Standardising surveillance of hepatitis E virus infection in the EU/EEA: A review of national practices and suggestions for the way forward
Background: Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses. Objective and study design: WHO's European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC's HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods. Results: The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission. Discussion: Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case. ; The work was supported by two service contracts No. ECD.7600 (HEV epidemiological support - NP/2017/OCS/253) and No. ID 5132: Hepatitis B, C, and E in the EU/EEA: monitoring and testing activities. Staff that were involved in the contracts: Esther Aspinall (Glasgow Caledonian University and Health Protection Scotland), Andrew Rideout (NHS Dumfries and Galloway), Chris Biggam (Glasgow Caledonian University), Gill Hawkins (Health Protection Scotland), and Alison Smith-Palmer (Health Protection Scotland). ; Sí