Acute sporadic hepatitis E in the Zhejiang coastal area of China: a 14-year hospital-based surveillance study

Jun Tan,Jian Cai,Shuwen Qin,Na Zhao,Lin Wang,Mi Zhou,Xiaoqing Zheng,Wei Li,Yijuan Chen,Ta-Chien Chan,Said Amer,Xiaobin Xu,Ziping Miao,Shelan Liu

doi:10.1186/s12985-019-1119-7

Abstract

BackgroundTo examine the epidemiological trends and changes of hepatitis E virus (HEV) infection and the potential risk factors for severe infection in the Zhejiang eastern coastal area of China.MethodsWe analyzed statutory hepatitis E cases notifications and inpatient data held by the national surveillance and hospital information systems in Wenzhou, Taizhou, Ningbo, and Zhoushan cities of the Zhejiang eastern coastal area of China.ResultsNine thousand four hundred sixteen hepatitis E cases were reported from 2004 to 2017, with an average incidence of 2.94 per 100,000. The overall death rate was 0.06% (6/9416). A gradual decline of hepatitis E cases was found in the coastal areas since 2007, while a rise was identified in the non-coastal areas. Annual incidence in non-coastal cities was much higher than that in coastal cities (4.345 vs. 2.945 per 100,000, relative risk = 1.5, P value < 0.001). The mean age was 52 years old and 50.55 years with a male-to-female ratio of 2.32:1 and 2.21:1 in coastal and noncoastal areas respectively (all P > 0.05). Hepatitis E cases prevalence increased with age, highest among men in their 70s (9.02 vs. 11.33 per 100,000) and women in their 60s (3.94 vs. 4.66 per 100,000) groups for both coastal and noncoastal areas respectively. A clear seasonal pattern was observed, with a peak in March (0.4429 per 100,000) in coastal areas. 202 inpatients were documented, of which 50.50% (102/202) were severe cases. Male individuals with alcohol consumption, alcohol hepatic diseases, and superinfection were the three independent highest risks for severe infections (all with P value < 0.05).ConclusionsThis is to our knowledge the largest epidemiological study of hepatitis E cases in the eastern coastal area of Zhejiang province of China. The patterns of infection across the coastal areas were similar to those of the non-coastal areas, but the incidence was substantially lower and decreased gradually since 2007.

Highlights

To examine the epidemiological trends and changes of hepatitis E virus (HEV) infection and the potential risk factors for severe infection in the Zhejiang eastern coastal area of China
A higher health risk of hepatitis E cases was found in the workers who have direct contact with raw seafood or users of water and consumers of shellfish contaminated by HEV in the Bohai coastal area of China [15, 16]
We defined hepatitis E cases based on the date of disease onset and on the updated diagnostic criteria issued by the Chinese Ministry of Health in 2008; these criteria are based on epidemiologic history, clinical signs, and laboratory test results [17]

Summary

Introduction

To examine the epidemiological trends and changes of hepatitis E virus (HEV) infection and the potential risk factors for severe infection in the Zhejiang eastern coastal area of China. The number of hepatitis E cases increased, with an annual percentage change of 7% in China overall, with eastern China having the highest prevalence [14]. A higher health risk of hepatitis E cases was found in the workers who have direct contact with raw seafood or users of water and consumers of shellfish contaminated by HEV in the Bohai coastal area of China [15, 16]. Human beings infected with HEV in the coastal area of eastern China appear to be extremely limited

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