Hepatitis E
Identity card of the disease
Hepatitis E is usually a benign disease, but can sometimes lead to serious complications that may be fatal (particularly in susceptible populations, such as pregnant women or individuals with liver disease). ANSES was asked in 2009 to assess the role of certain food products in its transmission. It published several opinions and scientific assessment of the risks related to the hepatitis E virus.
Hepatitis E is caused by a virus that is transmitted by the faecal-oral route, and mainly occurs in countries with poor hygiene. However, since 2002, increasing numbers of cases have been reported in industrialised countries in people who have never travelled to countries where the virus circulates actively.
In France, the National Reference Centre (NRC) for entero-transmissible hepatitis monitors hepatitis E. Since 2013, thanks to an improvement in the performance of diagnostic tests and increased vigilance by clinicians, approximately 2000 symptomatic cases have been recorded each year, with more than 95% being indigenous cases (www.cnrvha-vhe.org).
| 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of certain or probable cases | Indigenous | 24 | 97 | 159 | 183 | 216 | 249 | 801 | 1848 | 1813 | 2118 | 2292 |
Imported | 14 | 10 | 21 | 23 | 16 | 19 | 9 | 3 | 12 | 4 | 10 | |
Total | 38 | 107 | 180 | 206 | 232 | 268 | 810 | 1851 | 1825 | 2122 | 2302 | |
Number of patients tested | 583 | 1,012 | 1,700 | 2,150 | 2,549 | 3,429 | 17,566 | 35,416 | 44,382 | 66,000 | 76,000 | |
% of patients testing positive | 6.5 | 10.5 | 10.5 | 9.6 | 9.1 | 7.6 | 4.6 | 4.9 | 4.1 | 3.5 | 3.0 | |
What is hepatitis E ?
Hepatitis E is an infectious disease caused by a virus (HEV) whose target organ is the liver. The disease can take three forms.
Acute hepatitis E
Acute hepatitis E is in most cases asymptomatic (>70%). The symptomatic forms are more frequent among younger adults (15-35 years) in countries with poor hygiene, and in adults over the age of 55 in industrialized countries. Severe complications (fulminant hepatitis) can occur.
Chronic hepatitis E
Chronic infections with HEV particularly concern anyone whose immune system is deficient.
Extra-hepatic manifestations
Neurological disorders have been observed in the course of acute or chronic HEV infections in approximately 15% of cases. Kidney disorders have also been described.
How does disease transmission occur?
Transmission of the virus mainly occurs via food: consumption of contaminated water (the main route of contamination in countries with poor hygiene), products contaminated by polluted water (shellfish, vegetables, fruit) or products derived from animalscarrying the virus: for example, meat and offal from wild boar, pork and venison consumed raw or insufficiently cooked. In France, the most frequently incriminated products are those derived from raw pork (liver sausage, dried liver, liver dumplings, figatelli, etc.).
Some workers are more exposed through contact with live animals or animal carcasses: pig farmers, veterinarians, hunters, or slaughterhouse workers.
Lastly, transmission can occur exceptionally via biological products of human origin (such as during blood transfusion or organ transplants).
The Agency's recommendations
As a result of its work, the Agency has drawn up specific recommendations for the prevention of hepatitis E:
- wash hands and clean utensils and working surfaces after handling raw pork liver;
- ensure that foods are sufficiently cooked: risky foods intended to be consumed cooked (figatelli, dried liver sausage, liver dumplings) must be cooked thoroughly.
These recommendations should be followed with great care by population groups with a particular susceptibility to this virus: people taking immunosuppressant medicines or with underlying liver conditions, and pregnant women.
- in addition, the Agency recommends informing doctors and susceptible subjects about the risk related to hepatitis E and the means of preventing this disease. Screening could potentially be considered to test for immunity to hepatitis E for these subjects so that those found not to be immune could receive information from their doctor on how to prevent exposure through consumption of raw products;
- for workers coming into contact with carcasses or live animals, appropriate measures should be applied regarding general hygiene and the storage of waste and of dead animals;
- clear and understandable information should be displayed on all risky products, reminding consumers of the need to cook the above listed products thoroughly.
The Agency's role
ANSES carries out research and risk assessments on this subject.
The Agency participates in research and investigations in the following areas:
- the prevalence of the virus and assessment of the risk of zoonotic transmission;
- the dynamics of the virus's circulation from pig farms to the environment, including shellfish;
- the impact of cooking processes on the survival of the virus;
- the development of analytical methods.
ANSES has published several opinions and expert appraisals concerning assessment of the risks related to the hepatitis E virus:
- Anses opinion of 2012 (PDF);
- AFSSA Opinion of 30 April 2009 regarding the risk of human infection with the hepatitis E virus (HEV) after ingestion of figatelli (raw sausages containing pork liver) (PDF);
- AFSSA Opinion of 23 September 2009 regarding the hepatitis E virus: methods for detection, risks to the consumer and risks to the environment (PDF);
- data sheet on foodborne microbial hazards concerning the hepatitis E virus dated November 2010 (PDF).
Photo Credit: Jean-Yves Sgro