• A case-control study into risk factors for acute hepatitis E in the Netherlands, 2015-2017.

      Tulen, Anna Dolores; Vennema, Harry; van Pelt, Wilfrid; Franz, Eelco; Hofhuis, Agnetha (2019-02-08)
      A case-control study was performed (2015-2017) to identify risk factors for acute hepatitis E in the Netherlands. 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. 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). 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.
    • Monitoring of pork liver and meat products on the Dutch market for the presence of HEV RNA.

      Boxman, Ingeborg L A; Jansen, Claudia C C; Hägele, Geke; Zwartkruis-Nahuis, Ans; Tijsma, Aloys S L; Vennema, Harry (2019-05-02)
      The aim of the present study was to assess pork liver and meat products present on the Dutch market for the presence of hepatitis E virus (HEV) RNA. HEV RNA was detected in 27.3% of 521 products sampled from Dutch retail stores in 2016. 12.7% of livers were positive for HEV RNA (n = 79), 70.7% of liverwurst (n = 99), 68.9% of liver pate (n = 90), but in none of the pork chops (n = 98), fresh sausages (n = 103) or wild boar meat (n = 52). The highest level of HEV RNA contamination was observed in a liver (reaching up to 1 × 10
    • Porcine blood used as ingredient in meat productions may serve as a vehicle for hepatitis E virus transmission.

      Boxman, Ingeborg L A; Jansen, Claudia C C; Hägele, Geke; Zwartkruis-Nahuis, Ans; Cremer, Jeroen; Vennema, Harry; Tijsma, Aloys S L (2017-09-18)
      The aim of the present study was to investigate whether the use of porcine blood(products) in food could be a risk for a hepatitis E virus (HEV) infection. HEV RNA was detected in 33/36 batches of (non-heated) liquid products and in 7/24 spray dried powder products. Contamination levels varied among the products, but were highest in liquid whole blood, plasma and fibrinogen reaching levels of 2.2×102 to 2.8×102 HEV genome copies per 0.2g. Sequence analyses revealed genotype 3 strains, of which two were 100% (493nt) identical to recently diagnosed HEV cases, although no direct epidemiological link was established. The industry provided information on processing of blood products in (ready-to-eat)-meat. From this, it was concluded that blood products as an ingredient of processed meat may not be sufficiently heated prior to consumption, and therefore could be a vehicle for transmission.