Abstract

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.

Highlights

  • Recent serological studies indicate that hepatitis E virus (HEV) is endemic in industrialised countries

  • We investigated whether living close to pig farms is a risk factor for HEV seropositivity, focusing on the role of environmental transmission of HEV from pig farms to residents living in the vicinity of these farms

  • There were some differences between responders and non-responders, a non-response analysis within the initial questionnaire survey comparing the electronical medical records of the subjects recruited via general practitioner (GP), showed that these differences do not affect the relationship between health and the presence of livestock [53]

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Summary

Introduction

Recent serological studies indicate that hepatitis E virus (HEV) is endemic in industrialised countries. 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. The most common clinical presentation of HEV infection is acute hepatitis. Most HEV infections in industrialised countries are either unrecognised or asymptomatic [1, 14, 16, 17] This is supported by recent serological studies in several European countries, showing that the anti-HEV IgG seroprevalence in healthy blood donors varied between 7 and 52%, depending on both geographical area and the antibody assay used [17,18,19,20,21,22]

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