Hepatitis E | ANSES - National Agency for Food, Environmental and Occupational Health Safety

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 after 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.