A case-control study into risk factors for acute hepatitis E in the Netherlands, 2015–2017. Issue 5 (May 2019)

• Record Type: Journal Article
• Authors: Tulen, Anna Dolores; Vennema, Harry; van Pelt, Wilfrid; Franz, Eelco; Hofhuis, Agnetha
• Is Part Of: Journal of infection. Volume 78:Issue 5(2019)
• Page Start: 373
• Page End: 381
• Publication Date: 2019-05
• Subjects: Hepatitis E virus -- Risk factors -- Transmission routes -- Host risk factors -- Zoonoses; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2019.02.001
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: A large patient-control study identified traditional Dutch dry raw sausages, called "cervelaat", "snijworst", "boerenmetworst" as the main transmission routes for hepatitis E virus to the general population of the Netherlands. The prevalence and cause of HEV contamination in these sausages of raw pork muscle meat require further investigation. Strong, yet rarely reported risk factors for acute hepatitis E were direct contact with pigs and working with a septic tank. Host risk factors were pre-existing liver disease, diabetes, and use of immunosuppressants or gastric acid inhibitors. Summary: Objectives: A case-control study was performed (2015–2017) to identify risk factors for acute hepatitis E in the Netherlands. Methods: A questionnaire on potential sources of hepatitis E virus (HEV) exposure, health and socio-demographics was completed by 376 patients with acute hepatitis E, and 1534 controls matched for age, gender and region of residence. Results: Traditional Dutch dry raw sausages of pork muscle meat, called "cervelaat", "snijworst", and "boerenmetworst" were reported by 72% of the patients, and 46% of controls (aOR 3.0; 95%CI 2.2–4.1), with a population attributable fraction (PAF) of 48%. Direct contact with pigs and working with a septic tank were strong risk factors (aOR 3.1; 95%CI 1.3–7.3 and aOR 6.9; 95%CI 1.2–40.8, respectively), with a low PAF (2% and 1%, respectively). Host risk factors were pre-existing liver disease (aOR 3.8; 95%CI 2.0–7.1), diabetes (aOR 2.1; 95%CI 1.4–3.2), immunosuppressive medication (aOR 2.5; 95%CI 1.5–4.1), and gastric acid inhibitors (aOR 2.3; 95%CI 1.7–3.1). Conclusions: Dry raw pork sausages were the major source of HEV infection among our study population. The prevalence and cause of HEV contamination in these pork muscle meat products require further investigation. Infrequently reported, yet strong risk factors were contact with pigs, or a septic tank.