Antibodies to hepatitis E virus among several populations in Greece: increased prevalence in an hemodialysis unit

Dalekos, Georgios N.; Zervou, E K; Elisaf, Moses; Germanos, Nikolaos; Galanakis, Emmanouil; Bourantas, K. L.; Siamopoulos, K. C.; Tsianos, E.V.

doi:10.1046/j.1537-2995.1998.38698326339.x

Cited by 59 publications

(54 citation statements)

References 41 publications

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“…In some cases, this occurs after only 3 to 4 months, which makes the diagnosis of hepatitis E virus infection extremely difficult, particularly if HEV RNA or IgM anti-HEV antibodies are not used (5,17). In addition, reports suggest that some people may not produce a detectable antibody response and that the prevalence of anti-HEV in areas where the disease is endemic is much lower than expected, at a rate of 2.8 to 20.2%, with a very high proportion of HAV-seropositive individuals (3,8). In industrialized countries, anti-HEV antibodies have regularly been found at a rate below 5%, and in Spain, a level of 1 to 3% is reported in blood donors (22).…”

Section: Discussionmentioning

confidence: 99%

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Community-Based Seroepidemiological Survey of Hepatitis E Virus Infection in Catalonia, Spain

Buti

Domı́nguez

Plans

et al. 2006

Clin Vaccine Immunol

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The objective of the study was to investigate the prevalence of immunoglobulin G (IgG) antibodies to hepatitis E virus (HEV) infection in a population sample from Catalonia and to analyze the demographic and clinical variables associated with the presence of these antibodies. A total of 1,280 subjects between 15 and 74 years of age were selected randomly from urban and rural areas. Data for sociodemographic and clinical variables were collected by using a questionnaire. IgG antibodies to HEV were determined by an immunoenzymatic method. The odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for studied variables. Multiple logistic regression analysis was used to determine which variables were independently associated with the prevalence of HEV infection. Anti-HEV antibodies were detected in 96 (7.3%) of the 1,280 samples analyzed. The prevalence of antibodies was greater among males (7.8%) than among women (7%) and increased with age for both sexes, from 3% among subjects 15 to 24 years of age to 12% among subjects >65 years of age. Bivariate analysis of the sociodemographic and clinical variables showed an association between the prevalence of hepatitis E virus infection and minor surgery (OR, 1.96; 95% CI, 1.24 to 3.11), abdominal surgery (OR, 1.74; 95% CI, 1.12 to 2.73), and, for women, being uniparous or multiparous (OR, 2.84; 95% CI, 1.19 to 6.79). The multivariate analysis showed an association with minor surgery only (OR, 1.68; 95% CI, 1.03 to 2.70). In conclusion, anti-HEV antibodies were detected in 7.3% of the Catalan population. The seroprevalence of anti-HEV antibodies increased with age and was associated with previous minor surgery.

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Section: Discussionmentioning

confidence: 99%

“…Some studies have shown a prevalence among hemodialyzed patients higher than that among blood donors or the general population (1,6). However, there are no conclusive studies for this transmission mechanism and it seems that the risk, if it exists, would be low (1,8,28).…”

mentioning

confidence: 99%

Community-Based Seroepidemiological Survey of Hepatitis E Virus Infection in Catalonia, Spain

Buti

Domı́nguez

Plans

et al. 2006

Clin Vaccine Immunol

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“…Military and logistic restrictions precluded our acquiring accurate clinical, socioeconomic, or census data amongst the refugee community who appeared to be most at risk for hepatitis, presumably because of poor living conditions. Displaced populations in other places (for example, Albanians in Greece, 32 Indochinese in Australia 33 ) have been shown to have higher rates of HEV antibodies than the native populations, and the risk of HEV to groups affected by natural disasters and wars is well recognised. 5,34 Previously, sporadic or epidemic hepatitis E had been recognized in northern and central African countries.…”

Section: Discussionmentioning

confidence: 99%

An outbreak of hepatitis E in Northern Namibia, 1983.

Isaäcson

Frean²,

He³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

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Abstract. In 1983 in Namibia's Kavango region, epidemic jaundice affected hundreds of people living in settlements lacking potable water and waste disposal facilities. Many were Angolan refugees. The disease, which after investigation was designated non-A non-B hepatitis, was most common in males (72%), in persons aged 15-39 years, and was usually mild except in pregnant women, who incurred 6 (86%) of the 7 fatal infections. Fifteen years later, archived outbreak-associated samples were analyzed. Hepatitis E virus (HEV) was detected by reverse transcriptionpolymerase chain reaction in feces from 9 of 16 patients tested. Total Ig and IgM to HEV were quantitated in serum from 24 residents of an affected settlement at the outbreak's end: 42% had IgM diagnostic of recent infection and 25% had elevated total Ig without IgM, consistent with past HEV infection. The Namibia outbreak was typical hepatitis E clinically and epidemiologically. This first report of hepatitis E confirmed by virus detection from southern Africa extends the known range of HEV and highlights its risk for refugees.

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“…5%) had chronic liver disease. Although four EL2 seroepidemiological studies have also found that patients with comorbidities [5,[56][57][58] have a higher anti-HEV IgG positivity in comparison to the reference group a larger number of studies found no association (Table 6). This further supports the above-mentioned hypothesis that comorbidities affecting the liver are mainly associated with a higher risk of clinical disease but not infection.…”

Section: Comorbidity As a Risk Factormentioning

confidence: 98%

“…However, haemodialysis patients in four different studies [57,[96][97][98], those who had undergone minor surgery and abdominal surgery in Spain [4], healthcare workers in emergency admission and surgery in Germany [99] and male prisoners and drug treatment patients in Denmark [56] were found to have a higher anti-HEV IgG prevalence than the reference group.…”

Section: Potential For Parenteral Transmissionmentioning

confidence: 99%

Transmission routes and risk factors for autochthonous hepatitis E virus infection in Europe: a systematic review

2009

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SUMMARYIncreasing numbers of non-travel-associated hepatitis E virus (HEV) infections have been reported in Europe in recent years. Our objective was to review the evidence on risk factors and transmission routes of autochthonous HEV infection and hepatitis E in Europe in order to develop recommendations for future research, prevention and control. A systematic literature review was performed to identify all primary reports and studies published during 1998-2008 on hepatitis E in humans and animals in Europe by searching Pubmed, reference lists of major articles and international conference proceedings. Each of the 106 included studies was categorized into one of three evidence levels (EL) based on study design and diagnostic methodology. The evidence was generally weak (73 were assigned to EL1, two to both EL1 and EL2, and 30 to EL2), further compounded by the use of poorly validated serological assays in some studies. Only one casecontrol study was assigned to EL3. Persons with autochthonous hepatitis E infection were on average older than the general population and predominantly male. There was no evidence for one main transmission route of HEV infection or risk factor for hepatitis E. However, zoonotic transmission seemed likely and person-to-person transmission too inefficient to cause clinical disease. Multiple routes of transmission probably exist and should be further investigated through analytical studies and reliable diagnostic kits. Based on current evidence that points to zoonotic transmission from pigs, thorough cooking of all porcine products, prevention of crosscontamination in the kitchen and improved education for occupationally exposed people (e.g. pig farmers, veterinarians and sewage workers) may help prevent HEV infection. Although evidence for parenteral transmission is limited, it is recommended that a risk assessment is undertaken.

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Antibodies to hepatitis E virus among several populations in Greece: increased prevalence in an hemodialysis unit

Cited by 59 publications

References 41 publications

Community-Based Seroepidemiological Survey of Hepatitis E Virus Infection in Catalonia, Spain

Community-Based Seroepidemiological Survey of Hepatitis E Virus Infection in Catalonia, Spain

An outbreak of hepatitis E in Northern Namibia, 1983.

Transmission routes and risk factors for autochthonous hepatitis E virus infection in Europe: a systematic review

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