Surveys and Studies
Seroprevalence Studies of Hepatitis E
Estimates of anti-HEV seroprevalence vary from one study to another and depend on the sensitivity of the test used and the study population. The most recent studies using a highly sensitive test have reported higher prevalence estimates, for example among blood donors in the Midi-Pyrénées region (2003–2004 vs. 2010).
| Hepatitis E Seroprevalence Studies, France, 2003–2012 | ||||||
| Study region |
Year of study |
Data source |
Study population |
Seroprevalence |
Tests used Anti-VHE IgG |
References |
| Ile-de-France, Pays de la Loire |
Not documented |
INRA/AFSSA/ENVA |
Blood donors N=1,988 |
3.2% |
HEV EIA (Genelabs, Diagnostics) |
Boutrouille A et al 2007 |
| Midi-Pyrénées |
2003–2004 |
Toulouse University Hospital |
Blood donors (ages 18–64) N=529 |
16.6% |
HEV EIA (Genelabs Diagnostics) |
Mansuy JM et al 2008 |
| 2010 |
Toulouse University Hospital |
Blood donors N=512 (18–64 years) Children (2–4 years) N=188 |
52.5% [48.2–56.8] |
Wantai HEV IgG EIA (Wantai Biologic Pharmacy Enterprise |
Mansuy JM et al 2011 | |
| Mainland France |
2009–2010 |
InVS Séro-Inf Study |
General population (ages 6–49) N=5,400 |
4.9% [4.1–5.8] |
Adaltis EIAgen HEV IgG® assay Adaltis |
Lepoutre A et al 2013 |
| Champagne-Ardenne, Burgundy/Franche-Comté, Alsace, Lorraine |
2002–2003 and 2011 |
INRA/MSA |
Forest workers N=593 Controls (non-exposed professionals) N=135 |
31% 19% |
HEV ELISA (MP Biomedicals SAS |
Carpentier A et al 2012 |
| Northwest, North, Northeast, Southwest, Southeast, and Corsica departments |
2011–2012 |
MSA |
Pig farmers N=306 Tertiary sector employees N=322 Foresters N=231 |
44% 26% 36% |
HEV ELISA (MP Biomedicals SAS) |
Chaussade H et al 2013 |
| Marseille |
2003, 2005, 2006 |
University Hospital (Marseille) |
Homeless in 2 shelters N=490 |
11.6% [8.9–14.8] |
EIAgen HEV kits (Adaltis Italia Spa) |
Kaba M et al 2010 |
| Marseille |
2011–2012 (15 months) |
University Hospital (Marseille) |
Expatriates from the same company N=43 |
30.2% 48.8% |
AdaltisWantai |
Vernier M et al 2013 |
using samples from blood donors tested in 2003–2004.
Descriptive study of locally acquired cases of acute hepatitis E
In 2010, CNR-confirmed cases of acute hepatitis E were interviewed about their exposures in the 2 to 10 weeks prior to the onset of illness. Clinical, laboratory, and epidemiological data were collected for 139 cases.
Nearly three-quarters (74%) of the cases were men; the median age was 55 years [range 18–86]; 65% resided in southern France; and 59% reported having an underlying medical condition. HEV RNA was detected in blood or stool in 89% of cases, and the most common genotypes were 3f (74%) and 3c (14%).Raw pork liver products were consumed by 39% of cases. Of these, 80% were figatelles and 20% were pork liver. Figatelles were consumed raw or undercooked by 83% (34/41) of consumers. Consumption of raw pork liver products during the incubation period was more frequent among cases residing in southern France (47%) than among those residing in the north (25%). Furthermore, 56% of cases consumed shellfish, of whom 72% consumed mussels.
These results suggest that in France, the consumption of raw pork liver products may be a risk factor for hepatitis E. A case-control study, planned for 2014, is necessary to estimate the proportion of cases attributable to their consumption. Furthermore, it could identify other risk factors for hepatitis E, leading to the implementation of additional prevention measures.
Investigation of Hepatitis E Clusters
| Characteristics of hepatitis E cluster outbreaks, France, 2005–2013 | ||||||
| Region |
Year |
Data source |
Population |
Number of confirmed autochthonous cases |
Suspected source |
Bibliographic references |
| Paca |
2005–2006 |
Ddass, CNR |
Defined geographic area: Gapeau Plain (Var) N=NDa |
N=6 Symptomatic (6) |
Environmental (water, contaminated vegetables) |
Nicand E et al, BEH 2009, internal report Ddass 83 |
| PACA |
2007 |
Cire Sud |
Family meal N=4 |
N=3 Symptomaticb (1) |
Figatelli consumed raw |
InVS investigation report (unpublished) |
| PACA |
2007–2009 |
AP-HM, Marseille |
Family meal N=18 |
N=7 Symptomaticb (2) |
Raw figatelli consumed |
Colson P et al, JID 2010 |
| Mainland France |
2008–2009 |
CNR |
Isolated/family clusters N=NDa |
N=10 |
Figatelli, pork liver sausages, Corsican charcuterie |
CNR Reports (2008–2010) |
| PACA |
2009 |
Cire Sud |
Group meal N=4 |
N=1 Symptomaticb (1) |
Figatelli eaten raw |
Internal point Cire Sud (04/15/2009) |
| Midi-Pyrénées |
2011 |
Cire Midi-Pyrénées |
Operating room staff N=59 |
N=7 Symptomatic (0) with neurological involvement |
Unidentified |
InVS report available on the InVS website |
| PACA |
2011 |
Cire Sud, AP-HM, Marseille |
Isolated/family cluster cases diagnosed by two hospitals N=NDa |
N=11 Symptomaticb (8) |
Raw figatelli consumed |
Backx A, ESCAIDE Conference, 2011 |
| Franche-Comté |
2012 |
Cire Bourgogne/Franche-Comté |
Nursing home (Territoire de Belfort) N=132 beds and 90 employees |
N=4 (2 residents, 2 staff members) Symptomaticb (1) |
Unidentified |
InVS investigation report (unpublished), CNR 2012 report |
| Center |
2013 |
Cire Center |
Festive group meal N=15 |
N=2 Symptomaticb (1) |
"Homemade" smoked ham prepared by one of the guests and eaten raw |
Unpublished InVS investigation report |
Anonymous case, presence of jaundice, residential care facility for dependent elderly individuals.
