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29. Nine-year nationwide environmental surveillance of hepatitis E virus in urban wastewaters in Italy (2011–2019)

Author

Iaconelli, M., Ferraro, G. B., Mancini, P., Suffredini, E., Veneri, C., Ciccaglione, A. R., Bruni, R., Libera, S. D., Bignami, F., Brambilla, M., De Medici, D., Brandtner, D., Schembri, P., D&apos, amato, S., and Rosa, G. L.

Subjects
Hepatitis E virus, PCR, Prevalence, Sequencing, Sewage, Typing, Environmental Monitoring, Humans, Italy, Phylogeny, RNA, Viral, Hepatitis E, Waste Water
Published
2020

37. Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016

Author

Alfonsi, V., Romano, L., Ciccaglione, A. R., La Rosa, G., Bruni, R., Zanetti, A., Libera, S. D., Iaconelli, M., Bagnarelli, P., Capobianchi, M. R., Garbuglia, A. R., Riccardo, F., Tosti, M. E., Ferrigno, L., Crateri, S., Galli, C., Tagliacarne, C., Giordani, M. T., Morelli, E., Vit, A., Bertin, T., Marinello, S., De Checchi, G., Zotti, C., Amprino, V., Rossati, A., Di Vito, A., Guidoni, C., Fiacchini, D., Marinelli, K., Loffredo, M., De Angelis, G., Citarella, A., and Megnia, A. S.

Subjects
0301 basic medicine, Swine, Sewage, Wastewater, medicine.disease_cause, Surveillance and Outbreak Report, 0302 clinical medicine, Hepatitis E virus, Epidemiology, Genotype, 80 and over, risk factors, 030212 general & internal medicine, Viral, Child, Phylogeny, Aged, 80 and over, Travel, Transmission (medicine), Middle Aged, Hepatitis E, 6. Clean water, 3. Good health, One Health, Italy, surveillance, RNA, Viral, epidemiology, Travel-Related Illness, Environmental Monitoring, Adult, medicine.medical_specialty, Adolescent, viral infections, Food Contamination, 03 medical and health sciences, Young Adult, Virology, Environmental health, medicine, Animals, Humans, Waste Water, Risk factor, Aged, business.industry, Public Health, Environmental and Occupational Health, medicine.disease, 030104 developmental biology, RNA, business
Abstract

Increasing numbers of hepatitis E cases are being reported in several European countries, including Italy, but the burden of hepatitis E virus (HEV) infection is largely unknown in the latter. To gain a better understanding of HEV epidemiology at national level in Italy, we piloted a strengthened and integrated human (epidemiological and virological) and environmental HEV surveillance system between 2012 and 2016. Over the 5-year period, 169 confirmed hepatitis E cases were identified, with a national annual incidence of 0.72 cases per 1,000,000. Of 65 HEV-RNA positive samples of sufficient quality for molecular analysis, 66% were genotype HEV3, 32% HEV1 and 1% HEV4. The most frequent risk factor reported by all HEV3 infected cases, was the consumption of undercooked pork and sausage. For the environmental surveillance, 679 urban sewage samples were collected from 53 wastewater treatment plants and HEV-RNA was detected in 38/679 of the samples. Among these, 25 (66%) were genotype HEV3 and the remaining were HEV1. We demonstrate that autochthonous transmission and environmental circulation of genotype HEV3 is adding to travel-related HEV transmission in Italy. We recommend the ‘One Health’ approach to integrated surveillance, and to include HEV-related messages within health information campaigns focussing on food security.

Published
2018

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