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High hepatitis E incidence in Germany linked to raw pork intake

Researchers found a relatively high prevalence of hepatitis E viremia (0.12%) among blood donors in Germany. Further, consumption of raw pork tartare by this group represented a significant relevant risk for infection, according to a recently published study.

“Consumption of pork meat has been considered to be the major source of HEV genotype 3 infections in Europe. In addition to zoonotic transmission, blood products were shown to be a potential source of acute and chronic HEV-infection in industrialized countries,” Dirk Westhölter, MD, from the University Medical Center Hamburg-Eppendorf, Germany, and colleagues wrote. “The aim of the present study was to determine the prevalence of bloodborne HEV-infections at our academic tertiary care center in Northern Germany and to evaluate whether routine HEV testing of blood products should be performed.”

Between October 2016 and May 2017, the researchers prospectively tested 18,737 blood donations received within Westhölter’s institution for HEV and detected 23 asymptomatic donors.

Retrospective analysis showed that four of the asymptomatic donors tested positive in stored samples from previous blood donations. These products were transfused into a total of 14 patients, most of whom died prior to confirming HEV viremia; however, the researchers did confirm two recipients who became infected after transfusion with the infected blood products.

Eighteen of the asymptomatic donors participated in a standardized questionnaire to assess exposure to possible sources of HEV. Sixteen reported regular consumption of pork and 12 reported consumption of raw pork tartare within two months prior to donation. Additionally, two donors ate undercooked pork liver 4 weeks prior to donation. Residual meat stored at the donors’ home tested positive for HEV-RNA at 6,200 IU/mL.

“In this study eating raw pork tartare (a traditional German dish) represented a relevant risk

for acquisition of HEV infection in blood donors in Northern Germany,” the researchers wrote. “Domestic pigs are evidentially a major reservoir of HEV.”

The researchers conducted a control cohort including 256 previously unselected blood donors who filled out the same questionnaire. In the control cohort, 87% regularly consumed pork and 35% had consumed pork tartare in the prior two months.

“While immunosuppressed patients should be regularly reminded to avoid consumption of raw and undercooked meat to lower the risk of foodborne infections, blood component therapy may be necessary and unpreventable in certain situations,” the researchers concluded. “Our data suggest that routine HEV screening of blood products should be implemented at least at European tertiary care centers and at centers with a high proportion of immunosuppressed patients.” – by Talitha Bennett

Disclosure: Westhölter reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

Editor's note: This article was updated to reflect a correction to Westhölter's certification.