Hepatitis E cases rise in Singapore, and undercooked pork liver may be the cause: SGH

Pigs livers are pictured at the international meat industry fair in Frankfurt. (PHOTO: Daniel Roland/AFP/Getty Images)

SINGAPORE — A research study by Singapore General Hospital (SGH) has found a rising trend in Hepatitis E virus (HEV) cases among Singaporeans – and it could be due to the consumption of undercooked pig liver.

In a media release on Wednesday (9 October), SGH said that the number of HEV cases among Singaporeans has increased from 1.7 cases per 100,000 residents in 2012 to 4.1 cases per 100,000 residents in 2016. The infected individuals tend to be Chinese, male and aged 55 years and above.

Same HEV strain as detected in raw pork liver

Out of 59 patient blood samples obtained by the research study, 44 of them showed the same HEV subtype strain detected in three raw pork liver samples.

“Although we could not ascertain if pig liver is the main contributor of HEV cases in Singapore, we observed that pig liver can be found in many local dishes,” said Dr Chan Kwai Peng, senior author of the study and SGH’s senior consultant in the Department of Microbiology.

“As most people like it a little undercooked for its texture, this may put them at risk of Hepatitis E infection. The safest way of consuming food, including pork, is to cook it thoroughly,”

Symptoms of HEV

HEV is a virus that infects the liver. Most patients show no symptoms but if they do, the symptoms include fever, fatigue, nausea and jaundice.

The infection goes away on its own after a few weeks, and it usually does not lead to long-term illness or liver damage. However, it can be dangerous for pregnant women or anyone with weak immune systems, such as transplant patients or people with pre-existing chronic liver disease.

HEV can be acquired by ingesting faecally-contaminated water, or eating raw or undercooked products from infected animals. Worldwide, HEV food-borne infection is generally associated with the consumption of pork meat/offal, game meat and shellfish.

In Europe, the consumption of raw or undercooked pork or pork products is the most common cause of HEV infection. In 2010, Hong Kong’s Centre for Food Safety issued a report about eating undercooked pig livers for the same reason.


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