Phylogenetic and Case-Control Study on Hepatitis E Virus Infection in Germany

Background. Hepatitis E is a classic water-borne disease in developing countries. In Germany, hepatitis E virus (HEV) infections are notifiable. The number of non-travel-associated infections has increased in recent years, but the route of transmission in most is unknown. Our objective was to determ...

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Published in:The Journal of infectious diseases 2008-12, Vol.198 (12), p.1732-1741
Main Authors: Wichmann, Ole, Schimanski, Sven, Koch, Judith, Kohler, Martin, Rothe, Camilla, Plentz, Annelie, Jilg, Wolfgang, Stark, Klaus
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Case-Control Studies
Child
Epidemiology
Female
Fundamental and applied biological sciences. Psychology
Genotype
Genotypes
Germany - epidemiology
Hepatitis E
Hepatitis E - epidemiology
Hepatitis E - genetics
Hepatitis E virus
Hepatitis E virus - genetics
Human viral diseases
Humans
Infections
Infectious diseases
Liver
Male
Meats
Medical sciences
Microbiology
Middle Aged
Offal
Phylogeny
Polymerase chain reaction
Risk Factors
Swine
Travel
Viral diseases
Viral hepatitis
Viruses
Young Adult
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Summary:Background. Hepatitis E is a classic water-borne disease in developing countries. In Germany, hepatitis E virus (HEV) infections are notifiable. The number of non-travel-associated infections has increased in recent years, but the route of transmission in most is unknown. Our objective was to determine risk factors for autochthonous HEV infections in Germany. Methods. Cases of HEV met clinical definitions and were confirmed by laboratory analysis (defined as detection of HEV by polymerase chain reaction [PCR] or immunoglobulin M by serologic testing). PCR products from blood or stool samples were genotyped for phylogenetic analysis. A case-control study included case subjects with autochthonous HEV infection and matched control subjects who were randomly recruited from a population-based telephone list. Results. From May 2006 through August 2007, 76 of 96 persons for whom HEV infection had been reported to the routine surveillance system were interviewed. Sixty-six persons had disease that fulfilled the inclusion criteria: 45 (68%) had autochthonous infection, and 21 (32%) had travel-associated disease. Genotypes 3 or 4 were present in 15 of 15 persons with autochthonous infection, and genotype 1 was present in 8 of 9 persons with travel-associated infection. In conditional logistic regression involving 45 case subjects and 135 control subjects, consumption of offal (41% vs. 19%; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2–6.2) and wild-boar meat (20% vs. 7%; OR, 4.3; 95% CI, 1.2–15.9) were independently associated with autochthonous HEV infection. Conclusion. Hepatitis E is endemic in Germany and likely exists as a food-borne zoonosis. Implicated meat products should be investigated to provide recommendations for preventive measures.
ISSN:0022-1899
1537-6613
DOI:10.1086/593211