Hepatitis E virus epidemiology: follow up of an emerging food-borne zoonosis in Belgium [HEV EPI]

Last updated on 22-1-2019 by Aurélie Felice


Thomas Vanwolleghem
Wim van der Poel

In short

Infection by the hepatitis E virus (HEV) is a worldwide cause of viral hepatitis and a major public health concern. There are more and more indications that HEV causes an emerging food-borne infection in Western countries. HEV belongs to the Genus Orthohepevirus from the Familia Hepeviridae. Historically, hepatitis E was typically recognised as a waterborne disease in developing countries. Genotype 1 is responsible for most of the endemic cases of HEV in Asia and Africa. Genotype 2 is prevalent in Central Africa and Central America. Both genotypes are mainly transmitted via contaminated water and the oro-faecal route. In Western countries, genotypes 1 and 2 infections are considered as import infections related to travel to endemic regions. Genotypes 3 and 4 have been found on all continents, except South America and Antarctica. They are transmitted by animals. In 2008, the first case of chronic hepatitis E was reported in Europe and since then, chronic infections have increasingly been documented in immune compromised solid-organ transplant recipients, HIV-infected individuals and patients under chemotherapeutic treatment. Infection may be asymptomatic or cause an acute self-limiting hepatitis, but may become chronic in a small number of cases, particularly among those who are immunosuppressed or who have pre-existing liver disease. The seroprevalence in blood donors from Western countries ranges from 2 to 49 %. In the USA, a higher prevalence has been observed in persons working with swine. HEV RNA has also been detected in healthy populations from many European and non-European countries. HEV transmission by blood transfusion has also been described. Domestic swine and wild boar are considered as HEV reservoirs in Europe. There is emerging evidence that HEV is an under-recognised cause of disease in high-income countries and that the incidence of HEV infections has been steadily increasing over the last decade.

Project summary

The epidemiology of HEV infections in Belgium is not well described, and the zoonotic aspects were only recently recognised. In this project, we examine the epidemiology of HEV in Belgium. We monitor the number of laboratory confirmed cases, HEV IgG seropositivity, HEV genotypes, seasonal variation, age and gender distributions in collaboration with Belgian hospitals and international networks.

More specifically we:

  • work together with the CovetLab joint research network to elucidate which gt3/gt4 HEV strains are currently predominant in swine and humans in Northwestern European countries (2015-2017)
  • assess the burden of Hepatitis E virus infection in patients with rheumatic diseases (collaboration with Ghent University, 2015-2017)
  • determine the seroprevalence of Hepatitis E virus in subjects attending a sexually transmitted infection clinic in Brussels city (collaboration with CHU St-Pierre, 2016-2017).
  • determine the overall seroprevalence of HEV in the Belgian general population (collaboration with Epidemiology of Infectious diseases, Sciensano, 2016-2018)
  • compare the evolution of the age-specific seroprevalence of HEV in Belgium between 2006 and 2013 (collaboration with Antwerp University Hospital, 2018-2019)

Associated Health Topics

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