HAV in fresh vegetables: a hidden health risk in district Mardan, Pakistan

Microbiological quality of ready–to–eat vegetables salads served at meat restaurants under the COVID-19 in Turkey

In Turkish cuisine, ready–to–eat vegetable salads (REVS) served with pide/lahmacun, kebab types, and tantuni from animal source in meat restaurants were evaluated since they have the potential to carry risks in terms of Public Health. The microbiological properties of REVS were investigated using agar plate method. Antimicrobial resistance of foodborne pathogens including Escherichia coli and Staphylococcus aureus was tested using Kirby–Bauer disc diffusion method. Moreover, the presence of important enteric viruses was detected by Polymerase Chain Reaction (PCR). The number of total aerobic bacteria, coliform bacteria, yeast and molds and, Staphylococcus and Micrococcus spp. ranged from less than 1 to 6.40, 1 to 6.26, less than 1–5.82 and less than 1–5.66 log10 colony forming units·grams-1 (CFU·g–1) in REVS samples, respectively. None of the REVS tested in this study contained Salmonella spp., whereas E. coli and S. aureus were isolated in 38.1% (16/42) and 2.4% (1/42), respectively. S. aureus was resistant to gentamicin, kanamycin, aztreonam, and ciprofloxacin in the disc diffusion assay, however, it was not harboring the mecA gene. E. coli strains (n=16) were resistant (100%) to aminoglycoside antibiotics and 35.7% (6/16) of the isolates were extended spectrum beta lactamase (ESBL) producing. blaTEM and blaCTXM8/25 were detected in two isolates, whereas one isolate carried blaCTXM–1 and blaTEM together by PCR. Of the REVS, two were evaluated as positive for rotavirus (4.8%), six for hepatitis A (14%), and hepatitis E virus (14%). These results indicate the high microorganism load, presence of ESBL E. coli, and viral enteric pathogens in REVS, hence it is important to perform routine hygiene practices.

Foodborne transmission of hepatitis A and hepatitis E viruses: A literature review

Foodborne viruses have been recognized as a growing concern to the food industry and a serious public health problem. Hepatitis A virus (HAV) is responsible for the majority of viral outbreaks of food origin worldwide, while hepatitis E virus (HEV) has also been gaining prominence as a foodborne viral agent in the last years, due to its zoonotic transmission through the consumption of uncooked or undercooked infected meat or derivatives. However, there is a lack of scientific reports that gather all the updated information about HAV and HEV as foodborne viruses. A search of all scientific articles about HAV and HEV in food until March 2020 was carried out, using the keywords "HAV", "HEV", "foodborne", "outbreak" and "detection in food". Foodborne outbreaks due to HAV have been reported since 1956, mainly in the USA, and in Europe in recent years, where the number of outbreaks has been increasing throughout time, and nowadays it has become the continent with the highest foodborne HAV outbreak report. Investigation and detection of HAV in food is more recent, and the first detections were performed in the 1990s decade, most of them carried out on seafood, first, and frozen food, later. On the other hand, HEV has been mainly looked for and detected in food derived from reservoir animals, such as meat, sausages and pate of pigs and wild boars. For this virus, only isolated cases and small outbreaks of foodborne transmission have been recorded, most of them in industrialized countries, due to HEV genotype 3 or 4. Virus detection in food matrices requires special processing of the food matrix, followed by RNA detection by molecular techniques. For HAV, a real-time PCR has been agreed as the standard method for virus detection in food; in the case of HEV, a consensus assay for its detection in food has not been reached yet. Our investigation shows that there is still little data about HAV and HEV prevalence and frequency of contamination in food, prevalent viral strains, and sources of contamination, mainly in developing countries, where there is no research and legislation in this regard. Studies on these issues are needed to get a better understanding of foodborne viruses, their maintenance and their potential to cause diseases.

Characterisation of the environmental presence of hepatitis A virus in low-income and middle-income countries: a systematic review and meta-analysis

OBJECTIVE

To characterise the environmental presence of hepatitis A virus (HAV) in low- and middle-income countries (LMICs).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

EBSCOhost, PubMed, Scopus, ScienceDirect, Clinical Key and Web of Science were searched. Grey literature was sourced by searching the following electronic databases: Open Grey, National Health Research Database and Mednar.

ELIGIBILITY CRITERIA FOR INCLUDING STUDIES

Cross-sectional and ecological studies reporting HAV environmental presence and conducted in LMICs between January 2005 and May 2019, irrespective of language of publication.

DATA EXTRACTION AND DATA SYNTHESIS

Relevant data were extracted from articles meeting the inclusion criteria, and two reviewers independently assessed the studies for risk of bias. High heterogeneity of the extracted data led to the results being reported narratively.

RESULTS

A total of 2092 records were retrieved, of which 33 met the inclusion criteria. 21 studies were conducted in Tunisia, India and South Africa, and the rest were from Philippines, Pakistan, Morocco, Chad, Mozambique, Kenya and Uganda. In Tunisian raw sewage samples, the prevalence of HAV ranged from 12% to 68%, with an estimated average detection rate of 50% (95% CI 25 to 75), whereas HAV detection in treated sewage in Tunisia ranged from 23% to 65%, with an estimated average detection rate of 38% (95% CI 20 to 57). The prevalence of HAV detection in South African treated sewage and surface water samples ranged from 4% to 37% and from 16% to 76%, with an estimated average detection rates of 15% (95% CI 1 to 29) and 51% (95% CI 21 to 80), respectively. Over the review period, the estimated average detection rate of environmental HAV presence appeared to have declined by 10%.

CONCLUSION

The quality of included studies was fair, but sampling issues and paucity of data limited the strength of the review findings.

PROSPERO REGISTRATION NUMBER

CRD42019119592.

Quantitative PCR-based identification of enteric viruses contaminating fresh produce and surface water used for irrigation in Egypt

Fresh produce irrigated with surface water that may contain pathogens such as enteric viruses can lead to outbreaks of foodborne viral illnesses. In the current study, we performed real-time PCR (qPCR) to monitor the presence of enteric viruses such as human adenoviruses (HAdVs), hepatitis A virus (HAV), rotavirus group A (RVA), and norovirus GI (NoV GI) in surface water and fresh produce that were grown using this surface water in Egypt. Samples were collected on four occasions from different sites located in the Delta and in Greater Cairo, Egypt. Of the 32 water samples and 128 fresh produce samples, 27/32 (84.3%) and 99/128 (77.3%), respectively, were positive for at least one virus. HAdV (30/32) with a mean viral load = 1.5 × 10⁷ genome copies/L (GC/L) was the most commonly detected virus in water, followed by RVA (16/32, with a mean viral load = 2.7 × 10⁵ GC/L), HAV (11/32, with a mean viral load = 1.2 × 10⁴ GC /L), and NoV GI (10/32, with a mean viral load = 3.5 × 10³ GC/L). Additionally, HAdV (71/128, with a mean viral load = 9.8 × 10⁵ GC/g) was also the most commonly detected virus in the fresh produce, followed by NoV GI (43/128, with a mean viral load = 4.5 × 10³ GC/g), HAV (33/128, with a mean viral load = 6.4 × 10³ GC/g), and RVA (25/128, with a mean viral load = 1.5 × 10⁴ GC/g). Our results indicate that fresh produce may be contaminated with a wide range of enteric viruses, and these viruses may originate from virus-contaminated irrigation water. Moreover, this fresh produce may serve as a potential vector for the transmission of viral foodborne illnesses. These findings are important for future risk assessment analysis related to water/foodborne viruses. Graphical abstract . Please provide caption for Graphical AbstractGraphical abstract showing sample collection and processing.

Virological Quality of Irrigation Water in Leafy Green Vegetables and Berry Fruits Production Chains

This study condenses data acquired during investigations of the virological quality of irrigation water used in production of fresh produce. One hundred and eight samples of irrigation water were collected from five berry fruit farms in Finland (1), the Czech Republic (1), Serbia (2), and Poland (1), and sixty-one samples were collected from three leafy green vegetable farms in Poland, Serbia, and Greece. Samples were analyzed for index viruses of human or animal fecal contamination (human and porcine adenoviruses, and bovine polyoma viruses), and human pathogenic viruses (hepatitis A virus, hepatitis E virus, and noroviruses GI/GII). Both index and pathogenic viruses were found in irrigation water samples from the leafy green vegetables production chain. The data on the presence of index viruses indicated that the highest percentage of fecal contamination was of human origin (28.1 %, 18/64), followed by that of porcine (15.4 %, 6/39) and bovine (5.1 %, 2/39) origins. Hepatitis E virus (5 %, 1/20) and noroviruses GII (14.3 %, 4/28) were also detected. Samples from berry fruit production were also positive for both index and pathogenic viruses. The highest percentage of fecal contamination was of human origin (8.3 %, 9/108), followed by that of porcine, 4.5 % (4/89) and bovine, 1.1 % (1/89) origins. Norovirus GII (3.6 %, 2/56) was also detected. These data demonstrate that irrigation water used in primary production is an important vehicle of viral contamination for fresh produce, and thus is a critical control point which should be integrated into food safety management systems for viruses. The recommendations of Codex Alimentarius, as well as regulations on the use of water of appropriate quality for irrigation purposes, should be followed.

Viral Hepatitis in Pakistan: Past, Present, and Future

Viral hepatitis is a major cause of morbidity and mortality worldwide and a rising cause for concern in Asian countries. Weather it is blood borne or water/food borne hepatotropic virus, increasing burden is alarming for Asian countries. In this review we have evaluated the existing data to estimate the burden of viral hepatitis in populations of all age groups nationwide, along with an assessment of the risk factors and preventive and management strategies currently employed in Pakistan. The aim of our work is to consolidate and supplement the present knowledge regarding viral hepatitis in light of past and present trends and to provide future direction to the existing health policies.

How to cite this article

Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepato-Gastroenterol 2016;6(1):70-81.