ECDC monitoring Hepatitis E cases in Europe

The European Centre for Disease Prevention and Control (ECDC) monitors the situation after some countries reported a spike in Hepatitis E infections.

In January 2024, 520 Hepatitis E virus (HEV) infections have been noted in 10 countries. No connection has yet been established between all these cases.

An increase was reported in Belgium, the Czech Republic, and Finland compared to the same time period in 2023. Patients in these countries had a median age of 59, 62, and 64, respectively, and two-thirds were male.

In Finland, 21 of 24 interviewed cases reported eating mettwurst or salami of various brands during the incubation period, raising a hypothesis of these types of meat products as possible vehicles of infection. Only Finland has revealed information about case interviews, so it is unclear if patients in other countries share the same consumption patterns.

The National Institute of Health and Welfare (THL) is investigating the increase in Finland. In 2023, there were 30 cases.

In Belgium, genotype 3c was the most frequently identified among patients with available information. Genotyping of the virus is ongoing in Finland and Spain. Past research has found HEV genotype 3 is mainly transmitted by consuming contaminated food from infected animals.

Cases by Country
HEV is not under EU-wide surveillance, so health officials said assessing whether the increase was unexpected was impossible.

More than 350 patients were reported in Germany, 63 in the Czech Republic, 38 in Finland, and 36 in Belgium.

The Netherlands had nine cases, Ireland, Denmark, and Spain had six, and Portugal, Estonia, and Sweden all had one. The Estonian case was travel-related, and the six Irish cases were identified by blood donation screening.

Cases of Hepatitis E are likely to continue to be recorded in Europe, according to officials. Further investigations, including patient interviews of exposures and sequencing analyses, are recommended to assess better the epidemiological situation, transmission routes, and potential cross-border threat, said ECDC.

Hepatitis E infection is a liver disease caused by the hepatitis E virus (HEV). Advice to avoid infection includes thoroughly cooking all meat, especially pork, before eating it and washing hands after touching uncooked meat or meat products.

The mean incubation period for HEV is five to six weeks, with a range of two to nine weeks, and can persist for one to four weeks. Symptoms include fatigue, poor appetite, stomach pain, nausea, and jaundice. However, some people, especially young children, have no symptoms.

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