Investigation of an outbreak of hepatitis E virus 4d reveals the importance of good kitchen hygiene

In July–August 2022, an outbreak of hepatitis E was reported following a funeral dinner in a village of Yantai, June 2022. The aim of this study was to characterise the outbreak, search for more cases, and investigate the risk factors to help prevent hepatitis E infection in the future. A 1:2 case-control study was used to investigate the suspected causative food, and HEV antibody testing and genetic tracing were performed on clinical and environmental samples, and HEV antibody of 69 healthy people who did not attend the dinner in the same village were tested. A total of 80 people were exposed to this outbreak and 18 (22.5 %, 18/80) had acute infections, which was much higher than the positivity rate of healthy people of the same age group in the village (2.9 %, 2/69). Multifactorial analysis showed that the infection was significantly associated with the consumption of cucumber in sauce (aOR = 4.44, 95%CI = 1.23–16.06). Further investigation revealed that there was a mixing of pots and pans for washing raw pork products with those for cold meals during dish preparation. A whole genome sequence of HEV was obtained from sera of cases and from an environmental sample from the pork supplier's refrigerator. All sequences were typed as HEV-4d. This foodborne outbreak was most likely caused due to a failure in kitchen hygiene to differentiate between raw and cooked pots and pans during dish preparation, resulting in cross-contamination from defrosted pork to cold dishes. Our findings emphasize the importance of education of food hygiene, especially in remote areas.