BACKGROUND: Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses. OBJECTIVE AND STUDY DESIGN: WHO's European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC's HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods. RESULTS: The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission. DISCUSSION: Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.

European Centre for Disease Prevention and Control Gustav 3 s boulevard 40 169 73 Solna Sweden

Health Board Tallinn Estonia

Health Service Executive Health Protection Surveillance Centre Dublin Ireland

Hellenic Public Health Organization Athens Greece

Instituto Nacional de Saúde Doutor Ricardo Jorge Lisbon Portugal

Istituto Superiore di Sanità Rome Italy

National Institute for Health and Welfare Helsinki Finland

National Institute for Public Health and the Environment Bilthoven the Netherlands

National Institute of Public Health Prague Czech Republic

Norwegian Institute of Public Health Oslo Norway

Paul Ehrlich Institut Langen Germany

Public Health England London United Kingdom

Robert Koch Institut Berlin Germany

Sanquin Blood Supply Foundation Amsterdam the Netherlands

Santé Publique France Saint Maurice France

Statens Serum Institut Copenhagen Denmark

The Public Health Agency of Sweden Stockholm Sweden

Viral Hepatitis Reference and Research Laboratory National Center of Microbiology Carlos 3 Health Institute Madrid Spain

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$a Adlhoch, Cornelia $u European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73, Solna, Sweden. Electronic address: cornelia.adlhoch@ecdc.europa.eu.

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$a Standardising surveillance of hepatitis E virus infection in the EU/EEA: A review of national practices and suggestions for the way forward / $c C. Adlhoch, Z. Manďáková, S. Ethelberg, J. Epštein, R. Rimhanen-Finne, J. Figoni, SA. Baylis, M. Faber, K. Mellou, N. Murphy, J. O'Gorman, ME. Tosti, AR. Ciccaglione, A. Hofhuis, H. Zaaijer, H. Lange, R. de Sousa, A. Avellón, L. Sundqvist, B. Said, S. Ijaz,

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$a BACKGROUND: Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses. OBJECTIVE AND STUDY DESIGN: WHO's European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC's HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods. RESULTS: The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission. DISCUSSION: Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.

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$a Manďáková, Zdenka $u National Institute of Public Health, Prague, Czech Republic. Electronic address: zdenka.mandakova@szu.cz.

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$a Baylis, Sally A $u Paul-Ehrlich-Institut (PEI), Langen, Germany. Electronic address: Sally.Baylis@pei.de.

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$a Faber, Mirko $u Robert Koch-Institut, Berlin, Germany. Electronic address: FaberM@rki.de.

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$a Mellou, Kassiani $u Hellenic Public Health Organization, Athens, Greece. Electronic address: kmellou@gmail.com.

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$a Murphy, Niamh $u Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland. Electronic address: niamh.murphy@hse.ie.

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$a O'Gorman, Joanne $u Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland. Electronic address: joanne.ogorman4@hse.ie.

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$a Tosti, Maria Elena $u Istituto Superiore di Sanità, Rome, Italy. Electronic address: mariaelena.tosti@iss.it.

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$a Ciccaglione, Anna Rita $u Istituto Superiore di Sanità, Rome, Italy. Electronic address: annarita.ciccaglione@iss.it.

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$a Hofhuis, Agnetha $u National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Electronic address: agnetha.hofhuis@rivm.nl.

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$a Zaaijer, Hans $u Sanquin Blood Supply Foundation, Amsterdam, the Netherlands. Electronic address: h.zaaijer@sanquin.nl.

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$a Lange, Heidi $u Norwegian Institute of Public Health, Oslo, Norway. Electronic address: Heidi.Lange@fhi.no.

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$a de Sousa, Rita $u Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal. Electronic address: rita.sousa@insa.min-saude.pt.

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$a Avellón, Ana $u Viral Hepatitis Reference and Research Laboratory National Center of Microbiology Carlos III Health Institute, Madrid, Spain. Electronic address: aavellon@isciii.es.

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$a Sundqvist, Lena $u The Public Health Agency of Sweden (Folkhälsomyndigheten), Stockholm, Sweden. Electronic address: lena.sundqvist@folkhalsomyndigheten.se.

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$a Said, Bengü $u Public Health England, London, United Kingdom. Electronic address: bengu.said@phe.gov.uk.

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$a Ijaz, Samreen $u Public Health England, London, United Kingdom. Electronic address: Samreen.Ijaz@phe.gov.uk.

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