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Publications

Journal Article Ahead of print

PubMed: 42480405 DOI: 10.1016/j.scitotenv.2026.182052

What lies beneath? Hepatitis E virus surveillance in Belgian wastewater suggests hidden trends in community circulation.

Sci Total Environ 1048:182052

Authors: Noor Ul Hudda, Marie De Smedt, Raphael Janssens, Inge Roukaerts, Koenraad Van Hoorde, Veronik Hutse, Hadrien Maloux, Bavo Verhaegen, Arno Furquim d'Almeida, Naomi De Roeck, Michael Peeters, Steven Van Gucht, Guy Caljon, Thomas Vanwolleghem, Peter Delputte

Affiliations

  • Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Antwerp, Belgium.
  • Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium.
  • National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium.
  • Foodborne Pathogens, Sciensano, Brussels, Belgium.
  • Viral Hepatitis Research Group, Laboratory Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Fac. Medicine & Health Sciences, Antwerp, Belgium.
  • National Reference Centre of Hepatitis Viruses, Viral Diseases, Infectious Diseases in Humans, Sciensano, Brussels, Belgium; NITAG, Superior Health Council, Brussels, Belgium.
  • Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Antwerp, Belgium; Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
  • Viral Hepatitis Research Group, Laboratory Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Fac. Medicine & Health Sciences, Antwerp, Belgium; Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
  • Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Antwerp, Belgium; Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.

Abstract

Hepatitis E virus (HEV) is a major cause of acute viral hepatitis worldwide. Eight genotypes have been identified so far, with genotype 3 (gt3) predominating in high-income countries and commonly linked to eating undercooked pork. In Belgium, an estimated 54,000 annual HEV infections contrast sharply with only 25-117 clinically reported cases, revealing a critical surveillance blind spot. To evaluate the potential to complement clinical surveillance, we retrospectively analysed municipal wastewater weekly for HEV (presumed genotype 3) using digital PCR during 2022-2023. Sampling covered four Antwerp wastewater treatment plants (WWTPs) in 2022 (population of approximately 503,243 inhabitants) and 13 WWTPs across Flanders and Brussels in 2023, serving a population of approximately 2.6 million inhabitants (≈23% of Belgium's population). Viral signals were normalised to pepper mild mottle virus (PMMoV) as a proxy for faecal load and aggregated across sites to describe temporal trends. HEV gt3 RNA was detectable year-round in 2022 and 2023, but amplitudes and timing varied by catchment. In 2022, the wastewater HEV RNA signal showed an early-summer surge (May-June). In 2023, it rose from late May to a July-August peak with a second, broader elevation in late October-November. Weekly clinical case data identified at the Belgian National Reference Centre did not align with wastewater signals, suggesting that current surveillance captures only symptomatic or diagnosed infections. Since wastewater surveillance reveals sustained, seasonally patterned HEV gt3 circulation and captures asymptomatic infections missed by clinical surveillance, we advocate for further wastewater-based surveillance to complement traditional epidemiological monitoring.

MeSH

Hepatitis E Virus, Viruses, Genotype, Hepatitis E, Research, Complement System Proteins, Environment, Infections, Hepatitis