Pork Food Safety Risks and Hepatitis E

The hepatitis E virus (HEV) causes acute hepatitis in healthy persons and can cause chronic hepatitis in immune suppressed persons.

Hepatitis E occurs most often in countries with poor sanitation and communities where undercooked pork or pig products are eaten. Hepatitis E is the leading cause of acute viral hepatitis in developing countries.

The risk of getting #HepatitisE from eating pork or pork products is low if the meat is thoroughly cooked. Make sure the meat isn’t pink, juices run clear and the meat is steaming hot when cooked. This will reduce the risk of illness from harmful foodborne bacteria and viruses like hepatitis E.

2017 Hepatitis E Outbreak in England (UK)
In May 2017, a mutant strain of Hepatitis E was found within around 10% of imported pork and was circulation around the United Kingdom (UK). Tens of thousands probably fell ill after eating sausages, pork and salami contaminated with the hepatitis E virus, according to UK Government experts. The outbreak was believed to have been caused by pig farms in France, Germany, Netherlands and Denmark.

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Safe Cooking of Pork
For safety, the USDA recommends cooking:

  • All ground pork patties and ground pork mixtures such as meat loaf to 160 °F.
  • All organ and variety meats (such as heart, kidney, liver, tongue, and chitterlings) to 160 °F.
  • All raw pork steaks, chops, and roasts to a minimum internal temperature of 145 °F as measured with a food thermometer before removing meat from the heat source.

For safety and quality, allow meat to rest for at least three minutes before carving or consuming. For reasons of personal preference, consumers can choose to cook meat to higher temperatures.

What is hepatitis and hepatitis E?

Hepatitis is an inflammation of the liver which is often caused by an infection with the hepatitis virus. There are five main types of this virus (A, B, C, D, E). Hepatitis B, C and D are most commonly spread by exposure to infected blood or body fluids whereas hepatitis A and E are more commonly spread from person-to-person or by exposure to contaminated water. However, food is also known to be a source of hepatitis A infection and reports are emerging regarding foodborne hepatitis E infection.

Hepatitis E virus (HEV) is an illness of the liver which can infect both animals and humans. Most people will clear the virus without any symptoms. Some people who have suppressed immune systems may find the infection hard to fight which in turn can cause chronic inflammation of the liver.

Mode of Transmission

In countries with poor sanitation, HEV is transmitted by the feco-oral route by consuming contaminated water or food.  In developed countries, most cases are due to consumption of raw or undercooked pork meat, pork liver, or game (wild boar and deer) meat.

  • HEV has been found in 11% of pig livers obtained from grocery stores in the U.S., 10% of pork sausages in the U.K., 10% of wild boars in northern Italy, and 17% of figatelli (traditional Corsican sausages made from pig liver) in southern France, where consumption of figatelli has been linked to outbreaks of hepatitis E.

An outbreak on a cruise ship was attributed to shellfish.

In contrast to hepatitis A, interpersonal transmission of hepatitis E is uncommon; however, during pregnancy HEV is transmitted from mother to child, with poor fetal outcomes.

What are the symptoms of hepatitis infection?

Infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. More severe symptoms can occur in pregnant women and people with very weak immune systems.

Hepatitis A appears only as a limited duration infection and does not result in long term illness.

Hepatitis B, C and D can cause similar short term infections, but in some people, the virus remains in the body, resulting in long term disease and ongoing liver problems.

Most Hepatitis E (HEV) infections are mild or symptomless. When symptoms do appear, they include: jaundice (yellow eyes and skin and dark urine), fever, influenza-like symptoms, abdominal pain, vomiting, weight loss, and aching muscles. Symptoms usually resolve in 4-6 weeks. Rarely, neurological symptoms develop.

Can I catch hepatitis E from eating food?

Reports are emerging regarding hepatitis E infection in humans from eating raw or undercooked pig meat or pig liver products, but the evidence is limited.

The European Food Safety Authority looked at the matter in 2011 and noted that pork pies, liver pate, wild boar, under-cooked or raw pork, home-made sausages, meat (in general), unpasteurised milk, shellfish and ethnic foods were cited as risk factors in the scientific literature.

A case control study in Germany found ‘any offal’ and ‘wild boar meat’ were risk factors for hepatitis E infection in cases covered by the study. Another small case control study in France found ‘raw pig liver sausage’ was a risk factor.

Who is a risk from developing hepatitis E?

Considering this high prevalence, consumers at risk for developing severe forms of hepatitis E – HEV (e.g., solid-organ transplant recipients, person having underlying liver conditions, or pregnant women) should be informed about the HEV risk and should avoid eating such pork liver food products without thoroughly cooking them.