Wichmann Ole, Schimanski Sven, Koch Judith, Kohler Martin, Rothe Camilla, Plentz Annelie, Jilg Wolfgang, Stark Klaus
Department of Infectious Disease Epidemiology, Robert Koch Institute, Germany.
J Infect Dis. 2008 Dec 15;198(12):1732-41. doi: 10.1086/593211.
Hepatitis E is a classic water-borne disease in developing countries. In Germany, hepatitis E virus (HEV) infections are notifiable. The number of non-travel-associated infections has increased in recent years, but the route of transmission in most is unknown. Our objective was to determine risk factors for autochthonous HEV infections in Germany.
Cases of HEV met clinical definitions and were confirmed by laboratory analysis (defined as detection of HEV by polymerase chain reaction [PCR] or immunoglobulin M by serologic testing). PCR products from blood or stool samples were genotyped for phylogenetic analysis. A case-control study included case subjects with autochthonous HEV infection and matched control subjects who were randomly recruited from a population-based telephone list.
From May 2006 through August 2007, 76 of 96 persons for whom HEV infection had been reported to the routine surveillance system were interviewed. Sixty-six persons had disease that fulfilled the inclusion criteria: 45 (68%) had autochthonous infection, and 21 (32%) had travel-associated disease. Genotypes 3 or 4 were present in 15 of 15 persons with autochthonous infection, and genotype 1 was present in 8 of 9 persons with travel-associated infection. In conditional logistic regression involving 45 case subjects and 135 control subjects, consumption of offal (41% vs. 19%; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.2) and wild-boar meat (20% vs. 7%; OR, 4.3; 95% CI, 1.2-15.9) were independently associated with autochthonous HEV infection.
Hepatitis E is endemic in Germany and likely exists as a food-borne zoonosis. Implicated meat products should be investigated to provide recommendations for preventive measures.
戊型肝炎是发展中国家一种典型的经水传播的疾病。在德国，戊型肝炎病毒（HEV）感染属于应报告疾病。近年来，非旅行相关感染的数量有所增加，但大多数感染的传播途径尚不清楚。我们的目的是确定德国本土戊型肝炎病毒感染的危险因素。
戊型肝炎病例符合临床定义，并通过实验室分析确诊（定义为通过聚合酶链反应[PCR]检测到戊型肝炎病毒或通过血清学检测检测到免疫球蛋白M）。对血液或粪便样本的PCR产物进行基因分型以进行系统发育分析。一项病例对照研究纳入了本土戊型肝炎病毒感染的病例和从基于人群的电话名单中随机招募的匹配对照。
2006年5月至2007年8月，对向常规监测系统报告戊型肝炎病毒感染的96人中的76人进行了访谈。66人患有符合纳入标准的疾病：45人（68%）为本土感染，21人（32%）为旅行相关疾病。15例本土感染患者中有15例存在3型或4型基因型，9例旅行相关感染患者中有8例存在1型基因型。在涉及45例病例和135例对照的条件逻辑回归分析中，食用内脏（41%对19%；比值比[OR]，2.7；95%置信区间[CI]，1.2 - 6.2）和野猪肉（20%对7%；OR，4.3；95% CI，1.2 - 15.9）与本土戊型肝炎病毒感染独立相关。
戊型肝炎在德国呈地方性流行，可能以食源性人畜共患病的形式存在。应对相关肉制品进行调查，以提供预防措施建议。
