title: Pig liver sausage as a source of hepatitis E virus transmission to humans.
abstract: BACKGROUND
  The source and route of autochthonous hepatitis E virus (HEV) infections are not clearly established in industrialized countries despite evidence that it is a zoonosis in pigs. We investigated the role of figatellu, a traditional pig liver sausage widely eaten in France and commonly consumed raw, as a source of HEV infection.
  
  
  METHODS
  A case-control study was conducted of 3 patients who presented autochthonous hepatitis E and 15 members of their 3 different families. Anti-HEV immunoglobulin G and immunoglobulin M antibody testing was performed with commercial assays. HEV RNA was detected in serum samples of patients and in pig liver sausages by means of real-time polymerase chain reaction and sequenced by means of in-house sequencing assays. Genetic links between HEV sequences were analyzed.
  
  
  RESULTS
  Acute or recent HEV infection, defined by detection of anti-HEV immunoglobulin M antibodies and/or HEV RNA, was observed in 7 of 13 individuals who ate raw figatellu and 0 of 5 individuals who did not eat raw figatellu (P=.041). Moreover, HEV RNA of genotype 3 was recovered from 7 of 12 figatelli purchased in supermarkets, and statistically significant genetic links were found between these sequences and those recovered from patients who ate raw figatellu.
  
  
  CONCLUSIONS
  Our findings strongly support the hypothesis of HEV infection through ingestion of raw figatellu.
authors.affiliation: Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, Marseille, France. philippe.colson@ap-hm.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Colson
authors.forename: Patrick
authors.initials: P
authors.lastname: Borentain
authors.forename: Benjamin
authors.initials: B
authors.lastname: Queyriaux
authors.forename: Mamadou
authors.initials: M
authors.lastname: Kaba
authors.forename: Valérie
authors.initials: V
authors.lastname: Moal
authors.forename: Pierre
authors.initials: P
authors.lastname: Gallian
authors.forename: Laurent
authors.initials: L
authors.lastname: Heyries
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: René
authors.initials: R
authors.lastname: Gerolami
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005516:Food Microbiology; D005602:France / Q000453:epidemiology; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000175:diagnosis* / Q000635:transmission* / Q000821:virology; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008099:Liver; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D017422:Sequence Analysis, DNA; D013552:Swine; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral