2017-07-27 16:23:40
Hepatitis E is caused by a virus that is transmitted by the faecal-oral route, mainly present in countries with low levels of hygiene. However, since 2002, more and more cases have been described in industrialized countries in people who have never traveled to countries where the virus is actively circulating.
In France, hepatitis E is monitored by the National Reference Center (CNR) for entero-transmissible hepatitis. Since 2013, thanks to an improvement in the performance of diagnostic tests and increased vigilance by clinicians, approximately 2,000 symptomatic cases have been recorded each year, with more than 95% of autochthonous cases (www.cnrvha-vhe.org).
|
2006 |
2007 |
2008 |
2009 |
2010 |
2011 |
2012 |
2013 |
2014 |
2015 |
2016 |
||
|
NB 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 |
1012 |
1700 |
2150 |
2549 |
3429 |
17566 |
35416 |
44382 |
66000 |
76000 |
|
|
% positive cases among samples tested |
6,5 |
10,5 |
10,5 |
9,6 |
9,1 |
7,6 |
4,6 |
4,9 |
4,1 |
3,5 |
3, |
|
Main epidemiological data (data from the CNR VHE) – Updated: June 2017
What is hepatitis E?
Hepatitis E is an infectious disease caused by a virus (HEV) whose target organ is the liver. The disease has three forms:
Acute hepatitis E
The essential characteristic of acute hepatitis E is the high frequency of asymptomatic forms (> 70%). The symptomatic forms are more frequent in young adults (15-35 years) in countries with low levels of hygiene and in adults over 55 in industrialized countries. Severe complications (fulminant hepatitis) may occur.
Chronic hepatitis E
Chronic HEV infections more generally concern anyone with a deficient immune system.
Extrahepatic manifestations
Neurological damage has been observed during acute or chronic HEV infections in approximately 15% of cases. Kidney damage is also described.
How do we get infected?
The virus is transmitted mainly through food: consumption of undrinkable water (main route of contamination in countries with low levels of hygiene), products contaminated by contaminated water (shellfish, vegetables, fruits) or products from an animal carrying the virus: for example, meat and offal of wild boar, pork and deer eaten raw or undercooked. In France, it is mainly products made from raw pork liver that are implicated (liver sausages, dry liver, liver dumplings, figatelli, etc.).
Through their contact with live animals or their carcasses, some professionals are more exposed: pig farmers, veterinarians, hunters, people working in slaughterhouses.
Finally, transmission occurs exceptionally through biological products of human origin (such as blood transfusions or transplants).
The Agency’s recommendations
The Agency’s work led to the development of specific recommendations for the prevention of hepatitis E:
- wash hands, clean utensils and surfaces following handling raw pork liver;
- cook food sufficiently: cooking food at risk (figatelli, dry liver sausages, pâte à quenelle) intended to be eaten cooked.
These recommendations should be followed in particular for populations with a particular sensitivity to this virus: people on immunosuppressive treatment or with underlying liver disease and pregnant women.
- furthermore, the Agency recommends informing doctors and susceptible people of the risks associated with hepatitis E and the means of preventing this disease. If necessary, have a test carried out to verify the existence of immunity to the hepatitis E virus in these people, which would be followed, for non-immune people, by a warning, by the practitioner, on raw consumption of the products concerned;
- for workers in contact with carcasses or live animals, it is necessary to observe general hygiene measures and appropriate storage of animal waste and corpses;
- include legible and visible information on foods at risk, reminding consumers of the need for thorough cooking.
The role of the Agency
ANSES conducts research and risk assessment work on the subject.
The Agency participates in studies and research in the following areas:
- virus prevalence and zoonotic transmission risk assessment;
- virus dynamics from pig farms to the environment to shellfish;
- impact of cooking processes on the fate of the virus;
- development of analytical methods.
ANSES has issued several expert opinions and products relating to the assessment of the risk associated with the virus hepatitis E:
Photo credit: Jean-Yves Sgro
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