemic (held every 2–6 months from April 2020) and the PIENTER3 study (2016–17, as pre-pandemic baseline). In both, participants (ages 1–85 years) reported number and age group of all face-to-face persons contacted on the previous day in a survey. Transmission potential was examined using the next-generation matrix approach.

We found an average of 15.4 (95% CI: 14.3–16.4) community contacts per person per day after the pandemic in May 2023, 13% lower than baseline (17.8; 95% CI: 17.0–18.5). Among all ages, children (5–9 years) had the highest number of contacts, both pre- and post-pandemic. Mainly adults aged 20–59 years had not reverted to pre-pandemic behaviours, possibly because they more often work from home. Although the number of contacts is lower compared to the pre-pandemic period, the effect on transmission potential of a newly emerging respiratory pathogen is limited if all age groups were equally susceptible.

Continuous monitoring of contacts can signal changes in contact patterns and can define a ‘new normal’ baseline. Both aspects are needed to prepare for a future pandemic.