Age and Gender Trends in the Prevalence of Markers for Hepatitis E Virus Exposure in the Heterogeneous Bulgarian Population

Abstract

The prevalence of hepatitis E virus (HEV) in the Bulgarian population remains underestimated. The aim of the present study was to evaluate age and gender trends in HEV prevalence in the heterogeneous Bulgarian population. Stored serum samples from blood donors and different patient sub-populations—kidney recipients (KR), patients with Guillain–Barre syndrome (GBS), Lyme disease (LD), patients with liver involvement and a clinical diagnosis other than viral hepatitis A and E (non-AE), hemodialysis (HD) and HIV-positive patients (HIV)—were retrospectively investigated for markers of past and recent/ongoing HEV infection. The estimated overall seroprevalence of past infection was 10.6%, ranging from 5.9% to 24.5% for the sub-populations evaluated, while the seroprevalence of recent/ongoing HEV infection was 7.5%, ranging from 2.1% to 20.4%. The analysis of the individual sub-populations showed a different prevalence with respect to sex. In regard to age, the cohort effect was preserved, as a multimodal pattern was observed only for the GBS sub-population. Molecular analysis revealed HEV 3f and 3e. The type of the population is one of the main factors on which the anti-HEV prevalence depends, highlighting the need for the development of guidelines related to the detection and diagnosis of HEV infection with regard to specific patient populations.

First Insight into the Seroepidemiology of Hepatitis E Virus (HEV) in Dogs, Cats, Horses, Cattle, Sheep, and Goats from Bulgaria

“…Dogs and cats are carnivores and it is possible that they can become infected via the food chain by consuming raw meat contaminated with swine HEV gt 3 or rat HEV-C1. Furthermore, the moderate HEV seropositivity in our dogs (21.1%) and cats (17.7%) is similar to that found among Bulgarian blood donors (25.9%) [20] and individuals with Guillain-Barre syndrome (24.5%) [61].…”

“…Both previous Bulgarian studies [ 33 , 34 , 35 , 36 , 37 , 44 , 50 ] and the current results of this research show that HEV infection is widespread among animals in our country. Furthermore, HEV seropositivity is widespread among some groups of the Bulgarian population: blood donors (25.9%) [ 20 ], general hunters (48.7%) [ 20 ], hunters of wild boars (51.6%) [ 20 ], and individuals with Guillain-Barre syndrome (24.5%) [ 61 ]. These facts are a serious reason for increasing surveillance and control of HEV infection among animals and humans in Bulgaria.…”

Hepatitis E virus infections in German blood donors: results of 8 years of screening, 2015 to 2022

“…However, we found a significant proportional excess of male HEV RNA-positive donors compared with the total donor population in our data that exceeded the usual bias of a male surplus in blood donation. Interestingly, a study in Bulgaria showed that although the prevalence of past HEV infections (IgG-positive, IgM-negative, HEV RNA-negative) was similar in males and females, the prevalence of recent or ongoing infection (IgM- or HEV RNA-positive) was twice as high in men [ 30 ]. Future studies on the course of seroconversion in males and females may provide deeper insights into this phenomenon.…”

Butchering activity is the main risk factor for hepatitis E virus (Paslahepevirus balayani) infection in southwestern Nigeria: a prospective cohort study

“…However, the age-prevalence relationship for HEV infection can vary across settings. Factors such as local transmission dynamics, variations in sanitation practices, animal reservoirs, and changing demographics can all influence the age distribution of HEV infection in different ways ( Golkocheva-Markova et al, 2023 ). Thus, it’s important to consider the specific context of each study and population when interpreting the relationship between age and HEV infection.…”