Hepatitis Eand what we know about the situation in

Denmark

Steen Ethelberg

Statens Serum InstitutSenior Researcher, Head of unit

set@ssi.dk

This short presentation…

• Limited amount of data ~15 pub papers

I’ll go through:

• Surveillance

• Data on number of cases

• Animal and environmental studies

• Serological population studies.

HEV in DK

• Hepatitis E virus infections have so far not

been high on the agenda in Denmark

• Not notifiable

• …. But will be from next year!

• Only lab diagnosing is at the SSI

• Awareness probably limited among clinicians.

HEV diagnostic in Denmark

• Diagnosed in Denmark since 2000

• From 2000 to 2009 the samples were sent to

Smidttskytsinstituttet in Sweden

• Published case series (1993-2007):

Since 2010 diagnosed at SSI

Median age 43 years; Male gender 50.1%

Data: Hanne Thang Vestergaard, Vir Dept, SSI

Test/

patient

2010 2011 2012 2013 2014* Total

Patients

tested

302 293 340 475 162 1572

Samples

tested

327 426 473 635 234 2095

1st IgM

pos

9 21 13 21 9 73

1st IgG

pos

29 40 39 57 24 189

Pos IgM,

IgG and

PCR

4 13 7 6 2 32

Animal and environmental studies

Breum SØ, Hjulsager CK, de Deus N, Segalés J, Larsen LE.

Hepatitis E virus is highly prevalent in the Danish pig

population.

Vet Microbiol. 2010 Krog JS, Breum SØ, Jensen TH, Larsen LE.

Hepatitis E virus variant in farmed mink, Denmark.

Emerg Infect Dis. 2013 Krog JS, Larsen LE, Schultz AC:

Enteric porcine viruses in farmed shellfish in Denmark.

Int J Food Microbiol. 2014 Krog JS et al

Leaching of viruses naturally occurring in pig slurry to

field drains and their correlations with other

microorganisms. Submitted

• Faecal samples from 97 pigs, 1–5 months of age

• Analysed for HEV RNA with RT-PCR assay

• HEV prevalence: 55% and 50% for herds and animals, respectively.

• Sow herds: IgG prevalence of 92% ; correspond to 73% of the sows.

Seroprevalence studies

1. Christensen PB, Engle RE, Jacobsen SE, Krarup HB, Georgsen J, Purcell RH.

High prevalence of hepatitis E antibodies among Danish

prisoners and drug users. J Med Virol. 20022. Christensen PB, Engle RE, Hjort C, Homburg KM, Vach W, Georgsen J,

Purcell RH.

Time trend of the prevalence of hepatitis E antibodies

among farmers and blood donors: a potential zoonosis in

Denmark.

Clin Infect Dis. 20083. Holm DK, Moessner BK, Engle RE, Zaaijer HL, Georgsen J, Purcell RH,

Christensen PB.

Declining prevalence of hepatitis E antibodies among

Danish blood donors. Transfusion. 2015

The prevalence of anti-HEV IgG was:

• 50.4% among farmers,1983 (291 samples)

• 32.9% among donors, 1983 (169 samples)

• 20.6% among donors, 2003 (461 samples).

Method:

• NIH in-house ELISA; recombinant ORF2 protein

• Sensitivity of 96%, specificity of 98%, good test at the time.

Correlated with increasing age in all groups

Questionnaire, corr. with: Male sex, children, HAV, horses...

In conclusion

• Increasing awareness

– Notifiable from 2016

– Case definition to come

– More clinical labs to offer analysis

• Presently very few known cases

• Repeated seroprevalence studies:

– 1983: 33%; 2003: 21%; 2013: 11%

• Not indication of rise in cases/exposure.

THANKS!