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. 2021 Jan 22;10(2):107.
doi: 10.3390/pathogens10020107.

Control of Raw Pork Liver Sausage Production Can Reduce the Prevalence of HEV Infection

Paolo Ripellino  1 , Enea Pianezzi  2 , Gladys Martinetti  2 , Cinzia Zehnder  3 , Barbara Mathis  4 , Petra Giannini  5 , Nicola Forrer  5 , Giorgio Merlani  6 , Harry R Dalton  7 , Orlando Petrini  8 , Florian Bihl  9   10 , Stefano Fontana  11 , Claudio Gobbi  1   12
Affiliations

Control of Raw Pork Liver Sausage Production Can Reduce the Prevalence of HEV Infection

Paolo Ripellino et al. Pathogens. .

Abstract

After an acute hepatitis E (HEV) outbreak in Southern Switzerland, in January 2017 the local public health authorities started an active program of food chain control and public education. In this retrospective study, we analysed all laboratory-confirmed acute cases of HEV infection diagnosed between 2014 and 2020. In the period before the public health intervention, the number of cases increased steadily from 2014 (4 of 40 tests, 10%) reaching a peak in the last quarter of 2016 (42 of 285 tests, 14.7 %). Afterwards, the number of positive cases decreased steadily, reaching its lowest value (0.3%) in the second quarter of 2019. There was a statistically significant difference between the frequency of positive cases and period of testing, i.e., before and after the introduction of the public health interventions. Our study shows that active public health measures to control sausages containing raw pork liver can reduce the prevalence of HEV infection.

Keywords: epidemiology; food chain control; hepatitis E; one health; public health; raw liver; sausage.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
“Mortadella di fegato crudo”, a historical, traditional local product of Southern Switzerland containing raw pork liver. The production rules and consumption recommendations for this sausage were changed at the beginning of 2017.
Figure 2
Figure 2
Boxplot of the serological IgM positivity (frequency of acute cases) observed before and after the introduction of the public health intervention. Blue line: median; box: interquartile range; whiskers: 95% confidence interval of the median. The y-axis indicates the percentage of positive cases.
Figure 3
Figure 3
Acute HEV cases (% of tests) occurring in Southern Switzerland in the study period, by quarters of years. The red line was computed using a local polynomial smoothing, weighted by the total number of tests; this line represents the fluctuation over time in the percentage of positive cases. Grey shading: 95% confidence interval; blue dots: observed positivity rates at each measurement time; orange line: number of acute cases by quarter of year. The vertical dashed line indicates the start of the public health intervention in January 2017.
See this image and copyright information in PMC

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