Pig Liver Sausage as a Source of Hepatitis E Virus Transmission to Humans

TLDR

Autochthonous hepatitis E virus infections in industrialized countries have unclear sources and routes, although HEV is known to be a pig zoonosis. The study examined whether raw figatellu, a traditional French pig liver sausage, serves as a source of HEV infection through a case‑control design involving three patients and 15 family members. Researchers performed anti‑HEV IgG/IgM serology, detected HEV RNA by real‑time PCR in patients and sausages, sequenced the virus, and analyzed genetic links between isolates. Seven of 13 raw‑figatellu consumers had acute or recent HEV infection versus none of five non‑consumers (P = 0.041), and genotype 3 RNA from seven of 12 supermarket sausages matched patient sequences, confirming raw figatellu as a transmission source.

Abstract

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.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.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.Our findings strongly support the hypothesis of HEV infection through ingestion of raw figatellu.