DAILY MAIL: HEPATITIS E

HEPATITIS E - UK: PORK SAUSAGES, ALERT ************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Sun 15 Sep 2013 Source: The Daily Mail, Mail-online, Health [edited] As many as one in 10 sausages is infected with a potentially deadly virus that causes liver damage, scientists warn. They are concerned that rising numbers of Britons are being struck down with hepatitis E after eating contaminated pork. The infection was once considered very rare, but cases have risen by nearly 40 per cent in a year, and there were 657 in 2012. The virus usually causes only relatively mild symptoms such as sickness, a temperature and muscle pain, which clear up by themselves within a month. But it can be fatal for the elderly, cancer victims, pregnant women and others with existing liver problems. Around one in 50 of those infected will die, rising to one in 5 pregnant women, according to statistics. Experts say sausages have to be cooked at 70 C (158 F) for at least 20 minutes to kill the virus, but they say that most Britons do not leave them in the oven for this long. Tests have showed that it can survive at 60 C after an hour. A report published last week by the Department for Environment, Food, and Rural Affairs says 10 per cent of sausages recently sampled were found to contain the virus. It states that there is increasing evidence that hepatitis E, which is common in the developing world, where it is usually transmitted through contaminated water, is a food-borne infection and adds that it is increasingly being recognised as a major disease. All forms of hepatitis cause swelling of the liver, which in severe cases can cause severe damage to the organ, liver cancer and death. More than half of those infected with hepatitis E are men over 50, who are more susceptible as they tend to drink more and their livers are weaker. The virus is particularly harmful for pregnant women who catch it in the final 3 months of their pregnancy because it can lead to acute liver failure, and one in 5 expectant mothers who catch the virus will die. Dr Harry Dalton, a consultant at the Royal Cornwall Hospital in Truro and one of Britain's leading experts on hepatitis E, said: "This is emerging as a serious problem. About 85 per cent of British pigs carry the virus, which is quite hardy. Sausages have to be cooked at 70 C for 20 minutes to kill it, and that is longer than most sausages ever get cooked. Anyone cooking with sausages or other pork products should take stringent hygiene precautions including washing their hands and cleaning work surfaces." Sausages are regarded as the most dangerous product, as they often contain liver meat and traces of pig's blood as well as a casing from the animal's intestine. -- Communicated by: ProMED-mail [The following is the DEFRA statement entitled: "Hepatitis E and detection in pork and pork products," , referred to in the above press report. "There has been recent publicity about hepatitis E infection in humans. This relates to an increase in 2010-11 in the proportion of cases of hepatitis E diagnosed where there is no history of travel by the affected person. A recent publication (Berto and others, 2012) reported PCR detection of hepatitis E virus in 13 percent of pig faeces and 3 percent of pig livers at slaughter and 10 percent of pork sausages at retail. Whether virus is infective at these different stages was not established. The report of an extensive case control study in humans is expected in 2013 and may identify risk factors and assist in determining whether there is evidence to support the putative link with consumption of pork and pork products. In the meantime, a multi-agency, joint-funded abattoir survey of pigs, expected to be conducted in early 2013, will seek to establish the prevalence of infection in slaughter pigs in the UK. This is highlighted here as an issue which may cause adverse publicity for the pig industry at what is already a difficult time." See: . Hepatitis E is a liver disease caused by hepatitis E virus: a non-enveloped, positive-sense, single-stranded ribonucleic acid virus. Hepatitis E virus is transmitted usually mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4-6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death. The hepatitis E virus is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. Other transmission routes have been identified, which include: foodborne transmission from ingestion of products derived from infected animals, transfusion of infected blood products, and vertical transmission from a pregnant woman to her fetus. The incubation period following exposure to the hepatitis E virus ranges from 3-8 weeks, with a mean of 40 days. The period of communicability is unknown. Typical signs and symptoms of hepatitis include: jaundice (yellow discolouration of the skin and sclera of the eyes, dark urine and pale stools, anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea and vomiting. Overall population mortality rates from hepatitis E range from 0.5 to 4.0 percent. Fulminant hepatitis occurs more frequently during pregnancy. Pregnant women are at greater risk of obstetrical complications and mortality from hepatitis E, which can induce a mortality rate of 20 percent among pregnant women in their 3rd trimester. Cases of chronic hepatitis E infection have been reported in immunosuppressed people. Reactivation of hepatitis E infection has also been reported in immunocompromised people. (From: ). Previously, ProMED-mail reported cases of hepatitis E in France associated with undercooked pork sausage meat. - Mod.CP