Abstract
BackgroundIn the last decade hepatitis E virus (HEV) is increasingly recognized as a cause of acute viral hepatitis in developed countries. HEV is transmitted via the fecal-oral route. In countries like the Netherlands, HEV infection is suspected to be a zoonosis but HEV may also be introduced by migrants. We studied the seroprevalence of HEV among different migrants, mainly Moroccans and Turks, and compared this to that of the native Dutch population in Amsterdam, the Netherlands.MethodsData were obtained from a cross-sectional survey of the adult Amsterdam population performed in 2004; the Amsterdam Health Monitor. A total of 1199 plasma samples were tested for IgG-and IgM antibodies to HEV using the Wantai kit according to instructions of the manufacturer. Basic demographic data (gender, age, country of birth, and age at immigration) were used in the analyses. Hepatitis A virus (HAV) serology data were available from a previous study.ResultsThe total weighted anti-HEV IgG seroprevalence in the overall Amsterdam population was 26.7 %, based on 1199 samples. In the study population (not-weighted) this HEV seroprevalence was 157/426 (36.9 %) for the Dutch participants and it was 161/257 (62.6 %) for Moroccans, 99/296 (33.4 %) for Turks and 42/220 (19.1 %) for other ethnicities. HEV seroprevalence increased significantly with age. First-generation Moroccan migrants (44.0 %) had a significantly higher weighted HEV seroprevalence than the Dutch participants (29.7 %). In the first generation Turks (20.3 %) and first generation migrants from other countries (16.7 %) this weighted seroprevalence was lower, but this was only significant for the ‘other ethnicities’. The median age of migration was significantly higher in the Moroccan and Turkish migrants who were HEV IgG positive versus HEV IgG negative. However, when stratifying for age at time of study, median migration age was only significantly different for HEV sero-status for younger Turks and younger ‘other ethnicities’. HEV IgM antibodies were found in 0.6 % (n = 7) of participants and none were positive for HEV RNA, showing that there were no acute infections. Despite the common route of fecal-oral transmission for both viruses, there was no relation between HEV and HAV seropositivity.ConclusionWithin the multi-ethnical capital city of Amsterdam the HEV seroprevalence in first generation migrant populations differed from each other and from the autochthonous Dutch population. The relation between being HEV seropositive and a higher median age of migration suggests that younger migrants got more often infected in their country of origin than in the Netherlands.
Highlights
In the last decade hepatitis E virus (HEV) is increasingly recognized as a cause of acute viral hepatitis in developed countries
We looked whether anti-HEV seropositivity was related to the seroprevalence of hepatitis A virus (HAV) in the same Amsterdam Health Monitor (AHM) population [17]
Most participants were Dutch (35.5 %) and almost all 753 first generation migrant participants came from Turkey (296; 24.7 %) or Morocco (257; 21.4 %), due to deliberate oversampling among Turkish and Moroccan populations
Summary
In the last decade hepatitis E virus (HEV) is increasingly recognized as a cause of acute viral hepatitis in developed countries. HEV is transmitted via the fecal-oral route. In countries like the Netherlands, HEV infection is suspected to be a zoonosis but HEV may be introduced by migrants. Since 1980, hepatitis E virus (HEV) is recognized as a causative agent of acute viral inflammation of the human liver [1]. The clinical features resemble those of infection with hepatitis A virus (HAV), and both are transmitted by the fecal-oral route or by contaminated water [2]. The risk for a fulminant disease course is high in pregnant women, with an increased risk for adverse pregnancy outcomes and a maternal mortality rate up to 20 % in case of a genotype 1 infection [5,6,7]. An increased risk for complications is observed in immunosuppressed persons, especially in transplant patients who may develop chronic hepatitis [8, 9]
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