SlideShare una empresa de Scribd logo
1 de 22
Descargar para leer sin conexión
Hepatitis E
(Re-)Emerging in the Netherlands
Presented by Wilfrid van Pelt
CIb-RIVM
EPI Agnetha Hofhuis, Wilfrid van Pelt, Roan Pijnacker,
Rody Zuidema, Susan Hahné, Sofie Mooij
IDS Erwin Duizer, Harry Vennema
Z&O Saskia Rutjes, Martijn Bouwknegt
LCI Madelief Mollers, Jim van Steenbergen
NVWA (Dutch FSA) Aloys Tijsma, Ingeborg Boxman
Sanquin Hans Zaaijer, Boris Hogema
Anses (FR) Nicole Pavio
VVVL (BE) Isabel De Boosere
Bfr (DE) Reimar Johne
Acknowledgements
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
● Considered a travelers disease until the end of the last century
● 1 serotype, genotypes 1-4, with different transmissionroutes
Kamar et al. Lancet 2012; 379: 2477–88
Hepatitis E
Hepatitis E
Kamar et al. Lancet 2012; 379: 2477–88
● Liverinfection (O/B)
● Mostly asymptomatic, or
very mild complaints.
● Symptoms look like
hepatitis A:
jaundice, fever, abdominal
pain, fatigue…
● Underlying disease increases
risk symptomatic infection,
serious course and chronic
infection (GB, NA/PTS)
Guillain-Barré, Neuralgic amyotrophy/Parsonage-Turner S
●
Hepatitis E
(A) Acute icteric hepatitis
(B) Chronic infection
(C) Drug-induced injury
(D) Neurological injury
(E) Miscellaneous clinical
syndromes
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
Sanquin bloeddonor tests, 18-21 jaar, Hogema, 2014, Transfusion
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
HEV Inreasing in NL?
Virological laboratories 2012-2015 (patients)
Viremie Sanquin donoren
1:1800 (‘13) 1-800 (‘14,’15)
Viraemic Sanquin donors
1:1800 (‘13) 1-800 (‘14,’15)
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
HEV Inreasing in NL?
All large lab’s show
increase 2014
Many labs started in
2015 after joining
the Ca-Co study
0 50 100
Erasmus MC Rotterdam
Izore Friesland
LUMC
UMC Groningen
Streeklab Hengelo
UMC Utrecht
Vir Infectieziekten Groningen
HagaZiekenhuis
Veldhoven
Diakonessenhuis Utrecht
Streeklab Zeeland
Rijnstate Ziekenhuis Arnhem
VieCuri Venlo
UMC Nijmegen
Vumc
Maasstad Ziekenhuis Rdam
AZM Maastricht
MCH
GGD Amsterdam
AMC Adam
Streeklab Tilburg
SSDZ Delft
Laurentius Ziekenhuis Roermond 2012
2013
2014
2015
RIVM: all type 3
(3a,3c(mainly),3e,3f)
No regional clusters
No molecular clusters
HEV Inreasing in NL?
Seroprevalence
● Nederland
– Bloeddonors Sanquin 2012: 26,7% (23,6%-30,5%)
› 5239 sera
› Wantai anti-HEV IgG
– Livestock Farming & Resident Health Study (VGO), 2013-2014
› ~2500 sera residents
› Wantai anti-HEV IgG
› Preliminary seroprevalence 28,7%
● Europe
› Large differences, also dependent on assay
● France (october 2011)
› Dependent geography 20% - 71,3% Ariège Zuid Frankrijk
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
No association proximity of pig livestock farms
Age: OR 20-30yrs vs ≥60 yrs 5.43 [2.14-13.78]
Sex: OR Males vs Females 1.36 [1.16-1.64]
% HEV RNA positive donations in Europe
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
HEV RNA positive blood donors
a) Baylis,Vox 2012; b) Vollmer, JCM 2012; c) Slot, EuroSurv. 2013; d) Cleland, Vox 2013;
e) Hewitt, Lancet 2014; f) Gallian, EID 2014; g) Sauleda, Transfusion 2014; h) Fischer, PlosOne 2015;
i) Ikeda, ISS 2009; j) CBS Surveilance Report 2014;
k) pers. communication J.S. Epstein; l) Hogema, Transfusion 2015
What we know about sources in the Netherlands
● HEV RNA in animals
– Pigs (>90% seropositive; 50% RNA positive)
– Wild game, Veluwe (wild boar 25% seropositive, 8% RNA positive, deer lower)
– HEV RNA shown in oysters and mussels, Oosterschelde (5%)
› Other countries in oysters, mussels, cockles
– Not shown in faeces from muskrat (2007), veals (1999), dairy cattle (1999) and
poultry (1999)
● HEV RNA in food
– Pigmeat (6% in livers, 50% meats tested infectious, 2% meats in EU-study)
– Wildgame (prevalence in liver and meats <5% in NL, higher abroad)
– Raspberries (frozen) EU study (not NL) 3%
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
USA (Feagins et al., 2007) 11% RNA+; 2/3 infectious
The Netherlands (Bouwknegt et al., 2007) 6.5%
Japan (Yazaki et al., 2003) 1.9%
Korea (Jung et al., 2007) 10.8%
India (Kulkarni et al., 2008) 0.83%
France (Rose et al 2011) 4%
Germany (Wenzel JJ, 2011) 4%
Italy (Di Bartolo et al 2012) 6%
Canada (Wilhelm et al 2014) 3,5%
Pork Liver contaminated with HEV : grocery stores, slaughterhouse
USA 26% (Meng et al 2002)
Sweden 13% (Olsen et al 2006)
Moldavia 51.1% (Drobeniuc et al 2001)
The Netherlands 11% (Bouwknegt et al 2007)
France 44% (Chaussade et al 2013)
Germany 32 % (Krumbholz et al 2014)
Direct contact with infected animals. High HEV seroprevalence in personnel with
swine occupation (veterinarians, butchers, slaughterhouse).
Pork Liver sausages contaminated with HEV
France (Pavio et al 2014) 30%
Germany (Johne R communication) 25%
Italy (Di Bartolo et al 2014) 22%
Sources abroad
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
HEV RNA in the environment in the Netherlands
● Drinking water
HEV RNA shown in 2 water reservoirs with partly cleaned drinking water
● Sewage
– HEV RNA shown in slaughterhouse sewage
› Other countries in city sewages and sewage of pig farms
● Surfacewater
– In NL shown in the river Maas (17%)
› Other countries in irrigation water
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
Genetic relationship of HEV in the Netherlands
3c
3a
3f
3e
Prototype
Pig
Pig liver
Wild boar
Water
Human
Prototype
Pig
Pig liver
Wild boar
Water
Human
0 - 3 nt
4 - 11 nt
12 - 15 nt
16 - 20 nt
0 - 3 nt
4 - 11 nt
12 - 15 nt
16 - 20 nt
2004-2006
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
● HEV-infection is caused by consumption and/or direct or indirect
contact with specific (pig-)(meat-)products
Patient-Control studies
Working Hypothesis
Pilot patient-control comparison
(n=50 patients, n=147 age-sex matched control person (continuous survey))
● Patients predominantly middle aged man
● People with underlying disease more often get a symptomatic HEV
infection (Diabetes, Cardio-vascular disease, Immunodeficiency, Rheumatism)
● Medication, Meat and Food, Animal Contact: unclear
Riskfactor study, ideal
● Difference HEV IgM/PCR positive……IgG negatives
● Difference patients……asymptomatic viremic cases (medicatie-mod/cnt)
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
Vegetarians (bd 400) seroprevalence 15% lower at all ages (Sanquin p.c.)
Patients from 21 virological lab’s:
– Cases: HEV positive IgM or RNA Controls: HEV IgG negative
– June 2015 - june 2017
– Questionnair: from Laboratory –to- Treating Physician –to- Patient
– Sample: to RIVM for IgG testing and genotyping op IDS/VIR
– ~15 invitations / month Cases; ~30 invitations / month Controls
– ~50% expected respons
Participants from Livestock Farming & Resident Health Study (VGO)
– Cases: HEV positive IgG Controls: HEV IgG negative
– June 2013 - june 2014; 2500sera and questionnairs
Blood donors Sanquin (predominantly middle aged man)
– Cases: HEV positive IgG Controls: HEV IgG negative
– November 2015 (Februari 2016)
– 2500sera and questionnairs; 60% expected respons
Patient-Control studies
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
● Questionnair: Complaints, Medication (pig derived) Medical history, General
health, SES, Education, Age, Residence
– Exposure (2month before illness):
 travel history  fruit & vegetables profession
 meat consumption  eating outside outdoor activities
 shellfish/crustacean  water contact
 rawmilk products  animal contact
Extra Controls from the general population
– No serological testing
– 100 invitations / month, general control study
Pig meat products
in high detail
Patient-Control studies
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
“Hide(meat) Glue”
●Used for glueing pieces of meat:
› Steaks, Ham, Beefsteak, Pork tenderloin
●Thrombine and Fibrinogen derived from Cattle/Pig blood.
Dutch FSA approved animals (not-tested for HEV)
●No HEV-inactivating production step
●Endproduct not tested for HEV
●Risk-control: now (erronously) retailer/consumer
●Mandatory on productwrapper “Pig Protein” “Varkenseiwit”
●Production 2014: 175.000 kg
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
Spray Dried Porcine Plasma (SDPP)
● Hide (meat) Glue ≠ SDPP
● SDPP production (spray drying ~15 seconds 220 – 80 C):
Inactivation HEV?
● SDPP is used for:
● binding fats and water
● colouring food products
● Animal feed (piglets)
● Total production 2014 SDPP (1 big producer):
13.000.000 kg
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
Spray Dried Porcine Plasma (SDPP)
● Pujols et al. Virology Journal 2014, 11:232:
› 100 % tested SDPP batches HEV AB present
› 22,4% HEV RNA +
› HEV RNA in SDPP batches fed to pigs: no HEV seroconversion…….
– Meaning for Hide/Meat Glue and other pig blood derived
products?
Action plan Dutch FSA, Hide Glue:
●HEV incorporating in the “foodsafetyplan”
●Monitoring-project, starting in 2016
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
Recent (re-)emerging of Hepatitis E cases in the Netherlands,
among blood donors as well
HEV RNA is present / found in the Netherlands in:
› domestic pigs and wild boars in NL
› meat products: pigmeat and wildgame in NL
› Sewage, surface water and drinking water in NL
Unknown:
› Why HEV is increasing in humans
› Role Hide/Meat Glue and SDPP in foods
› Relative importance of different transmission pathways (env/food)
› Risk factors for developing clinical disease (also dose-resp)
› Inactivation of HEV in foods
› Stability/Infectivity of HEV in food. Infectivity testing is difficult
Conclusions
ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015

Más contenido relacionado

La actualidad más candente

Hepatitis E virus infection, France, 2002-2015
Hepatitis E virus infection, France, 2002-2015Hepatitis E virus infection, France, 2002-2015
Hepatitis E virus infection, France, 2002-2015Cornelia Adlhoch
 
Hepatitis E Virus in England and Wales
Hepatitis E Virus in England and WalesHepatitis E Virus in England and Wales
Hepatitis E Virus in England and WalesCornelia Adlhoch
 
HEV surveillance in EU/EEA, 2015
HEV surveillance in EU/EEA, 2015HEV surveillance in EU/EEA, 2015
HEV surveillance in EU/EEA, 2015Cornelia Adlhoch
 
Hepatitis E infections in Hungary, 2002-2014
Hepatitis E infections in Hungary, 2002-2014Hepatitis E infections in Hungary, 2002-2014
Hepatitis E infections in Hungary, 2002-2014Cornelia Adlhoch
 
Microbiology of hepatitis e virus
Microbiology of hepatitis e virusMicrobiology of hepatitis e virus
Microbiology of hepatitis e virusMadiha Ahmed
 
Investigating Foodborne Illness Outbreaks With Attorney William Marler
Investigating Foodborne Illness Outbreaks With Attorney William MarlerInvestigating Foodborne Illness Outbreaks With Attorney William Marler
Investigating Foodborne Illness Outbreaks With Attorney William MarlerBill Marler
 
Hepatitis C Research Gaps - Graham Cooke
Hepatitis C Research Gaps - Graham CookeHepatitis C Research Gaps - Graham Cooke
Hepatitis C Research Gaps - Graham CookeReShape
 
Epidemiology of Hepatitis C Virus in Egypt; an overview
Epidemiology of Hepatitis C Virus in Egypt; an overviewEpidemiology of Hepatitis C Virus in Egypt; an overview
Epidemiology of Hepatitis C Virus in Egypt; an overviewMahmoud Elzalabany
 
Hiv recent guidelines naco 2015
Hiv recent guidelines naco 2015Hiv recent guidelines naco 2015
Hiv recent guidelines naco 2015Mehakinder Singh
 
DGH Lecture Series: Judd Walson
DGH Lecture Series: Judd WalsonDGH Lecture Series: Judd Walson
DGH Lecture Series: Judd WalsonUWGlobalHealth
 
Understanding Hiv Diagnostics And Lab Tests
Understanding Hiv Diagnostics And Lab TestsUnderstanding Hiv Diagnostics And Lab Tests
Understanding Hiv Diagnostics And Lab Testsarthur_smith
 
H I V/ T B CO INFECTION A CASE PRESENTATION
H I V/ T B  CO INFECTION A CASE PRESENTATIONH I V/ T B  CO INFECTION A CASE PRESENTATION
H I V/ T B CO INFECTION A CASE PRESENTATIONFarouq Dayyab
 
Hepatitis C in Egypt
Hepatitis C in EgyptHepatitis C in Egypt
Hepatitis C in Egyptahmedicine
 

La actualidad más candente (20)

Hepatitis E virus infection, France, 2002-2015
Hepatitis E virus infection, France, 2002-2015Hepatitis E virus infection, France, 2002-2015
Hepatitis E virus infection, France, 2002-2015
 
Hepatitis E Virus in England and Wales
Hepatitis E Virus in England and WalesHepatitis E Virus in England and Wales
Hepatitis E Virus in England and Wales
 
HEV surveillance in EU/EEA, 2015
HEV surveillance in EU/EEA, 2015HEV surveillance in EU/EEA, 2015
HEV surveillance in EU/EEA, 2015
 
Hepatitis E infections in Hungary, 2002-2014
Hepatitis E infections in Hungary, 2002-2014Hepatitis E infections in Hungary, 2002-2014
Hepatitis E infections in Hungary, 2002-2014
 
Hepatitis E in Ireland
Hepatitis E in Ireland Hepatitis E in Ireland
Hepatitis E in Ireland
 
HEV
HEVHEV
HEV
 
04.09.21 | Making Sense of the COVID-19 Data in Persons with HIV
04.09.21 | Making Sense of the COVID-19 Data in Persons with HIV04.09.21 | Making Sense of the COVID-19 Data in Persons with HIV
04.09.21 | Making Sense of the COVID-19 Data in Persons with HIV
 
Microbiology of hepatitis e virus
Microbiology of hepatitis e virusMicrobiology of hepatitis e virus
Microbiology of hepatitis e virus
 
Knowledge about hiv aids among nurses [compatibility mode]
Knowledge about hiv aids among nurses [compatibility mode]Knowledge about hiv aids among nurses [compatibility mode]
Knowledge about hiv aids among nurses [compatibility mode]
 
HIV and Hepatitis C by Dr Alison Ratcliff
HIV and Hepatitis C by Dr Alison RatcliffHIV and Hepatitis C by Dr Alison Ratcliff
HIV and Hepatitis C by Dr Alison Ratcliff
 
Investigating Foodborne Illness Outbreaks With Attorney William Marler
Investigating Foodborne Illness Outbreaks With Attorney William MarlerInvestigating Foodborne Illness Outbreaks With Attorney William Marler
Investigating Foodborne Illness Outbreaks With Attorney William Marler
 
Hepatitis C Research Gaps - Graham Cooke
Hepatitis C Research Gaps - Graham CookeHepatitis C Research Gaps - Graham Cooke
Hepatitis C Research Gaps - Graham Cooke
 
Epidemiology of Hepatitis C Virus in Egypt; an overview
Epidemiology of Hepatitis C Virus in Egypt; an overviewEpidemiology of Hepatitis C Virus in Egypt; an overview
Epidemiology of Hepatitis C Virus in Egypt; an overview
 
HEPATITIS B AND C PRESENTATION
HEPATITIS B AND C PRESENTATION HEPATITIS B AND C PRESENTATION
HEPATITIS B AND C PRESENTATION
 
Hiv recent guidelines naco 2015
Hiv recent guidelines naco 2015Hiv recent guidelines naco 2015
Hiv recent guidelines naco 2015
 
DGH Lecture Series: Judd Walson
DGH Lecture Series: Judd WalsonDGH Lecture Series: Judd Walson
DGH Lecture Series: Judd Walson
 
Understanding Hiv Diagnostics And Lab Tests
Understanding Hiv Diagnostics And Lab TestsUnderstanding Hiv Diagnostics And Lab Tests
Understanding Hiv Diagnostics And Lab Tests
 
H I V/ T B CO INFECTION A CASE PRESENTATION
H I V/ T B  CO INFECTION A CASE PRESENTATIONH I V/ T B  CO INFECTION A CASE PRESENTATION
H I V/ T B CO INFECTION A CASE PRESENTATION
 
Hepatitis C in Egypt
Hepatitis C in EgyptHepatitis C in Egypt
Hepatitis C in Egypt
 
Solid Organ Transplantation and HIV
Solid Organ Transplantation and HIVSolid Organ Transplantation and HIV
Solid Organ Transplantation and HIV
 

Similar a Hepatitis E virus in the Netherlands

Hepatitis E in the Netherlands, November 2018
Hepatitis E in the Netherlands, November 2018Hepatitis E in the Netherlands, November 2018
Hepatitis E in the Netherlands, November 2018AgnethaRIVM1
 
Liver Transplantation in the setting of HIV infection
Liver Transplantation in the setting of HIV infectionLiver Transplantation in the setting of HIV infection
Liver Transplantation in the setting of HIV infectionEric Vibert, MD, PhD
 
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...
Сравнение  режимов лечения ВИЧ в  разрезе различных клинических сценариев.ART...Сравнение  режимов лечения ВИЧ в  разрезе различных клинических сценариев.ART...
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...hivlifeinfo
 
Aavellon ecdchev spain
Aavellon ecdchev spainAavellon ecdchev spain
Aavellon ecdchev spainAna Avellón
 
Fungal Research Trust 20th Anniversary Meeting June 2011 - Dr Sue Howard
Fungal Research Trust 20th Anniversary Meeting June 2011 - Dr Sue HowardFungal Research Trust 20th Anniversary Meeting June 2011 - Dr Sue Howard
Fungal Research Trust 20th Anniversary Meeting June 2011 - Dr Sue HowardGraham Atherton
 
Andres Diaz - Dynamics of swine influenza in a wean-finish population
Andres Diaz - Dynamics of swine influenza in a wean-finish populationAndres Diaz - Dynamics of swine influenza in a wean-finish population
Andres Diaz - Dynamics of swine influenza in a wean-finish populationJohn Blue
 
Enterovirus D68: an underestimated pathogen - Prof. Niesters
Enterovirus D68: an underestimated pathogen - Prof. NiestersEnterovirus D68: an underestimated pathogen - Prof. Niesters
Enterovirus D68: an underestimated pathogen - Prof. NiestersWAidid
 
Dr. Pedro Urriola - Survival And Mitigation Strategies Of PEDv & Deltacorona ...
Dr. Pedro Urriola - Survival And Mitigation Strategies Of PEDv & Deltacorona ...Dr. Pedro Urriola - Survival And Mitigation Strategies Of PEDv & Deltacorona ...
Dr. Pedro Urriola - Survival And Mitigation Strategies Of PEDv & Deltacorona ...John Blue
 

Similar a Hepatitis E virus in the Netherlands (20)

Hepatitis E in the Netherlands, November 2018
Hepatitis E in the Netherlands, November 2018Hepatitis E in the Netherlands, November 2018
Hepatitis E in the Netherlands, November 2018
 
HEV and Blood Donations
HEV and Blood DonationsHEV and Blood Donations
HEV and Blood Donations
 
Hepatitis D and E: The Forgotten Viruses
Hepatitis D and E: The Forgotten VirusesHepatitis D and E: The Forgotten Viruses
Hepatitis D and E: The Forgotten Viruses
 
Liver Transplantation in the setting of HIV infection
Liver Transplantation in the setting of HIV infectionLiver Transplantation in the setting of HIV infection
Liver Transplantation in the setting of HIV infection
 
HIV/HCV Co-Infection: The Journey of a Special Population
HIV/HCV Co-Infection: The Journey of a Special PopulationHIV/HCV Co-Infection: The Journey of a Special Population
HIV/HCV Co-Infection: The Journey of a Special Population
 
Hepatitis E
Hepatitis EHepatitis E
Hepatitis E
 
Hiv
HivHiv
Hiv
 
Viral hepatitis 2014
Viral hepatitis 2014Viral hepatitis 2014
Viral hepatitis 2014
 
Viral hepatitis 2013
Viral hepatitis 2013Viral hepatitis 2013
Viral hepatitis 2013
 
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...
Сравнение  режимов лечения ВИЧ в  разрезе различных клинических сценариев.ART...Сравнение  режимов лечения ВИЧ в  разрезе различных клинических сценариев.ART...
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...
 
Paul McKeown (Head GZV, HPSC)
Paul McKeown (Head GZV, HPSC)  Paul McKeown (Head GZV, HPSC)
Paul McKeown (Head GZV, HPSC)
 
Aavellon ecdchev spain
Aavellon ecdchev spainAavellon ecdchev spain
Aavellon ecdchev spain
 
Viral markers
Viral markersViral markers
Viral markers
 
Fungal Research Trust 20th Anniversary Meeting June 2011 - Dr Sue Howard
Fungal Research Trust 20th Anniversary Meeting June 2011 - Dr Sue HowardFungal Research Trust 20th Anniversary Meeting June 2011 - Dr Sue Howard
Fungal Research Trust 20th Anniversary Meeting June 2011 - Dr Sue Howard
 
Recurring hepatitis A outbreaks in the EU/EEA: summary of the recommendations...
Recurring hepatitis A outbreaks in the EU/EEA: summary of the recommendations...Recurring hepatitis A outbreaks in the EU/EEA: summary of the recommendations...
Recurring hepatitis A outbreaks in the EU/EEA: summary of the recommendations...
 
Hev in holland 2018
Hev in holland 2018Hev in holland 2018
Hev in holland 2018
 
Viral Hepatitis Viral Hepatitis
Viral Hepatitis 	 Viral HepatitisViral Hepatitis 	 Viral Hepatitis
Viral Hepatitis Viral Hepatitis
 
Andres Diaz - Dynamics of swine influenza in a wean-finish population
Andres Diaz - Dynamics of swine influenza in a wean-finish populationAndres Diaz - Dynamics of swine influenza in a wean-finish population
Andres Diaz - Dynamics of swine influenza in a wean-finish population
 
Enterovirus D68: an underestimated pathogen - Prof. Niesters
Enterovirus D68: an underestimated pathogen - Prof. NiestersEnterovirus D68: an underestimated pathogen - Prof. Niesters
Enterovirus D68: an underestimated pathogen - Prof. Niesters
 
Dr. Pedro Urriola - Survival And Mitigation Strategies Of PEDv & Deltacorona ...
Dr. Pedro Urriola - Survival And Mitigation Strategies Of PEDv & Deltacorona ...Dr. Pedro Urriola - Survival And Mitigation Strategies Of PEDv & Deltacorona ...
Dr. Pedro Urriola - Survival And Mitigation Strategies Of PEDv & Deltacorona ...
 

Más de Cornelia Adlhoch

ECDC_intro_hev_meeting_nov2018
ECDC_intro_hev_meeting_nov2018ECDC_intro_hev_meeting_nov2018
ECDC_intro_hev_meeting_nov2018Cornelia Adlhoch
 
Risk factor analysis influenza
Risk factor analysis influenzaRisk factor analysis influenza
Risk factor analysis influenzaCornelia Adlhoch
 
Intensive care surveillance of influenza, 11 countries, 2009-2016
Intensive care surveillance of influenza, 11 countries, 2009-2016Intensive care surveillance of influenza, 11 countries, 2009-2016
Intensive care surveillance of influenza, 11 countries, 2009-2016Cornelia Adlhoch
 
EU control strategy for avian influenza
EU control strategy for avian influenzaEU control strategy for avian influenza
EU control strategy for avian influenzaCornelia Adlhoch
 
Avian influenza in the Netherlands
Avian influenza in the NetherlandsAvian influenza in the Netherlands
Avian influenza in the NetherlandsCornelia Adlhoch
 
Avian influenza viruses, a serious threat to human health, Bulgaria
Avian influenza viruses, a serious threat to human health, BulgariaAvian influenza viruses, a serious threat to human health, Bulgaria
Avian influenza viruses, a serious threat to human health, BulgariaCornelia Adlhoch
 
Avian influenza detections and management in Bulgaria
Avian influenza detections and management in BulgariaAvian influenza detections and management in Bulgaria
Avian influenza detections and management in BulgariaCornelia Adlhoch
 
Outbreak of avian influenza A(H5N8) in Hungary
Outbreak of avian influenza A(H5N8) in HungaryOutbreak of avian influenza A(H5N8) in Hungary
Outbreak of avian influenza A(H5N8) in HungaryCornelia Adlhoch
 
Decision cross border health threats intersectoral collaboration
Decision cross border health threats intersectoral collaborationDecision cross border health threats intersectoral collaboration
Decision cross border health threats intersectoral collaborationCornelia Adlhoch
 
Hev risk hide glue and spray dried porcine plasma
Hev risk hide glue and spray dried porcine plasmaHev risk hide glue and spray dried porcine plasma
Hev risk hide glue and spray dried porcine plasmaCornelia Adlhoch
 
Avian influenza workshop 2015_ecdc
Avian influenza workshop 2015_ecdcAvian influenza workshop 2015_ecdc
Avian influenza workshop 2015_ecdcCornelia Adlhoch
 

Más de Cornelia Adlhoch (12)

ECDC_intro_hev_meeting_nov2018
ECDC_intro_hev_meeting_nov2018ECDC_intro_hev_meeting_nov2018
ECDC_intro_hev_meeting_nov2018
 
Risk factor analysis influenza
Risk factor analysis influenzaRisk factor analysis influenza
Risk factor analysis influenza
 
Intensive care surveillance of influenza, 11 countries, 2009-2016
Intensive care surveillance of influenza, 11 countries, 2009-2016Intensive care surveillance of influenza, 11 countries, 2009-2016
Intensive care surveillance of influenza, 11 countries, 2009-2016
 
EU control strategy for avian influenza
EU control strategy for avian influenzaEU control strategy for avian influenza
EU control strategy for avian influenza
 
Avian influenza in the Netherlands
Avian influenza in the NetherlandsAvian influenza in the Netherlands
Avian influenza in the Netherlands
 
Avian influenza viruses, a serious threat to human health, Bulgaria
Avian influenza viruses, a serious threat to human health, BulgariaAvian influenza viruses, a serious threat to human health, Bulgaria
Avian influenza viruses, a serious threat to human health, Bulgaria
 
Avian influenza detections and management in Bulgaria
Avian influenza detections and management in BulgariaAvian influenza detections and management in Bulgaria
Avian influenza detections and management in Bulgaria
 
Outbreak of avian influenza A(H5N8) in Hungary
Outbreak of avian influenza A(H5N8) in HungaryOutbreak of avian influenza A(H5N8) in Hungary
Outbreak of avian influenza A(H5N8) in Hungary
 
HPAIV H5N8 in Sweden
HPAIV H5N8 in SwedenHPAIV H5N8 in Sweden
HPAIV H5N8 in Sweden
 
Decision cross border health threats intersectoral collaboration
Decision cross border health threats intersectoral collaborationDecision cross border health threats intersectoral collaboration
Decision cross border health threats intersectoral collaboration
 
Hev risk hide glue and spray dried porcine plasma
Hev risk hide glue and spray dried porcine plasmaHev risk hide glue and spray dried porcine plasma
Hev risk hide glue and spray dried porcine plasma
 
Avian influenza workshop 2015_ecdc
Avian influenza workshop 2015_ecdcAvian influenza workshop 2015_ecdc
Avian influenza workshop 2015_ecdc
 

Último

CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 

Último (20)

CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 

Hepatitis E virus in the Netherlands

  • 1. Hepatitis E (Re-)Emerging in the Netherlands Presented by Wilfrid van Pelt
  • 2. CIb-RIVM EPI Agnetha Hofhuis, Wilfrid van Pelt, Roan Pijnacker, Rody Zuidema, Susan Hahné, Sofie Mooij IDS Erwin Duizer, Harry Vennema Z&O Saskia Rutjes, Martijn Bouwknegt LCI Madelief Mollers, Jim van Steenbergen NVWA (Dutch FSA) Aloys Tijsma, Ingeborg Boxman Sanquin Hans Zaaijer, Boris Hogema Anses (FR) Nicole Pavio VVVL (BE) Isabel De Boosere Bfr (DE) Reimar Johne Acknowledgements ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 3. ● Considered a travelers disease until the end of the last century ● 1 serotype, genotypes 1-4, with different transmissionroutes Kamar et al. Lancet 2012; 379: 2477–88 Hepatitis E
  • 5. Kamar et al. Lancet 2012; 379: 2477–88 ● Liverinfection (O/B) ● Mostly asymptomatic, or very mild complaints. ● Symptoms look like hepatitis A: jaundice, fever, abdominal pain, fatigue… ● Underlying disease increases risk symptomatic infection, serious course and chronic infection (GB, NA/PTS) Guillain-Barré, Neuralgic amyotrophy/Parsonage-Turner S ● Hepatitis E (A) Acute icteric hepatitis (B) Chronic infection (C) Drug-induced injury (D) Neurological injury (E) Miscellaneous clinical syndromes ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 6. Sanquin bloeddonor tests, 18-21 jaar, Hogema, 2014, Transfusion ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015 HEV Inreasing in NL?
  • 7. Virological laboratories 2012-2015 (patients) Viremie Sanquin donoren 1:1800 (‘13) 1-800 (‘14,’15) Viraemic Sanquin donors 1:1800 (‘13) 1-800 (‘14,’15) ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015 HEV Inreasing in NL?
  • 8. All large lab’s show increase 2014 Many labs started in 2015 after joining the Ca-Co study 0 50 100 Erasmus MC Rotterdam Izore Friesland LUMC UMC Groningen Streeklab Hengelo UMC Utrecht Vir Infectieziekten Groningen HagaZiekenhuis Veldhoven Diakonessenhuis Utrecht Streeklab Zeeland Rijnstate Ziekenhuis Arnhem VieCuri Venlo UMC Nijmegen Vumc Maasstad Ziekenhuis Rdam AZM Maastricht MCH GGD Amsterdam AMC Adam Streeklab Tilburg SSDZ Delft Laurentius Ziekenhuis Roermond 2012 2013 2014 2015 RIVM: all type 3 (3a,3c(mainly),3e,3f) No regional clusters No molecular clusters HEV Inreasing in NL?
  • 9. Seroprevalence ● Nederland – Bloeddonors Sanquin 2012: 26,7% (23,6%-30,5%) › 5239 sera › Wantai anti-HEV IgG – Livestock Farming & Resident Health Study (VGO), 2013-2014 › ~2500 sera residents › Wantai anti-HEV IgG › Preliminary seroprevalence 28,7% ● Europe › Large differences, also dependent on assay ● France (october 2011) › Dependent geography 20% - 71,3% Ariège Zuid Frankrijk ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015 No association proximity of pig livestock farms Age: OR 20-30yrs vs ≥60 yrs 5.43 [2.14-13.78] Sex: OR Males vs Females 1.36 [1.16-1.64]
  • 10. % HEV RNA positive donations in Europe ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 11. HEV RNA positive blood donors a) Baylis,Vox 2012; b) Vollmer, JCM 2012; c) Slot, EuroSurv. 2013; d) Cleland, Vox 2013; e) Hewitt, Lancet 2014; f) Gallian, EID 2014; g) Sauleda, Transfusion 2014; h) Fischer, PlosOne 2015; i) Ikeda, ISS 2009; j) CBS Surveilance Report 2014; k) pers. communication J.S. Epstein; l) Hogema, Transfusion 2015
  • 12. What we know about sources in the Netherlands ● HEV RNA in animals – Pigs (>90% seropositive; 50% RNA positive) – Wild game, Veluwe (wild boar 25% seropositive, 8% RNA positive, deer lower) – HEV RNA shown in oysters and mussels, Oosterschelde (5%) › Other countries in oysters, mussels, cockles – Not shown in faeces from muskrat (2007), veals (1999), dairy cattle (1999) and poultry (1999) ● HEV RNA in food – Pigmeat (6% in livers, 50% meats tested infectious, 2% meats in EU-study) – Wildgame (prevalence in liver and meats <5% in NL, higher abroad) – Raspberries (frozen) EU study (not NL) 3% ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 13. USA (Feagins et al., 2007) 11% RNA+; 2/3 infectious The Netherlands (Bouwknegt et al., 2007) 6.5% Japan (Yazaki et al., 2003) 1.9% Korea (Jung et al., 2007) 10.8% India (Kulkarni et al., 2008) 0.83% France (Rose et al 2011) 4% Germany (Wenzel JJ, 2011) 4% Italy (Di Bartolo et al 2012) 6% Canada (Wilhelm et al 2014) 3,5% Pork Liver contaminated with HEV : grocery stores, slaughterhouse USA 26% (Meng et al 2002) Sweden 13% (Olsen et al 2006) Moldavia 51.1% (Drobeniuc et al 2001) The Netherlands 11% (Bouwknegt et al 2007) France 44% (Chaussade et al 2013) Germany 32 % (Krumbholz et al 2014) Direct contact with infected animals. High HEV seroprevalence in personnel with swine occupation (veterinarians, butchers, slaughterhouse). Pork Liver sausages contaminated with HEV France (Pavio et al 2014) 30% Germany (Johne R communication) 25% Italy (Di Bartolo et al 2014) 22% Sources abroad ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 14. HEV RNA in the environment in the Netherlands ● Drinking water HEV RNA shown in 2 water reservoirs with partly cleaned drinking water ● Sewage – HEV RNA shown in slaughterhouse sewage › Other countries in city sewages and sewage of pig farms ● Surfacewater – In NL shown in the river Maas (17%) › Other countries in irrigation water ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 15. Genetic relationship of HEV in the Netherlands 3c 3a 3f 3e Prototype Pig Pig liver Wild boar Water Human Prototype Pig Pig liver Wild boar Water Human 0 - 3 nt 4 - 11 nt 12 - 15 nt 16 - 20 nt 0 - 3 nt 4 - 11 nt 12 - 15 nt 16 - 20 nt 2004-2006 ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 16. ● HEV-infection is caused by consumption and/or direct or indirect contact with specific (pig-)(meat-)products Patient-Control studies Working Hypothesis Pilot patient-control comparison (n=50 patients, n=147 age-sex matched control person (continuous survey)) ● Patients predominantly middle aged man ● People with underlying disease more often get a symptomatic HEV infection (Diabetes, Cardio-vascular disease, Immunodeficiency, Rheumatism) ● Medication, Meat and Food, Animal Contact: unclear Riskfactor study, ideal ● Difference HEV IgM/PCR positive……IgG negatives ● Difference patients……asymptomatic viremic cases (medicatie-mod/cnt) ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015 Vegetarians (bd 400) seroprevalence 15% lower at all ages (Sanquin p.c.)
  • 17. Patients from 21 virological lab’s: – Cases: HEV positive IgM or RNA Controls: HEV IgG negative – June 2015 - june 2017 – Questionnair: from Laboratory –to- Treating Physician –to- Patient – Sample: to RIVM for IgG testing and genotyping op IDS/VIR – ~15 invitations / month Cases; ~30 invitations / month Controls – ~50% expected respons Participants from Livestock Farming & Resident Health Study (VGO) – Cases: HEV positive IgG Controls: HEV IgG negative – June 2013 - june 2014; 2500sera and questionnairs Blood donors Sanquin (predominantly middle aged man) – Cases: HEV positive IgG Controls: HEV IgG negative – November 2015 (Februari 2016) – 2500sera and questionnairs; 60% expected respons Patient-Control studies ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 18. ● Questionnair: Complaints, Medication (pig derived) Medical history, General health, SES, Education, Age, Residence – Exposure (2month before illness):  travel history  fruit & vegetables profession  meat consumption  eating outside outdoor activities  shellfish/crustacean  water contact  rawmilk products  animal contact Extra Controls from the general population – No serological testing – 100 invitations / month, general control study Pig meat products in high detail Patient-Control studies ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 19. “Hide(meat) Glue” ●Used for glueing pieces of meat: › Steaks, Ham, Beefsteak, Pork tenderloin ●Thrombine and Fibrinogen derived from Cattle/Pig blood. Dutch FSA approved animals (not-tested for HEV) ●No HEV-inactivating production step ●Endproduct not tested for HEV ●Risk-control: now (erronously) retailer/consumer ●Mandatory on productwrapper “Pig Protein” “Varkenseiwit” ●Production 2014: 175.000 kg ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 20. Spray Dried Porcine Plasma (SDPP) ● Hide (meat) Glue ≠ SDPP ● SDPP production (spray drying ~15 seconds 220 – 80 C): Inactivation HEV? ● SDPP is used for: ● binding fats and water ● colouring food products ● Animal feed (piglets) ● Total production 2014 SDPP (1 big producer): 13.000.000 kg ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 21. Spray Dried Porcine Plasma (SDPP) ● Pujols et al. Virology Journal 2014, 11:232: › 100 % tested SDPP batches HEV AB present › 22,4% HEV RNA + › HEV RNA in SDPP batches fed to pigs: no HEV seroconversion……. – Meaning for Hide/Meat Glue and other pig blood derived products? Action plan Dutch FSA, Hide Glue: ●HEV incorporating in the “foodsafetyplan” ●Monitoring-project, starting in 2016 ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015
  • 22. Recent (re-)emerging of Hepatitis E cases in the Netherlands, among blood donors as well HEV RNA is present / found in the Netherlands in: › domestic pigs and wild boars in NL › meat products: pigmeat and wildgame in NL › Sewage, surface water and drinking water in NL Unknown: › Why HEV is increasing in humans › Role Hide/Meat Glue and SDPP in foods › Relative importance of different transmission pathways (env/food) › Risk factors for developing clinical disease (also dose-resp) › Inactivation of HEV in foods › Stability/Infectivity of HEV in food. Infectivity testing is difficult Conclusions ECDC- HEV-Exp meeting , Stockholm, 9,10 Dec 2015