Hepatitis E Seroprevalence and Environmental Determinants Among Displaced Populations in Sudan

Hepatitis E virus (HEV) is a major cause of viral hepatitis in humanitarian and resource-limited settings. Internally displaced persons (IDPs) are especially vulnerable due to overcrowding and inadequate water, sanitation, and hygiene (WASH) conditions. However, spatial variation in HEV exposure within camps remains poorly characterized. The objective of the current study was to determine the seroprevalence, spatial distribution, and environmental correlates of HEV exposure among IDPs in Al-Azaza Camp, Blue Nile State, Sudan. A cross-sectional study was conducted among 1078 IDPs from August to December 2021. Serum samples were tested for anti-HEV IgG and IgM using ELISA. Household environmental and behavioral data were collected through questionnaires and observation. GPS coordinates were mapped in ArcGIS Pro to assess spatial clustering. Multivariable logistic regression identified independent predictors of seropositivity. Overall HEV seroprevalence was 76.4%, with low IgM positivity (1.85%), suggesting limited recent transmission. Significant spatial clustering was observed, driven mainly by IgG-positive cases. Independent risk factors included proximity to open defecation sites, unsafe water storage, poor solid waste disposal, and animal husbandry. HEV exposure was widespread and spatially clustered, reflecting cumulative transmission. Targeted, sustained improvements in WASH infrastructure are crucial to reduce ongoing risk among displaced populations.

in previously healthy white patients from Germany differ from previously published cases. These 2 patients were not of Asian ethnicity and had no travel history, no contact with persons in a high-risk group (10), and no common risk factors such as malignancy (8); however, 1 patient had type-2 diabetes. K. pneumoniae liver abscesses might be an emerging problem with global spread. Although initial radiographic findings might more commonly indicate metastasis than abscesses, differential diagnosis of liver lesions should include K. pneumoniaeinduced abscesses.

Hepatitis E Virus Seroprevalence among Men Who Have Sex with Men, United Kingdom

The majority of Hepatitis E Virus (HEV)-related studies are carried out in adults whereas information about HEV seroprevalence, clinical disease manifestation, molecular epidemiology, and transmission patterns in children is limited. To estimate HEV seroprevalence among scholar children living in an urban setting and to analyze risk factors for an infection, we invited children aged 5-18 years from Bogotá (Colombia) for a cross-sectional survey. We collected self-reported data on demographics, social, clinical, and exposure variables in a structured interview. Venous blood samples were analyzed with two commercially available ELISAs for HEV-specific IgG antibodies. Among the 263 participants, we found three HEV IgG-reactive samples (1.1%) using both assays. We additionally characterized the samples for HEV IgM using a commercially available IgM ELISA and for HEV RNA. Here, we found one IgM-reactive sample, which was also reactive for IgG. In contrast, none of the IgM- and IgG-reactive sera samples showed detectable RNA levels indicating HEV exposure had not been recently. All participants reported access to drinking water and sanitary systems in their households and frequent hand washing routines (76-88%). Eighty percent of children reported no direct contact with pigs, but occasional pork consumption was common (90%). In contrast to the majority of studies performed in Colombian adults, we found a low unadjusted HEV seroprevalence of 1.1% (95% CI: 0.3-3.6%) for both HEV IgG ELISAs in our study population. While the majority of participants reported pork consumption, we speculate in the absence of viral RNA for genotyping in the affected individuals, that existing access to drinking water and sanitary systems within our study group contribute to the low HEV seroprevalence.

Hepatitis E virus (HEV) is a waterborne zoonotic disease that can result in a high fatality rate in pregnant women and infants. In 2018, a large HEV outbreak emerged in Chattogram, Bangladesh, resulting in 2800 cases and a significant public health response to mitigate the transmission. While the source of the outbreak remained poorly understood, authorities suggested that possible risk factors for HEV infection included contamination of water supply, exacerbated by concurrent severe flooding events in the community. A cross-sectional study was conducted to investigate the distribution and risk factors for HEV seroprevalence between January and December 2018 in the Chattogram city area. A total of 505 blood samples were collected from symptomatic patients of 10 hospitals who met the case definition for an HEV infection. Standard ELISA tests were performed in all patients to identify anti-HEV antibodies. The size and location of HEV seroprevalence clusters within Chattogram were investigated using SaTScan. We investigated the association between risk of HEV infection and individual and environmentally lagged risk factors using Bernoulli generalised linear regression models. Our results indicate an overall HEV seroprevalence of 35% with significant variation according to sex, source of drinking water, and boiling of drinking water. A positive cross-correlation was found between HEV exposure and precipitation, modified normalised difference water index (MNDWI), and normalised difference vegetation index (NDVI). Our model indicated that risk of infection was associated with sex, age, source of drinking water, boiling of water, increased precipitation, and increased MNDWI. The results from this study indicate that source and boiling of drinking water and increased precipitation were critical drivers of the 2018 HEV outbreak. The communities at highest risk identified in our analyses should be targeted for investments in safe water infrastructure to reduce the likelihood of future HEV outbreaks in Chattogram.

Assessment of hepatitis E virus (HEV) in the edible goat products pointed out a risk for human infection in Upper Egypt

Hepatitis E virus (HEV) is an emerging zoonotic pathogen in Europe. In the Iberian Peninsula, wild boar (Sus scrofa) is considered the main wildlife reservoir of HEV. This wild ungulate shares habitat and resources with other potential HEV carriers in Iberian Mediterranean ecosystems, although information about the role of such sympatric species in the HEV epidemiological cycle is still very limited. The aims of the present large-scale, long-term study were: (1) to determine the seroprevalence and prevalence of HEV in both free-living and captive populations of the Iberian lynx (Lynx pardinus), the most endangered felid in the world; (2) to determine potential risk factors associated with HEV exposure in this species and (3) to evaluate the dynamics of seropositivity in longitudinally sampled animals during the study period. Between 2010 and 2021, serum samples from 275 Iberian lynxes were collected in free-ranging and captive populations across the Iberian Peninsula. Forty-four of the 275 lynxes were also longitudinally sampled during the study period. A double-antigen sandwich ELISA was used to test for the presence of antibodies against HEV. A subset of seropositive samples was analysed by Western blot (WB) assay to confirm exposure to HEV. In addition, serum, liver and/or faecal samples from 367 individuals were tested for orthohepevirus RNA by RT-PCR. A total of 50 (18.2%; 95% CI: 14.1-23.2) of the 275 animals analysed had anti-HEV antibodies by ELISA. Exposure to HEV was confirmed by WB in most of the ELISA-positive Iberian lynxes analysed. Significantly higher seroprevalence was found in captive (33.6%) compared to free-ranging (7.4%) individuals. Within captive population, the GEE model identified 'age' (senile, adult and subadult) as risk a factor potentially associated with HEV exposure in the Iberian lynx. Thirteen (29.5%) of 44 longitudinally surveyed individuals seroconverted against HEV during the study period. HEV RNA was detected in the faeces of one (1/364; 0.3%; 95% CI: 0.0-0.8) free-ranging adult animal sampled in 2021. Phylogenetic analysis showed that the sequenced strain belongs to HEV-3f subtype and shared a high nucleotide sequence identity (97-99.6%) with human HEV-3f sequences from Spain and France. To the best of the authors' knowledge, this is the first survey study on HEV in the Iberian lynx and the first molecular report of HEV-A infection in free-ranging felines. Our results indicate high exposure to HEV-3 in Iberian lynx populations, particularly those kept in captivity. The serological results suggest widespread but not homogeneous circulation of HEV in Iberian lynx populations. Further studies are required to assess the epidemiological role of this endangered species as a potential spillover host of HEV.

BackgroundVery few case-control studies to assess the risk of hepatitis E virus (HEV) infection in meat workers have been published. Therefore, we sought to determine: 1) the association of HEV IgG seropositivity and the occupation of butcher; and 2) the sociodemographic, work, clinical and behavioral characteristics of butchers associated with HEV exposure.MethodsWe performed a case-control seroprevalence study of 101 butchers (mean age: 38.50 ± 12.52 years) and 101 age-, gender- and residence-matched control subjects of the general population. Anti-HEV IgG antibodies were determined using a commercially available enzyme-linked immunoassay. Bivariate and regression analyses were used to assess the association between HEV seropositivity and characteristics of butchers.ResultsAnti-HEV IgG antibodies were found in 18 (17.8%) of the 101 butchers and in 14 (13.9%) of the 101 control subjects (odds ratio (OR): 1.34; 95% confidence interval (CI): 0.63 - 2.88; P = 0.44). Stratification by sex, age and area of residence (rural or urban) in cases and controls showed similar seroprevalences of HEV infection among groups. Bivariate analysis showed that HEV seroprevalence was associated with low education (up to 6 years), work place, seniority, eating while working, a history of raising farm animals and national trips. However, further analysis by logistic regression showed that only the variable of national trips was associated with HEV exposure (OR: 5.38; 95% CI: 1.02 - 28.16; P = 0.04). Concerning clinical characteristics of butchers, no association between HEV exposure and health status, history of surgery or blood transfusion was found.ConclusionsResults from this first age-, gender- and residence-matched serosurvey of HEV infection in butchers in Mexico suggest that this population group does not have a higher risk for HEV infection than people from the general population. However, further studies to confirm the lack of association between HEV infection and the occupation of butcher are needed.

The reported incidence of clinical hepatitis E cases is rising in some non‐endemic countries, with concurrent concerns regarding potential hepatitis E virus (HEV) contamination of the blood supply. Therefore, the characterization of major potential sources of human HEV exposure is important to inform risk assessment and public health policy. A systematic review was conducted, including a comprehensive search in six electronic bibliographic databases, verified by hand‐searching reference lists of HEV reviews, and a grey literature search, of the broad research question ‘what is the evidence of the association between predictors of human HEV exposure, and HEV IgG seropositivity, in non‐endemic countries?’ Using forms designed a priori, captured studies were appraised at first‐level screening, second‐level characterization, and third‐level data extraction and risk of bias assessment. Meta‐analysis yielded summary estimates of association between potential predictors and odds of HEV seropositivity. Meta‐analysis and meta‐regression of the odds of HEV seroprevalence in specific groups characterized potential sources of HEV exposure. From 4,163 captured citations, 245 relevant studies underwent data extraction, investigating HEV seroprevalence or predictors in both healthy subjects and targeted patient groups. Across these groups, increasing age was a predictor of HEV IgG seropositivity. Both human immunodeficiency virus patients and haemodialysis patients had significantly increased odds of HEV seropositivity relative to the general population. Working with pigs, in forestry, or in hospitals, was significantly associated with increased odds of HEV seropositivity, as were consumption of meat, pork or game meat, or hunting. Chronological time was not associated with HEV seropositivity within our data sets. Further study of the distribution of potential dietary or behavioural predictors between high and lower prevalence areas within non‐endemic countries could improve our understanding of the relative importance of specific HEV transmission pathways.

Pathogenesis and Treatment of Hepatitis E Virus Infection

Introduction: Hepatitis E virus (HEV) has emerged as an important infectious disease in immunocompromised patients, especially those who are post-liver transplanted (LT). Reported HEV seroprevalence rates in general populations of Europe and the United States are 5-12% and 19%, respectively. Reported HEV RNA detection rates are remarkably lower, however, being 1.4% in Europe and 0.12% in Japan. We evaluated the HEV seroprevalence and RNA detection in post-LT patients to evaluate the hypothesis that HEV may pose potential subclinical risk in this particular immunocompromised patient population. Method: 106 post-LT patients were enrolled and provided blood and feces samples. All patients were tested for HEV seroprevalence. After exclusion of acute/chronic HEV cases (n=3) and other unavailable cases (n=13), 91 post-LT patients were investigated for HEV serology (IgG and IgM) and HEV RNA detection (serum and feces) every 4 months during 1-year follow-up period. All patient samples were kept in -70C storage. HEV RNA in serum and feces were detected by real-time (in-house) RT-PCR technique (lowest level of detection=10 IU/mL). Demographic and clinical data were retrieved from the medical records for descriptive statistical analysis. Result: The 106 post-LT patients had an HEV seroprevalence of 53.8%. After exclusion of the unavailable cases, 91 post-LT patients were prospectively investigated. HEV seropositive group was 50.5%, while the seronegative group was 49.5%. Baseline characteristics between two groups were not different. The serum and feces HEV RNA detection at baseline in seropositive group were 5/46 (21%) and 1/46 (2%), respectively. In seronegative group, the serum and feces HEV RNA detection were 2/45 (4.5%) and 3/45 (6.7%), respectively. Due to unprecedently high in proportion of patients with positive serum HEV RNA in both groups at the 4th visit, we decided to report our prospective result of the 8-month follow-up period. In seropositive group, serum and feces HEV RNA were detected in 11/46 (24%), 3/46 (6.5%), respectively. In seronegative group, serum and feces HEV RNA were detected in 9/45 (20%), 4/45 (8.8%), respectively. During 8-month period, 8 out of 14 and 8 out of 13 more cases of positive HEV in serum or feces in patients with and without IgG (+) were newly discovered, respectively. 2 out of 27 patients with positive serum or feces HEV RNA had abnormal liver function tests and one case was proved to be from anastomosis stricture with intrahepatic stone which was relieved after underwent ERCP. Conclusion: Thailand has high prevalence of HEV seroprevalence in post LT patients. Post-LT patients could have subclinical HEV infection without obvious clinical clues. Without HEV RNA assays, active HEV infection could be missed even in HEV IgG seronegative patients. Feces HEV RNA detection adds on benefit of the diagnostic yield. However, clinical significance of these silence detection remains to be elucidated

BackgroundRecent serological studies indicate that hepatitis E virus (HEV) is endemic in industrialised countries. The increasing trend in the number of autochthonous cases of HEV genotype 3 in Western European countries, stresses the importance to get insight in the exact routes of exposure. Pigs are the main animal reservoir, and zoonotic food-borne transmission of HEV is proven. However, infected pigs can excrete large amounts of virus via their faeces enabling environmental transmission of HEV to humans. This might pose a risk for of neighbouring residents of livestock farming.MethodsWithin a large study on the health of people living in the vicinity of livestock farming we performed a cross-sectional population-based serological survey among 2,494 non-farming adults from the general population in a livestock-dense area in the south of the Netherlands. Participants completed risk factor questionnaires and blood samples of 2,422 subjects (median age 58 years, range 20–72) were tested for anti-HEV IgG using an enzyme immune assay (Wantai). The aim of this study was to determine the HEV seroprevalence and to assess whether seropositivity in adults was associated with living in the vicinity of pig farms.ResultsThe average seroprevalence of HEV was 28.7% (95% CI: 26.9–30.5). Determinants associated with an increased risk for HEV seropositivity were male gender and low level of education. There was a clear trend of increasing prevalence with increasing age (Chi-square test for linear trend, X2 = 83.1; p < 0.001). A high number of pigs within 1,000 m of the residential address was not a risk factor for seropositivity.ConclusionsThis study confirmed the high HEV seroprevalence (29%) in the general population of the Netherlands, but presence of antibodies was not associated with residential proximity to pig farms. The prevalence increased with age from 10% in adolescents to 33% among those aged 50 and above, supporting the assumption of a cumulative lifetime exposure to HEV in the Netherlands as well as a higher infection pressure in the past. Our findings cannot refute the assumption that transmission is primarily food-borne.

Background: Hepatitis E virus (HEV) is a major cause of acute viral hepatitis worldwide and can lead to severe complications, particularly among pregnant women. In sub-Saharan Africa, outbreaks occur periodically, yet routine surveillance remain limited. Domestic pigs are known reservoirs of zoonotic HEV genotypes, raising concern about transmission at the human–animal interface. However, evidence on HEV exposure in both humans and pigs in Tanzania is scarce. This study assessed the seroprevalence of HEV among pregnant women and slaughter pigs in resource-limited communities in Tanzania. Methods: Cross-sectional study was conducted between September 2023 and July 2024 in Dodoma and Morogoro regions. Pregnant women attending antenatal care clinics and pigs presented for slaughter at municipal abattoirs were systematically sampled. Serum samples were tested for anti-HEV IgG antibodies using a commercial enzyme-linked immunosorbent assay (ELISA). Sociodemographic data from women and pig husbandry practices were collected using structured questionnaires. Descriptive statistics were used to estimate seroprevalence with 95% confidence intervals (CIs). Associations between HEV seropositivity and risk factors were assessed using Chi-square or Fisher’s exact tests, followed by logistic regression analysis. Results: A total of 372 pregnant women and 280 pigs were included in the study. HEV seroprevalence was 15.1% (95% CI: 11.8 – 19.0) among women and 32.9% (95% CI: 27.6–38.6) among pigs. Higher seropositivity among women was observed in the 25 to 34-year age group. In pigs, housing systems, water sources, and farm biosecurity practices were associated with HEV infection. Conclusion: These findings demonstrate concurrent HEV exposure in humans and pigs in central Tanzania. The higher prevalence in pigs supports their role as potential reservoirs, while detection in pregnant women suggests ongoing community transmission. Strengthening surveillance and adopting a One Health approach integrating maternal health services, veterinary monitoring, and improved farm biosecurity are essential to reduce zoonotic transmission risks.

Hepatitis E virus (HEV), classified in Hepeviridae family, Hepevirus genus, is a non-enveloped virus with icosahedral capsid containing single-stranded positive sense RNA genome. HEV infections may be asymptomatic especially in children, however it may present as fulminant hepatitis in pregnant women, as well as chronic hepatitis in immunocompromised patients. There are four well-known genotypes of HEV that infect humans and many mammalian species. Genotype 1 and 2 are frequently responsible for water-borne infections transmitted by fecal-oral way in developing countries, while genotype 3 and 4 cause zoonotic infections in developed countries. Turkey is considered as an endemic country with a total seroprevalence rate of 6.3% for normal population, showing significant variation (0-73%) according to the regions and study groups. The aims of this study were to investigate the HEV seropositivity in cases admitted to Hacettepe University Medical Faculty Hospital (HUMFH), to evaluate the results according to the demographic features of patients, and to determine the current HEV seroprevalence in our region, contributing seroepidemiological data in Turkey. A total of 1043 serum samples (514 female, 529 male; age range: 1-90 years, mean age: 38.03) obtained from 327 blood donors (32 female, 295 male; age range: 19-59 years, mean age: 31.1) who were admitted to HUMFH Blood Center, and 716 sera (482 female, 234 male; age range: 1-90 years, mean age: 41.7) that were sent to HUMFH Central Laboratory from various outpatient/inpatient clinics, between November 2012 to November 2013, were included in the study. The presence of HEV-IgG antibodies in serum samples was detected by a commercial ELISA method (Euroimmun, Germany), and the presence of HEV-IgM antibodies was also investigated in the sera with IgG-positive results. The overall HEV-IgG seropositivity rate was determined as 4.4% (46/1043), and the seropositivity rates for blood donors and in/outpatients were as 0.92% (3/327) and 6.0% (43/716), respectively. HEV-IgM antibody was not detected in any of the cases. The HEV-IgG seropositivity was 3.2% among male, and 5.6% among female, yielding no statistically significant difference between the gender (p= 0.056). HEV-IgG antibodies were detected in none (0/118) of the pediatric age group (0-18 years), while the seropositivity rates were 1.9% (14/731) and 16.5% (32/194) in 19-55 and ≥ 56 years-old groups, respectively. The difference between the age groups was statistically significant (p< 0.001), indicating the age-related pattern of HEV exposure. In conclusion, the total HEV seroprevalence rate found as 4.4% in our study, is comparable to the average results reported from Turkey. Our data is also in agreement with the result of a previous report (3.8%) that performed from Ankara province in 2002 with similar study groups, emphasizing that there was no significant changes for HEV exposure have occured over more than the last decade in Ankara, Cental Anatolia, Turkey.

BackgroundAs one of the causative agents of viral hepatitis, hepatitis E virus (HEV) has gained public health attention globally. HEV epidemics occur in developing countries, associated with faecal contamination of water and poor sanitation. In industrialised nations, HEV infections are associated with travel to countries endemic for HEV, however, autochthonous infections, mainly through zoonotic transmission, are increasingly being reported. HEV can also be transmitted by blood transfusion. Nepal has experienced a number of HEV outbreaks, and recent earthquakes resulted in predictions raising the risk of an HEV outbreak to very high. This study aimed to measure HEV exposure in Nepalese blood donors after large earthquakes.MethodsSamples (n = 1,845) were collected from blood donors from Kathmandu, Chitwan, Bhaktapur and Kavre. Demographic details, including age and sex along with possible risk factors associated with HEV exposure were collected via a study-specific questionnaire. Samples were tested for HEV IgM, IgG and antigen. The proportion of donors positive for HEV IgM or IgG was calculated overall, and for each of the variables studied. Chi square and regression analyses were performed to identify factors associated with HEV exposure.ResultsOf the donors residing in earthquake affected regions (Kathmandu, Bhaktapur and Kavre), 3.2% (54/1,686; 95% CI 2.7–4.0%) were HEV IgM positive and two donors were positive for HEV antigen. Overall, 41.9% (773/1,845; 95% CI 39.7–44.2%) of donors were HEV IgG positive, with regional variation observed. Higher HEV IgG and IgM prevalence was observed in donors who reported eating pork, likely an indicator of zoonotic transmission. Previous exposure to HEV in Nepalese blood donors is relatively high.ConclusionDetection of recent markers of HEV infection in healthy donors suggests recent asymptomatic HEV infection and therefore transfusion-transmission in vulnerable patients is a risk in Nepal. Surprisingly, this study did not provide evidence of a large HEV outbreak following the devastating earthquakes in 2015.