Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
Epidemiol Infect. 2010 Feb;138(2):145-66. doi: 10.1017/S0950268809990847. Epub 2009 Oct 6.
Increasing numbers of non-travel-associated hepatitis E virus (HEV) infections have been reported in Europe in recent years. Our objective was to review the evidence on risk factors and transmission routes of autochthonous HEV infection and hepatitis E in Europe in order to develop recommendations for future research, prevention and control. A systematic literature review was performed to identify all primary reports and studies published during 1998-2008 on hepatitis E in humans and animals in Europe by searching Pubmed, reference lists of major articles and international conference proceedings. Each of the 106 included studies was categorized into one of three evidence levels (EL) based on study design and diagnostic methodology. The evidence was generally weak (73 were assigned to EL1, two to both EL1 and EL2, and 30 to EL2), further compounded by the use of poorly validated serological assays in some studies. Only one case-control study was assigned to EL3. Persons with autochthonous hepatitis E infection were on average older than the general population and predominantly male. There was no evidence for one main transmission route of HEV infection or risk factor for hepatitis E. However, zoonotic transmission seemed likely and person-to-person transmission too inefficient to cause clinical disease. Multiple routes of transmission probably exist and should be further investigated through analytical studies and reliable diagnostic kits. Based on current evidence that points to zoonotic transmission from pigs, thorough cooking of all porcine products, prevention of cross-contamination in the kitchen and improved education for occupationally exposed people (e.g. pig farmers, veterinarians and sewage workers) may help prevent HEV infection. Although evidence for parenteral transmission is limited, it is recommended that a risk assessment is undertaken.
近年来，越来越多的非旅行相关的戊型肝炎病毒（HEV）感染在欧洲被报告。我们的目的是回顾欧洲本土 HEV 感染和戊型肝炎的危险因素和传播途径的证据，以便为未来的研究、预防和控制提供建议。通过在 Pubmed、主要文章的参考文献列表和国际会议论文集上搜索，进行了系统的文献回顾，以确定 1998-2008 年期间在欧洲发表的所有关于人类和动物的戊型肝炎的原始报告和研究。根据研究设计和诊断方法，将 106 项纳入的研究中的每一项分为三个证据水平（EL）之一。证据通常较弱（73 项被归类为 EL1，两项同时归类为 EL1 和 EL2，30 项被归类为 EL2），一些研究中使用的血清学检测方法验证不足，使情况进一步恶化。只有一项病例对照研究被归类为 EL3。具有本土性戊型肝炎感染的患者平均比一般人群年龄大，主要为男性。没有证据表明 HEV 感染有一个主要的传播途径或危险因素。然而，从猪传播的人畜共患病传播似乎是可能的，人与人之间的传播效率太低，无法引起临床疾病。可能存在多种传播途径，应通过分析研究和可靠的诊断试剂盒进一步研究。基于目前指向猪的人畜共患病传播的证据，彻底烹饪所有猪肉产品，预防厨房中的交叉污染，并为职业暴露人群（如养猪户、兽医和污水工人）提供更好的教育，可能有助于预防 HEV 感染。尽管经注射途径传播的证据有限，但建议进行风险评估。
