Hepatitis E Seroprevalence in Europe: A Meta-Analysis

Abstract

There have been large numbers of studies on anti-HEV IgG seroprevalence in Europe, however, the results of these studies have produced high variability of seroprevalence rates, making interpretation increasingly problematic. Therefore, the aim of this study was to develop a clearer understanding of anti-HEV IgG seroprevalence in Europe and identify risk groups for HEV exposure by a meta-analysis of published studies. Methods: All European HEV-seroprevalence studies from 2003 to 2015 were reviewed. Data were stratified by assay, geographical location, and patient cohort (general population, patients with HIV, solid-organ transplant recipients, chronic liver disease patients, and individuals in contact with swine/wild animals). Data were pooled using a mixed-effects model. Results: Four hundred thirty-two studies were initially identified, of which 73 studies were included in the analysis. Seroprevalence estimates ranged from 0.6% to 52.5%, increased with age, but were unrelated to gender. General population seroprevalence varied depending on assays: Wantai (WT): 17%, Mikrogen (MG): 10%, MP-diagnostics (MP): 7%, DiaPro: 4%, Abbott 2%. The WT assay reported significantly higher seroprevalence rates across all cohorts (p < 0.001). Individuals in contact with swine/wild animals had significantly higher seroprevalence rates than the general population, irrespective of assay (p < 0.0001). There was no difference between any other cohorts. The highest seroprevalence was observed in France (WT: 32%, MP: 16%) the lowest in Italy (WT: 7.5%, MP 0.9%). Seroprevalence varied between and within countries. The observed heterogeneity was attributed to geographical region (23%), assay employed (23%) and study cohort (7%). Conclusion: Seroprevalcence rates primarily depend on the seroassy that is used, followed by the geographical region and study cohort. Seroprevalence is higher in individuals exposed to swine and/or wild animals, and increases with age.

Hepatitis E Virus: Time to Change the Textbooks

“…Previous studies suggest that at any given time at least 20% of pigs are excreting HEV in their feces, and it is likely that significant amounts of HEV enter watercourses through run-off from pig farms [15] . A number of studies, including a meta-analysis, looking at HEV seroprevalence in Europe linked contact with swine and wild animals with significantly higher seroprevalence rates than those seen in the general population [16] .…”

“…In hyperendemic developing countries, somewhat predictably, rates ranging from 16 to 61.9% [21,22] have been reported. A recent meta-analysis found that seroprevalence rates in Europe vary significantly, from 7.5% in Italy to 12.7% in the UK and as high as 32% in France [16] . In the past, the seroprevalence in these countries was thought to be much lower, with early studies suggesting rates <5% [23] .…”

Performance of Hepatitis E Virus (HEV)-antibody tests: a comparative analysis based on samples from individuals with direct contact to domestic pigs or wild boar in Germany

“…Again, these estimates depend on the used assay [28]. In humans, seroprevalence in the general population (blood donors) in Europe ranged from 0.6 to 52.5% [32]. Higher prevalence estimates were demonstrated for professional risk groups with direct contact to domestic pigs as well as for hunters and forestry workers [33][34][35][36][37][38].…”

Acute Hepatitis E: Two Sides of the Same Coin

“…For instance, HEV GT 1 and 2 are obligate human pathogens and mainly transmitted via contaminated drinking water in regions with low sanitation, while zoonotic transmission, predominantly by infected swine meat, seems to be the major source of HEV GT 3 and 4 transmission [4,6,7]. In addition, it has been shown that either people in contact with animals or forestry workers have a higher risk for anti-HEV immunoglobulin G (IgG) positivity, demonstrating that these present risk factors for contact with HEV [8]. Moreover, HEV GT 1 infection is associated with fulminant hepatitis and fatal outcomes in pregnant women, but no such association has been observed in zoonotic hepatitis E.…”