hepatitis e

Rita de Sousa

Surveillance and diagnostic of Hepatitis E in Portugal

National Institute of Health Dr. Ricardo JorgePortugal

1st ECDC Hepatitis E virus expert group meetingStockholm, 9-10 December 2015

quinta-feira, 21 de Janeiro de 16

1_ National surveillance system for HEV infection in Portugal

2_ Case definition

3_Lab diagnostic methods for detection and confirmation HEV

infection

4_Studies on HEV in Portuguese population and animals

reservoirs.

Topics


Surveillance system of HEV in Portugal

_Hepatitis E is a obligatory notifiable disease since 2014

(Ministerial order nº 5681-A-2014, 29/April)

_Directorate General of Health _National Institute of Health

National Surveillance _National reference Laboratory

Regional Administrations of Health

Ministry of Health

Report the case

Physician

Report the lab result


Surveillance system of HEV in Portugal_Data source

• Directorate-General of Health (www.dgs.pt)

National Epidemiological surveillance System (SINAVE)- Online registration of all the obligatory notifiable diseases (since 1st January 2015).

_Type of data reported

• Data is reported (through SINAVE) by physicians from all over the country (mainland and Islands)

• Compulsory online notification for obligatory notifiable diseases.

• Passive surveillance

• Case-based report (daily reporting)


http://www.dgs.pt

http://www.dgs.pt

Case definition of HEV

_Clinical Criteria

Any person with a onset of symptoms compatible with acute viral hepatitis (e.g. fatigue, abdominal pain, loss of appetite, intermittent nausea and vomiting)ANDAt least one of the following three:a) Feverb) Jaundicec) Elevated serum aminotransferase levels

At least one of the following two:a) Detection of hepatitis A virus nucleic acid in plasma or stoolb) Hepatitis A virus specific antibody response

_Laboratory Criteria

At least one of the following five:a) Human to human transmissionb) Exposure to a common source of one or more casesc) Exposure to contaminated food/drinking waterd) Environmental exposurec) Recent travel to endemic region in less than 3 months

a) Possible case NAb) Probable caseAny person meeting the clinical criteria and with an epidemiological link c) Confirmed caseAny person meeting the clinical and the laboratory criteria

_Epidemiological Criteria

_Case Classification


Laboratory diagnosis of HEV infection at National Institute of Health

_Detecting an immune response in the host:

a) Serology : detection of immunoglobulins of classe M(IgM) and G (IgG).

Performed by enzyme immunoassay (ELISA), Commercial Kit :

Until 2013 performing tests with MP Biomedicals (Genelabs)

Since 2014 using Euroimmune HEV IgG and IgM

b) Type specimens: Plasma and serum

_Detection of nucleic acids of the virus in human specimens:

a) Molecular detection of HEV virus RNA by Real-time RT-PCR, and typing by conventional PCR and sequencing (In-house protocol)

b) Type of specimens: plasma, sera and stool


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<=2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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IgM+/IgG+ Nº samples tested % of postive samples

Serological diagnosis of HEV at the National Institute of Health, 2006 - 2015

Textoquinta-feira, 21 de Janeiro de 16

!Year!

!IgM+/IgG,!

!IgM+/IgG+!

!IgM,/IgG+!

Not!detectable!an5bodies!

Total!tested!samples!

≤2006 0 1 2 78 81

2007 1 3 2 10 16

2008 4 3 2 14 23

2009 1 4 4 18 27

2010 4 2 3 17 26

2011 1 7 7 53 68

2012 1 3 5 47 56

2013 5 7 2 62 76

2014 7 8 6 92 113

2015* 1 2 5 38 46

Total 25 40 38 429 532

Laboratory diagnostic of HEV infection at the National Institute of Health, 2000 - 2015


Year of the study Type of screened population (n)

Seroprevalence References

2015 Swine slaughterhouse workers (72) 14,9% (IgG) Teixeira et al, 2015

2015 Nationwide serosurvey Portuguese Population (1, 656) 9% (IgG) Pereira et al., 2015

2013pet veterinarians (373)

general population (120)

9,9% (IgG)

13% (IgG)Mesquita et al., 2014

1996

Blood donors (50)

Chronic liver disease patients (103)

4% (IgG)

6,8% (IgG)Macedo et al., 1998

1996 Blood donors (1,473) 2.5% (IgG) Queiros et al., 1997

Studies on HEV in Portuguese population

Serosurveys


Serosurveys


Year of the study Reported human cases

Anti-HEV immunoglobulins

(IgM/IgG)HEV-RNA detection

(genotype)References

2009 and 20112 cases acute

infection(kidney transplant)

Positive (IgM and IgG) positive (genotype 3c) Breda et al.,2014

2012 1 case acute infection

Positive (IgM and IgG) positive (genotype 3a) Santos et al., 2013

2012 1 case acute infection Positive IgM positive Vieira et al., 2013

2010 1 case acute infection

Positive (IgM and IgG) Not performed Duque et al., 2012

Studies on HEV in Portuguese population

Case Reports


Case Reports


Studies on HEV in Animal population

Serosurvey

Year of the Study: 2010 - 2011

Regions of Portugal : North and Center

Overal, 44 (22%) out of 200 pig faeces tested for the presence of HEV RNA


*EEA (European Economic Area Grants) - Public Health Initiatives

- Population-based cross sectional study

- Blood donors from different regions of Portugal

- Evaluation of the risk of porcine-derived pharmaceutical products as potential sources of HEV infection (Faculty of Pharmacy, University of Porto (PI, Alexandre MJ)*

Project : HEPeCONTROL - Hepatitis E virus epidemiology, safety and control

Ongoing and future studies on HEV


http://hepecontrol.weebly.com/

http://hepecontrol.weebly.com/

_ Av. Padre Cruz | 1649-016 Lisbon, PortugalTel: (+351) 217519200 | 2175226447 | 265 912 222Fax: (+351) 265 912 155E-mail: [email protected]

Thank for your attention


hepatitis e

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