Abstract
Background and aimsHepatitis E virus (HEV), as an emerging zoonotic pathogen, is a leading cause of acute viral hepatitis worldwide, with a high risk of developing chronic infection in immunocompromised patients. However, the global epidemiology of HEV infection has not been comprehensively assessed. This study aims to map the global prevalence and identify the risk factors of HEV infection by performing a systematic review and meta‐analysis.MethodsA systematic searching of articles published in Medline, Embase, Web of science, Cochrane and Google scholar databases till July 2019 was conducted to identify studies with HEV prevalence data. Pooled prevalence among different countries and continents was estimated. HEV IgG seroprevalence of subgroups was compared and risk factors for HEV infection were evaluated using odd ratios (OR).ResultsWe identified 419 related studies which comprised of 1 519 872 individuals. A total of 1 099 717 participants pooled from 287 studies of general population estimated a global anti‐HEV IgG seroprevalence of 12.47% (95% CI 10.42‐14.67; I 2 = 100%). Notably, the use of ELISA kits from different manufacturers has a substantial impact on the global estimation of anti‐HEV IgG seroprevalence. The pooled estimate of anti‐HEV IgM seroprevalence based on 98 studies is 1.47% (95% CI 1.14‐1.85; I 2 = 99%). The overall estimate of HEV viral RNA‐positive rate in general population is 0.20% (95% CI 0.15‐0.25; I 2 = 98%). Consumption of raw meat (P = .0001), exposure to soil (P < .0001), blood transfusion (P = .0138), travelling to endemic areas (P = .0244), contacting with dogs (P = .0416), living in rural areas (P = .0349) and receiving education less than elementary school (P < .0001) were identified as risk factors for anti‐HEV IgG positivity.ConclusionsGlobally, approximately 939 million corresponding to 1 in 8 individuals have ever experienced HEV infection. 15‐110 million individuals have recent or ongoing HEV infection. Our study highlights the substantial burden of HEV infection and calls for increasing routine screening and preventive measures.
Highlights
Hepatitis E virus (HEV) as a positive-sense single-stranded RNA virus is a leading cause of acute viral hepatitis worldwide
The pooled estimate of anti-HEV IgM seroprevalence based on 98 studies is 1.47% (479 001 individuals; 95% 95% confidential interval (CI) 1.14-1.85; I2 = 99%; Figure 2B; Figure S2)
The anti-HEV IgG-positive rates in two special groups are higher than that in general population, with 16.91% in the human immunodeficiency virus (HIV) population and 13.10% in haemodialysis population, while it is slightly lower in organ transplant recipients with 11.68% seropositivity (Figures S20-S27; Table S5)
Summary
Hepatitis E virus (HEV) as a positive-sense single-stranded RNA virus is a leading cause of acute viral hepatitis worldwide. Acute infection in pregnant women may cause severe clinical outcomes, including fulminant hepatic failure with high mortality rate reaching up to 20%-30%.1. These patients are mostly from resource-limited regions. In European countries, HEV infection has been frequently reported to bear high risk of developing into chronic hepatitis in immunocompromised individuals, in particular organ transplant patients.[2,3] HEV is truly imposing a global health burden in both developing and developed countries. We have mapped the global prevalence of past, recent and ongoing HEV infection and evaluated the key risk factors of infection
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