{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T03:16:34Z","timestamp":1787973394388,"version":"build-2784847793"},"reference-count":80,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T00:00:00Z","timestamp":1584662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009647","name":"Ministry of Health","doi-asserted-by":"publisher","award":["CCM 2016"],"award-info":[{"award-number":["CCM 2016"]}],"id":[{"id":"10.13039\/100009647","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Seventh Framework Programme","award":["278433-PREDEMICS"],"award-info":[{"award-number":["278433-PREDEMICS"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Hepatitis E virus (HEV) is an emerging causative agent of acute hepatitis worldwide. To provide insights into the epidemiology of HEV in Italy, a large-scale investigation was conducted into urban sewage over nine years (2011\u20132019), collecting 1374 sewage samples from 48 wastewater treatment plants located in all the 20 regions of Italy. Broadly reactive primers targeting the ORF1 and ORF2 regions were used for the detection and typing of HEV, followed by Sanger and next generation sequencing (NGS). Real-time RT-qPCR was also used to attempt quantification of positive samples. HEV RNA detection occurred in 74 urban sewage samples (5.4%), with a statistically significant higher frequency (7.1%) in central Italy. Fifty-six samples were characterized as G3 strains and 18 as G1. While the detection of G3 strains occurred in all the surveillance period, G1 strains were mainly detected in 2011\u20132012, and never in 2017\u20132019. Typing was achieved in 2 samples (3f subtype). Viral concentrations in quantifiable samples ranged from 1.2 \u00d7 103 g.c.\/L to 2.8 \u00d7 104 g.c.\/L. Our results suggest the considerable circulation of the virus in the Italian population, despite a relatively small number of notified cases, a higher occurrence in central Italy, and a noteworthy predominance of G3 strains.<\/jats:p>","DOI":"10.3390\/ijerph17062059","type":"journal-article","created":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T07:29:07Z","timestamp":1584689347000},"page":"2059","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Nine-Year Nationwide Environmental Surveillance of Hepatitis E Virus in Urban Wastewaters in Italy (2011\u20132019)"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5402-927X","authenticated-orcid":false,"given":"Marcello","family":"Iaconelli","sequence":"first","affiliation":[{"name":"Department of Environment and Health - Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giusy","family":"Bonanno Ferraro","sequence":"additional","affiliation":[{"name":"Department of Environment and Health - Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1685-9982","authenticated-orcid":false,"given":"Pamela","family":"Mancini","sequence":"additional","affiliation":[{"name":"Department of Environment and Health - Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7605-0539","authenticated-orcid":false,"given":"Elisabetta","family":"Suffredini","sequence":"additional","affiliation":[{"name":"Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Veneri","sequence":"additional","affiliation":[{"name":"Department of Environment and Health - Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Rita","family":"Ciccaglione","sequence":"additional","affiliation":[{"name":"Department Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3035-5510","authenticated-orcid":false,"given":"Roberto","family":"Bruni","sequence":"additional","affiliation":[{"name":"Department Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simonetta","family":"Della Libera","sequence":"additional","affiliation":[{"name":"Department of Environment and Health - Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bignami","sequence":"additional","affiliation":[{"name":"Department of Environment and Health - Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0998-0522","authenticated-orcid":false,"given":"Massimo","family":"Brambilla","sequence":"additional","affiliation":[{"name":"Consiglio per la ricerca in agricoltura e l\u2019analisi dell\u2019economia agraria (CREA), Research Centre for Engineering and Agri Food Processing, 24047 Treviglio, BG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6917-8478","authenticated-orcid":false,"given":"Dario","family":"De Medici","sequence":"additional","affiliation":[{"name":"Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Brandtner","sequence":"additional","affiliation":[{"name":"Indipendent Researcher, 00156 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Schembri","sequence":"additional","affiliation":[{"name":"Regional Department for Health Activities and Epidemiological Observatory of the Sicilian Region, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"D\u2019Amato","sequence":"additional","affiliation":[{"name":"Ministry of Health, Directorate-General for Prevention, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-100X","authenticated-orcid":false,"given":"Giuseppina","family":"La Rosa","sequence":"additional","affiliation":[{"name":"Department of Environment and Health - Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,20]]},"reference":[{"key":"ref_1","first-page":"117","article-title":"Current Knowledge on Hepatitis E","volume":"3","author":"Garcia","year":"2015","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1136\/jclinpath-2017-204627","article-title":"Unexplained abnormal liver function in patients with primary antibody deficiency: Could it be chronic hepatitis E infection?","volume":"71","author":"Mohamed","year":"2018","journal-title":"J. Clin. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.jhep.2007.12.008","article-title":"Hepatitis E: An emerging awareness of an old disease","volume":"48","author":"Purcell","year":"2008","journal-title":"J. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1111\/tbed.13251","article-title":"Emergent subtype of hepatitis E virus genotype 3 in wild boar in Spain","volume":"66","author":"Vicente","year":"2019","journal-title":"Transbound. Emerg. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s12560-019-09403-2","article-title":"Occurrence of HEV-RNA in Italian Regional Pork and Wild Boar Food Products","volume":"11","author":"Montone","year":"2019","journal-title":"Food Environ. Virol."},{"key":"ref_6","unstructured":"EFSA (2017). BIOHAZ Panel (EFSA Panel on Biological Hazards). Scientific Opinion on the public health risks associated with hepatitis E virus (HEV) as a food-borne pathogen. 15, 4886\u20134889."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sridhar, S., Teng, J.L.L., Chiu, T.H., Lau, S.K.P., and Woo, P.C.Y. (2017). Hepatitis E Virus Genotypes and Evolution: Emergence of Camel Hepatitis E Variants. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18040869"},{"key":"ref_8","first-page":"331","article-title":"Zoonotic transmission of hepatitis E virus in industrialized countries","volume":"36","author":"Ruggeri","year":"2013","journal-title":"New Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"ofz306","DOI":"10.1093\/ofid\/ofz306","article-title":"High Hepatitis E virus (HEV) Positivity Among Domestic Pigs and Risk of HEV Infection of Individuals Occupationally Exposed to Pigs and Pork Meat in Hanoi, Vietnam","volume":"6","author":"Hoan","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/j.1440-1746.2010.06540.x","article-title":"Hepatitis E: Historical, contemporary and future perspectives","volume":"26","author":"Aggarwal","year":"2011","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/rmv.384","article-title":"Hepatitis E virus","volume":"13","author":"Emerson","year":"2003","journal-title":"Rev. Med. Virol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1099\/jgv.0.000393","article-title":"Proposed reference sequences for hepatitis E virus subtypes","volume":"97","author":"Smith","year":"2016","journal-title":"J. Gen. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2645","DOI":"10.1099\/jgv.0.000940","article-title":"ICTV Virus Taxonomy Profile: Hepeviridae","volume":"98","author":"Purdy","year":"2017","journal-title":"J. Gen. Virol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1053\/j.gastro.2015.10.048","article-title":"Chronic Infection With Camelid Hepatitis E Virus in a Liver Transplant Recipient Who Regularly Consumes Camel Meat and Milk","volume":"150","author":"Lee","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/liv.13014","article-title":"Hepatitis E, the neglected one","volume":"36","author":"Abravanel","year":"2016","journal-title":"Liver Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/j.1863-2378.2008.01136.x","article-title":"Hepatitis E virus infection among domestic animals in eastern China","volume":"55","author":"Zhang","year":"2008","journal-title":"Zoonoses Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1017\/S0950268814001150","article-title":"Hepatitis E virus genotype 4 in a pig farm, Italy, 2013","volume":"143","author":"Monne","year":"2015","journal-title":"Epidemiol. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"110","DOI":"10.3201\/eid1901.120983","article-title":"Hepatitis E virus genotype 4 outbreak, Italy, 2011","volume":"19","author":"Garbuglia","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s12560-015-9200-x","article-title":"A 1-Year Quantitative Survey of Noro-, Adeno-, Human Boca-, and Hepatitis E Viruses in Raw and Secondarily Treated Sewage from Two Plants in Norway","volume":"7","author":"Myrmel","year":"2015","journal-title":"Food Environ. Virol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"364","DOI":"10.26444\/aaem\/90497","article-title":"First detection and molecular characterization of hepatitis E virus in water from wastewater treatment plants in Portugal","volume":"25","author":"Matos","year":"2018","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5101","DOI":"10.1016\/j.watres.2013.05.050","article-title":"High occurrence of hepatitis E virus in samples from wastewater treatment plants in Switzerland and comparison with other enteric viruses","volume":"47","author":"Masclaux","year":"2013","journal-title":"Water Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"346","DOI":"10.2166\/wh.2009.042","article-title":"Analysis of the evolution in the circulation of HAV and HEV in eastern Spain by testing urban sewage samples","volume":"8","author":"Miagostovich","year":"2010","journal-title":"J. Water Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"448","DOI":"10.3201\/eid0904.020351","article-title":"Hepatitis E virus epidemiology in industrialized countries","volume":"9","author":"Pina","year":"2003","journal-title":"Emerg. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.jenvman.2015.05.019","article-title":"Evidence of viral dissemination and seasonality in a Mediterranean river catchment: Implications for water pollution management","volume":"159","author":"Rusinol","year":"2015","journal-title":"J. Environ. Manag."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.ijheh.2018.01.012","article-title":"Differential removal of human pathogenic viruses from sewage by conventional and ozone treatments","volume":"221","author":"Wang","year":"2018","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1002\/jmv.24403","article-title":"The use of human sewage screening for community surveillance of hepatitis E virus in the UK","volume":"88","author":"Smith","year":"2016","journal-title":"J. Med. Virol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1186\/1743-422X-8-195","article-title":"Molecular detection of multiple viral targets in untreated urban sewage from Greece","volume":"8","author":"Kokkinos","year":"2011","journal-title":"Virol. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5870","DOI":"10.1128\/AEM.00336-10","article-title":"Molecular detection of hepatitis E virus in sewage samples","volume":"76","author":"Pourshaban","year":"2010","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"La Rosa, G., Della Libera, S., Iaconelli, M., Ciccaglione, A.R., Bruni, R., Taffon, S., Equestre, M., Alfonsi, V., Rizzo, C., and Tosti, M.E. (2014). Surveillance of hepatitis A virus in urban sewages and comparison with cases notified in the course of an outbreak, Italy 2013. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-419"},{"key":"ref_30","unstructured":"World Health Organization (2020, February 27). Guidelines for Environmental Surveillance of Poliovirus Circulation. World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/67854."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1002\/jmv.21564","article-title":"Imported and autochthonous hepatitis E virus strains in Spain","volume":"81","author":"Fogeda","year":"2009","journal-title":"J. Med. Virol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/1743-422X-11-72","article-title":"Molecular characterisation of human hepatitis E virus from Italy: Comparative analysis of five reverse transcription-PCR assays","volume":"11","author":"Fratini","year":"2014","journal-title":"Virol. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1006\/bbrc.2001.6088","article-title":"Analysis of the complete genome of indigenous swine hepatitis E virus isolated in Japan","volume":"289","author":"Okamoto","year":"2001","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/jmv.10276","article-title":"Molecular investigation of hepatitis E virus infection in patients with acute hepatitis in Kathmandu, Nepal","volume":"69","author":"Shrestha","year":"2003","journal-title":"J. Med. Virol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1099\/vir.0.031278-0","article-title":"Hepatitis E Virus In Italy: Molecular Analysis Of Travel-Related And Autochthonous Cases","volume":"92","author":"Muscillo","year":"2011","journal-title":"J. Gen. Virol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.watres.2017.05.039","article-title":"Molecular characterization of human adenoviruses in urban wastewaters using next generation and Sanger sequencing","volume":"121","author":"Iaconelli","year":"2017","journal-title":"Water Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1093\/bioinformatics\/btu135","article-title":"Orione, a web-based framework for NGS analysis in microbiology","volume":"30","author":"Cuccuru","year":"2014","journal-title":"Bioinformatics"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1038\/nmeth.1923","article-title":"Fast gapped-read alignment with Bowtie 2","volume":"9","author":"Langmead","year":"2012","journal-title":"Nat. Methods"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1093\/bioinformatics\/btl629","article-title":"Assembling millions of short DNA sequences using SSAKE","volume":"23","author":"Warren","year":"2007","journal-title":"Bioinformatics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.fm.2019.02.005","article-title":"Quantification and genetic diversity of Hepatitis E virus in wild boar (Sus scrofa) hunted for domestic consumption in Central Italy","volume":"82","author":"Iaconelli","year":"2019","journal-title":"Food Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jviromet.2012.07.027","article-title":"Minor groove binder modification of widely used TaqMan probe for hepatitis E virus reduces risk of false negative real-time PCR results","volume":"186","author":"Garson","year":"2012","journal-title":"J. Virol. Methods"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jviromet.2005.07.004","article-title":"A broadly reactive one-step real-time RT-PCR assay for rapid and sensitive detection of hepatitis E virus","volume":"131","author":"Jothikumar","year":"2006","journal-title":"J. Virol. Methods"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Candido, A., Taffon, S., Chionne, P., Pisani, G., Madonna, E., Dettori, S., Hamza, A., Valdarchi, C., Bruni, R., and Ciccaglione, A.R. (2012). Diagnosis of HEV infection by serological and real-time PCR assays: A study on acute non-A-C hepatitis collected from 2004 to 2010 in Italy. BMC Res. Notes, 5.","DOI":"10.1186\/1756-0500-5-297"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1111\/jvh.13049","article-title":"Incidence of hepatitis E virus infection among blood donors in a high endemic area of Central Italy","volume":"26","author":"Marcantonio","year":"2019","journal-title":"J. Viral Hepat."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2547","DOI":"10.1007\/s00705-015-2538-4","article-title":"Detection and molecular characterization of zoonotic viruses in swine fecal samples in Italian pig herds","volume":"160","author":"Monini","year":"2015","journal-title":"Arch. Virol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Ponterio, E., Di Bartolo, I., Orru, G., Liciardi, M., Ostanello, F., and Ruggeri, F.M. (2014). Detection of serum antibodies to hepatitis E virus in domestic pigs in Italy using a recombinant swine HEV capsid protein. BMC Vet. Res., 10.","DOI":"10.1186\/1746-6148-10-133"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.vetmic.2010.12.007","article-title":"Viral and antibody HEV prevalence in swine at slaughterhouse in Italy","volume":"149","author":"Ponterio","year":"2011","journal-title":"Vet. Microbiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.rvsc.2009.12.011","article-title":"Detection of Hepatitis E Virus (HEV) in Italian pigs displaying different pathological lesions","volume":"88","author":"Martelli","year":"2010","journal-title":"Res. Vet. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.vetmic.2008.04.028","article-title":"Widespread diffusion of genotype 3 hepatitis E virus among farming swine in Northern Italy","volume":"132","author":"Martelli","year":"2008","journal-title":"Vet. Microbiol."},{"key":"ref_50","first-page":"219","article-title":"Hepatitis E Virus (Genotype 3) in Slurry Samples from Swine Farming Activities in Italy","volume":"9","author":"Brambilla","year":"2016","journal-title":"Food Environ. Virol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.vetmic.2007.07.004","article-title":"Detection of hepatitis E virus (HEV) in a demographic managed wild boar (Sus scrofa scrofa) population in Italy","volume":"126","author":"Martelli","year":"2008","journal-title":"Vet. Microbiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s12560-015-9201-9","article-title":"Molecular Investigation on the Presence of Hepatitis E Virus (HEV) in Wild Game in North-Western Italy","volume":"7","author":"Serracca","year":"2015","journal-title":"Food Environ. Virol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1111\/tbed.12948","article-title":"Molecular survey of HEV infection in wild boar population in Italy","volume":"65","author":"Ostanello","year":"2018","journal-title":"Transbound. Emerg. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1111\/tbed.13157","article-title":"Hepatitis E virus in sheep in Italy","volume":"66","author":"Sarchese","year":"2019","journal-title":"Transbound. Emerg. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"664","DOI":"10.2166\/wh.2009.120","article-title":"Hepatitis E virus genotype 3 and sporadically also genotype 1 circulate in the population of Catalonia, Spain","volume":"7","author":"Girones","year":"2009","journal-title":"J. Water Health"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1111\/j.1469-0691.2011.03461.x","article-title":"Presence of enteric hepatitis viruses in the sewage and population of Greater Cairo","volume":"17","author":"Kamel","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1007\/s12560-016-9241-9","article-title":"Detection of Hepatitis E Virus in Sewage After an Outbreak on a French Island","volume":"8","author":"Miura","year":"2016","journal-title":"Food Environ. Virol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"661","DOI":"10.5604\/12321966.1185903","article-title":"Frequency of hepatitis E and Hepatitis A virus in water sample collected from Faisalabad, Pakistan","volume":"22","author":"Ahmad","year":"2015","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s00705-014-2251-8","article-title":"Hepatitis E virus genotypes 1 and 3 in wastewater samples in Tunisia","volume":"160","author":"Iaconelli","year":"2015","journal-title":"Arch. Virol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jcv.2014.08.016","article-title":"First detection of hepatitis E virus in Central Argentina: Environmental and serological survey","volume":"61","author":"Pisano","year":"2014","journal-title":"J. Clin. Virol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/jvh.12038","article-title":"Identification of HEV in symptom-free migrants and environmental samples in Italy","volume":"20","author":"Idolo","year":"2013","journal-title":"J. Viral Hepat."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1007\/s00705-012-1422-8","article-title":"Detection and molecular characterization of hepatitis E virus in clinical, environmental and putative animal sources","volume":"157","author":"Ishida","year":"2012","journal-title":"Arch. Virol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s12560-016-9263-3","article-title":"One-year Surveillance of Human Enteric Viruses in Raw and Treated Wastewaters, Downstream River Waters, and Drinking Waters","volume":"9","author":"Iaconelli","year":"2017","journal-title":"Food Environ. Virol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"216","DOI":"10.4269\/ajtmh.15-0925","article-title":"Hepatitis E Virus Genotype 3 in Sewage and Genotype 1 in Acute Hepatitis Cases, Israel","volume":"95","author":"Ram","year":"2016","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"230","DOI":"10.3389\/fmicb.2017.00230","article-title":"Metagenomic Sequencing for Surveillance of Food- and Waterborne Viral Diseases","volume":"8","author":"Nieuwenhuijse","year":"2017","journal-title":"Front. Microbiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.tmaid.2017.03.014","article-title":"Acute hepatitis E virus infection in a migrant population in North East Italy: A retrospective analysis","volume":"20","author":"Bradanini","year":"2017","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.watres.2018.12.014","article-title":"Transmission of hepatitis E virus by water: An issue still pending in industrialized countries","volume":"151","author":"Fenaux","year":"2019","journal-title":"Water Res."},{"key":"ref_68","first-page":"253","article-title":"Seroprevalence of hepatitis E virus (HEV) infection in blood donors and renal transplant recipients: A retrospective study from central Italy","volume":"23","author":"Puttini","year":"2015","journal-title":"Infez. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s10096-016-2821-7","article-title":"Seroepidemiology of HEV and HAV in two populations with different socio-economic levels and hygienic\/sanitary conditions","volume":"36","author":"Zuin","year":"2017","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/jmv.1890420321","article-title":"Hepatitis type E in Italy: A seroepidemiological survey. Study Group of Hepatitis E","volume":"42","author":"Zanetti","year":"1994","journal-title":"J. Med. Virol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0923-2516(99)89005-0","article-title":"Epidemiology and prevention of enterically transmitted hepatitis in Italy","volume":"149","author":"Coppola","year":"1998","journal-title":"Res. Virol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1111\/tbed.12533","article-title":"Hepatitis E Virus: A Cross-Sectional Serological and Virological Study in Pigs and Humans at Zoonotic Risk within a High-Density Pig Farming Area","volume":"64","author":"Caruso","year":"2017","journal-title":"Transbound. Emerg. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1017\/S0950268813001167","article-title":"Epidemiological and clinical features of HEV infection: A survey in the district of Foggia (Apulia, Southern Italy)","volume":"142","author":"Scotto","year":"2014","journal-title":"Epidemiol. Infect."},{"key":"ref_74","first-page":"413","article-title":"A nationwide retrospective study on prevalence of hepatitis E virus infection in Italian blood donors","volume":"16","author":"Spada","year":"2018","journal-title":"Blood Transfus"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"30299","DOI":"10.2807\/1560-7917.ES.2016.21.30.30299","article-title":"High prevalence of anti-hepatitis E virus antibodies among blood donors in central Italy, February to March 2014","volume":"21","author":"Lucarelli","year":"2016","journal-title":"Eurosurveillance"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ijfoodmicro.2014.10.005","article-title":"Detection of hepatitis E virus in pork liver sausages","volume":"193","author":"Angeloni","year":"2015","journal-title":"Int. J. Food Microbiol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1700517","DOI":"10.2807\/1560-7917.ES.2018.23.41.1700517","article-title":"Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016","volume":"23","author":"Alfonsi","year":"2018","journal-title":"Eurosurveillance"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1007\/s12560-015-9207-3","article-title":"Hepatitis A and E Viruses in Wastewaters, in River Waters, and in Bivalve Molluscs in Italy","volume":"7","author":"Iaconelli","year":"2015","journal-title":"Food Environ. Virol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s12560-017-9319-z","article-title":"First Detection of Hepatitis E Virus in Shellfish and in Seawater from Production Areas in Southern Italy","volume":"10","author":"Proroga","year":"2018","journal-title":"Food Environ. Virol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ijid.2018.12.011","article-title":"Molecular characterization of human enteric viruses in food, water samples, and surface swabs in Sicily","volume":"80","author":"Purpari","year":"2019","journal-title":"Int. J. Infect. Dis."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/6\/2059\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:09:59Z","timestamp":1760173799000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/6\/2059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,20]]},"references-count":80,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["ijerph17062059"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17062059","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,20]]}}}