title: Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15.
abstract: Hepatitis E virus (HEV) is endemic in EU/EEA countries, but the understanding of the burden of the infection in humans is inconsistent as the disease is not under EU surveillance but subject to national policies.
  
  
  
  Countries were asked to nominate experts and to complete a standardised questionnaire about the epidemiological situation and surveillance of HEV in their respective EU/EEA country. This study reviewed surveillance systems for human cases of HEV in EU/EEA countries and nominated experts assessed the epidemiology in particular examining the recent increase in the number of autochthonous cases.
  
  
  
  Surveillance systems and case definitions across EU/EEA countries were shown to be highly variable and testing algorithms were unreliable. Large increases of autochthonous cases were reported from Western EU/EEA countries with lower case numbers seen in Northern and Southern European countries. Lack of clinical awareness and variability in testing strategies might account for the observed differences in hepatitis E incidence across EU/EEA countries. Infections were predominantly caused by HEV genotype 3, the most prevalent virus type in the animal reservoirs.
  
  
  
  Discussions from the expert group supported joint working across countries to better monitor the epidemiology and possible changes in risk of virus acquisition at a European level. There was agreement to share surveillance strategies and algorithms but also importantly the collation of HEV data from human and animal populations. These data collected at a European level would serve the 'One Health' approach to better informing on human exposure to HEV.
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: cornelia.adlhoch@ecdc.europa.eu.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Adlhoch
authors.affiliation: Spanish National Centre of Microbiology, Carlos III Institute of Health, Madrid, Spain. Electronic address: aavellon@isciii.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Avellon
authors.affiliation: Paul-Ehrlich-Institut, Langen, Germany. Electronic address: Sally.Baylis@pei.de.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Baylis
authors.affiliation: National Institute of Health (Istituto Superiore di Sanità - ISS), Rome, Italy. Electronic address: annarita.ciccaglione@iss.it.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Ciccaglione
authors.affiliation: Institut de veille sanitaire, Saint-Maurice, France. Electronic address: e.couturier@invs.sante.fr.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Couturier
authors.affiliation: National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal. Electronic address: rita.sousa@insa.min-saude.pt.
authors.forename: Rita
authors.initials: R
authors.lastname: de Sousa
authors.affiliation: Health Board, Tallinn, Estonia. Electronic address: Jevgenia.Epstein@terviseamet.ee.
authors.forename: Jevgenia
authors.initials: J
authors.lastname: Epštein
authors.affiliation: Statens Serum Institut, Copenhagen, Denmark. Electronic address: SET@ssi.dk.
authors.forename: Steen
authors.initials: S
authors.lastname: Ethelberg
authors.affiliation: Robert Koch Institute, Berlin, Germany. Electronic address: FaberM@rki.de.
authors.forename: Mirko
authors.initials: M
authors.lastname: Faber
authors.affiliation: National Center for Epidemiology (NCE), Budapest, Hungary. Electronic address: feher.agnes@oek.antsz.hu.
authors.forename: Ágnes
authors.initials: Á
authors.lastname: Fehér
authors.affiliation: National Infection Service, Public Health England, London, United Kingdom. Electronic address: Samreen.Ijaz@phe.gov.uk.
authors.forename: Samreen
authors.initials: S
authors.lastname: Ijaz
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway. Electronic address: Heidi.Lange@fhi.no.
authors.forename: Heidi
authors.initials: H
authors.lastname: Lange
authors.affiliation: National Institute of Public Health, Prague, Czech Republic. Electronic address: zdenka.mandakova@szu.cz.
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Manďáková
authors.affiliation: Greek Center for Disease Prevention and Control, Athens, Greece. Electronic address: mellou@keelpno.gr.
authors.forename: Kassiani
authors.initials: K
authors.lastname: Mellou
authors.affiliation: World Health Organization (WHO), Regional Office for Europe, Copenhagen, Denmark. Electronic address: AMZ@euro.who.int.
authors.forename: Antons
authors.initials: A
authors.lastname: Mozalevskis
authors.affiliation: National Institute for Health and Welfare (THL), Finland. Electronic address: ruska.rimhanen-finne@thl.fi.
authors.forename: Ruska
authors.initials: R
authors.lastname: Rimhanen-Finne
authors.affiliation: European Food Safety Authority (EFSA), Parma, Italy. Electronic address: Valentina.RIZZI@efsa.europa.eu.
authors.forename: Valentina
authors.initials: V
authors.lastname: Rizzi
authors.affiliation: National Infection Service, Public Health England, London, United Kingdom. Electronic address: bengu.said@phe.gov.uk.
authors.forename: Bengü
authors.initials: B
authors.lastname: Said
authors.affiliation: Public Health Agency of Sweden, Stockholm, Sweden. Electronic address: lena.sundqvist@folkhalsomyndigheten.se.
authors.forename: Lena
authors.initials: L
authors.lastname: Sundqvist
authors.affiliation: Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland. Electronic address: lelia.thornton@hse.ie.
authors.forename: Lelia
authors.initials: L
authors.lastname: Thornton
authors.affiliation: National Institute of Health (Istituto Superiore di Sanità - ISS), Rome, Italy. Electronic address: mariaelena.tosti@iss.it.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Tosti
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, Netherlands. Electronic address: Wilfrid.van.Pelt@rivm.nl.
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
authors.affiliation: National Health Services, Health Scotland, Glasgow, United Kingdom. Electronic address: esther.aspinall@nhs.net.
authors.forename: Esther
authors.initials: E
authors.lastname: Aspinall
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: Dragoslav.Domanovic@ecdc.europa.eu.
authors.forename: Dragoslav
authors.initials: D
authors.lastname: Domanovic
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: Ettore.Severi@ecdc.europa.eu.
authors.forename: Ettore
authors.initials: E
authors.lastname: Severi
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: Johanna.Takkinen@ecdc.europa.eu.
authors.forename: Johanna
authors.initials: J
authors.lastname: Takkinen
authors.affiliation: European Centre for Environment and Human Health, University of Exeter, United Kingdom. Electronic address: harry.dalton@rcht.cornwall.nhs.uk.
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
mesh_terms: D017281:Cost of Illness; D019353:Endemic Diseases; D005060:Europe / Q000453:epidemiology; D006505:Hepatitis / Q000453:epidemiology*; D006801:Humans
keywords: Epidemiology; Europe; Hepatitis E virus; Surveillance; Zoonotic infections