Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2021; 13(7): 723-730
Published online Jul 27, 2021. doi: 10.4254/wjh.v13.i7.723
Hepatitis E virus in professionally exposed: A reason for concern?
Anna Mrzljak, Ivan Balen, Ljubo Barbic, Maja Ilic, Tatjana Vilibic-Cavlek
Anna Mrzljak, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Anna Mrzljak, Tatjana Vilibic-Cavlek, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Ivan Balen, Department of Gastroenterology and Endocrinology, General Hospital “Dr. Josip Bencevic”, Slavonski Brod 35000, Croatia
Ljubo Barbic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
Maja Ilic, Department of Epidemiology, Croatian Institute of Public Health, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Tatjana Vilibic-Cavlek, Department of Virology, Croatian Institute of Public Health, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Author contributions: Mrzljak A and Balen I made contributions to the conception and design of the study, drafted, and revised the manuscript critically; Vilibic-Cavlek T, Barbic Lj and Ilic M collected data, drafted and wrote the manuscript; All authors read and approved the final manuscript.
Conflict-of-interest statement: All authors have nothing to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anna Mrzljak, FEBGH, MD, Associate Professor, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb 10000, Croatia. anna.mrzljak@gmail.com
Received: March 14, 2021
Peer-review started: March 14, 2021
First decision: March 29, 2021
Revised: March 31, 2021
Accepted: June 25, 2021
Article in press: June 25, 2021
Published online: July 27, 2021
Processing time: 130 Days and 19.9 Hours
Abstract

The zoonotic risk of hepatitis E virus (HEV) is well established. The HEV seroprevalence rates vary according to geographical region, assays used, and study cohorts. HEV infection is still underdiagnosed, implying the need to evaluate the disease's burden in the general population and specific risk groups, such as professionally exposed. Close contact with various animal reservoirs such as pigs, rabbits, sheep, dogs, wild boars, and deer has been associated with higher anti-HEV seroprevalence as a part of occupational exposure. While exact transmission routes remain to be determined, some general preventive measures such as proper hand hygiene, the usage of personal protective equipment, and the thermal processing of food before consumption should be followed. A “One-Health” multisectoral approach should be implemented to achieve optimal health and well-being outcomes, recognizing the interconnections between humans, animals, plants, and their shared environment, in which a vaccine against the zoonotic genotypes 3 and 4 and swine vaccination should be considered as a possible public health measure. This opinion review comprehensively addresses the HEV burden of professional exposure for butchers, slaughterhouse workers, veterinarians, farmers, hunters, and forestry workers delineates the current limits of protective work measures, and tackles future directions.

Keywords: Hepatitis E virus; Zoonotic infection; Occupational disease; Veterinarians; Farmers; Butchers; Slaughterhouse workers; Forestry workers; Hunters

Core Tip: The zoonotic risk of hepatitis E virus (HEV) is well established. Close contact with various animal reservoirs such as pigs, rabbits, sheep, dogs, wild boars, and deer has been associated with higher anti-HEV seroprevalence as a part of occupational exposure. However, precise HEV transmission routes yet need to be determined. This opinion review addresses the HEV burden of professional exposure, delineates the current limits of protective work measures, and tackles future directions.