title: Phylogenetic and case-control study on hepatitis E virus infection in Germany.
abstract: BACKGROUND
  Hepatitis E is a classic water-borne disease in developing countries. In Germany, hepatitis E virus (HEV) infections are notifiable. The number of non-travel-associated infections has increased in recent years, but the route of transmission in most is unknown. Our objective was to determine risk factors for autochthonous HEV infections in Germany.
  
  
  METHODS
  Cases of HEV met clinical definitions and were confirmed by laboratory analysis (defined as detection of HEV by polymerase chain reaction [PCR] or immunoglobulin M by serologic testing). PCR products from blood or stool samples were genotyped for phylogenetic analysis. A case-control study included case subjects with autochthonous HEV infection and matched control subjects who were randomly recruited from a population-based telephone list.
  
  
  RESULTS
  From May 2006 through August 2007, 76 of 96 persons for whom HEV infection had been reported to the routine surveillance system were interviewed. Sixty-six persons had disease that fulfilled the inclusion criteria: 45 (68%) had autochthonous infection, and 21 (32%) had travel-associated disease. Genotypes 3 or 4 were present in 15 of 15 persons with autochthonous infection, and genotype 1 was present in 8 of 9 persons with travel-associated infection. In conditional logistic regression involving 45 case subjects and 135 control subjects, consumption of offal (41% vs. 19%; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.2) and wild-boar meat (20% vs. 7%; OR, 4.3; 95% CI, 1.2-15.9) were independently associated with autochthonous HEV infection.
  
  
  CONCLUSIONS
  Hepatitis E is endemic in Germany and likely exists as a food-borne zoonosis. Implicated meat products should be investigated to provide recommendations for preventive measures.
authors.affiliation: Department of Infectious Disease Epidemiology, Robert Koch Institute, Germany. owichmann@pdvi.org
authors.forename: Ole
authors.initials: O
authors.lastname: Wichmann
authors.forename: Sven
authors.initials: S
authors.lastname: Schimanski
authors.forename: Judith
authors.initials: J
authors.lastname: Koch
authors.forename: Martin
authors.initials: M
authors.lastname: Kohler
authors.forename: Camilla
authors.initials: C
authors.lastname: Rothe
authors.forename: Annelie
authors.initials: A
authors.lastname: Plentz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Jilg
authors.forename: Klaus
authors.initials: K
authors.lastname: Stark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D016751:Hepatitis E / Q000453:epidemiology* / Q000235:genetics*; D016752:Hepatitis E virus / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012307:Risk Factors; D014195:Travel; D055815:Young Adult