Hepatitis E Virus IgG Seroprevalence Research Articles

Epidemiology of Hepatitis E Virus in European Countries.

Over the last decade the seroprevalence of immunoglobulin (IgG) anti hepatitis E virus (HEV) has been increasing in European countries and shows significant variability among different geographical areas. In this review, we describe the serological data concerning the general population and risk groups in different European countries. Anti-HEV antibody prevalence ranged from 1.3% (blood donors in Italy) to 52% (blood donors in France). Various studies performed on risk groups in Denmark, Moldova and Sweden revealed that swine farmers have a high seroprevalence of HEV IgG (range 13%–51.1%), confirming that pigs represent an important risk factor in HEV infection in humans. Subtypes 3e,f are the main genotypes detected in the European population. Sporadic cases of autochthonous genotype 4 have been described in Spain, France, and Italy. Although most HEV infections are subclinical, in immune-suppressed and transplant patients they could provoke chronic infection. Fulminant hepatitis has rarely been observed and it was related to genotype 3. Interferon and ribavirin treatment was seen to represent the most promising therapy.

Hepatitis E virus in patients with decompensated chronic liver disease: a prospective UK/French study.

In developed countries, hepatitis E is a porcine zoonosis caused by hepatitis E virus (HEV) genotype 3. In developing countries, hepatitis E is mainly caused by genotype 1, and causes increased mortality in patients with pre-existing chronic liver disease (CLD). To determine the role of HEV in patients with decompensated CLD. Prospective HEV testing of 343 patients with decompensated CLD at three UK centres and Toulouse France, with follow-up for 6months or death. IgG seroprevalence was compared with 911 controls. 11/343 patients (3.2%) had acute hepatitis E infection, and three died. There were no differences in mortality (27% vs. 26%, OR 1.1, 95% CI 0.28-4.1), age (P=0.9), bilirubin (P=0.5), alanine aminotransferase (P=0.06) albumin (P=0.5) or international normalised ratio (P=0.6) in patients with and without hepatitis E infection. Five cases were polymerase chain reaction (PCR) positive (genotype 3). Hepatitis E was more common in Toulouse (7.9%) compared to the UK cohort (1.2%, P=0.003). HEV IgG seroprevalence was higher in Toulouse (OR 17, 95% CI 9.2-30) and Truro (OR 2.5, 95% CI 1.4-4.6) than in Glasgow, but lower in cases, compared to controls (OR 0.59, 95% CI 0.41-0.86). Hepatitis E occurs in a minority of patients with decompensated chronic liver disease. The mortality is no different to the mortality in patients without hepatitis E infection. The diagnosis can only be established by a combination of serology and PCR, the yield and utility of which vary by geographical location.

Seroprevalence and Incidence of hepatitis E in blood donors in Upper Austria.

BackgroundIn recent years various studies showed, that hepatitis E virus (HEV) is a growing public health problem in many developed countries. Therefore, HEV infections might bear a transmission risk by blood transfusions. The clinical relevance still requires further investigations. The aim of this study was to provide an overview of acute HEV infections in Upper Austrian blood donors as well as a risk estimation of this transfusion-related infection.Methods and FindingsA total of 58,915 blood donors were tested for HEV RNA using a commercial HEV RT-PCR Kit. 7 of these donors (0.01%) were PCR-positive with normal laboratory parameters in absence of clinical signs of hepatitis. Viral load determined by quantitative real-time PCR showed a HEV nucleic acid concentration of 2,217 293,635 IU/ml. At follow-up testing (2–11 weeks after donation) all blood donors had negative HEV RNA results. Additionally, genotyping was performed by amplification and sequencing of the ORF1 or ORF2 region of the HEV genome. All HEV RNA positive donor samples revealed a genotype 3 isolate. For the antibody screening, anti-HEV IgM and IgG were detected by ELISA. Follow up serological testing revealed that no donor was seropositive for HEV IgM or IgG antibodies at time of donation. Moreover, we verified the prevalence of anti-HEV IgG in 1,203 of the HEV RNA negative tested blood donors. Overall 13.55% showed positive results for anti-HEV IgG.ConclusionsIn the presented study, we investigated HEV infections in blood donations of Upper Austria over 1 year. We concluded that 1 out of 8,416 blood donations is HEV RNA positive. Seroprevalence of anti HEV IgG results in an age-related increase of 13.55%. Therefore, based on this data, we recommend HEV-PCR screening to prevent transmission of hepatitis E virus by transfusion.

Hepatitis E virus seroprevalence among hemodialysis and hemophiliac patients in Tunisia (North Africa).

The aims of this study are to determine seroprevalence of Hepatitis E virus (HEV) in Tunisian blood donors and to evaluate its risk of parenteral transmission. Sera collected from 426 blood donors were tested for HEV IgG by indirect ELISA. Individuals were recruited from two national transfusion centers, in the North and the South of the country. Seroprevalence of HEV IgG was then compared with two other groups with increased risk of exposure to parenterally transmitted agents: 80 hemophiliac and 286 hemodialysis patients. Among blood donors, the seroprevalence was estimated to be 4.5%. It was significantly higher in the hemophiliac and hemodialysis groups with 7.5% and 10.2%, respectively, (P = 0.002). No significant correlation was observed for this IgG 1 seroprevalence between age and sex among three studied groups. These results suggest that HEV has a high risk of parenteral transmission and confirm that the low endemicity of hepatitis E in Tunisia was observed.

Genetic characterization and serological prevalence of swine hepatitis E virus in Shandong province, China

Hepatitis E virus (HEV), the causative agent of hepatitis E, is classified into four major genotypes (1 to 4) and swine is the main natural reservoir for genotypes 3 and 4. In this study, a total of 106 bile samples from a slaughterhouse in the Shandong province of China were tested for the partial ORF2 gene of HEV by RT-nPCR to determine the virus genotypes, and two indirect ELISA were developed for the detection of swine HEV specific IgM and IgG antibodies in 980 serum samples from 24 farms, in order to investigate the seroprevalence. Thirty-two out of 106 (30.2%) bile samples were positive for HEV and a high degree of partial ORF2 sequence similarity (86.8–100%) was observed among 20 samples. The viral sequences belonged to genotype 4, subtypes 4a and 4d. One complete genome sequence of a subtype 4d HEV was further determined and characterized. The seroprevalence of HEV IgG and IgM antibodies was 100% (24/24) and 41.7% (10/24) for herds, and 66.4% (651/980) and 1.6% (16/980) for the individual pigs, respectively. These results suggested a high prevalence of genotype 4 of swine HEV infection both in swine farms and at the slaughterhouse in Shandong province, which further raise public-health concerns for zoonosis and pork safety.

Silent hepatitis E virus infection in Dutch blood donors, 2011 to 2012

In Europe, the dynamics of endemic hepatitis E virus (HEV) infection remain enigmatic. We studied the presence of silent HEV infection among Dutch blood donors. Using donations collected throughout the Netherlands in 2011 and 2012, 40,176 donations were tested for HEV RNA in 459 pools of 48 or 480 donations. Deconstruction of the reactive pools identified 13 viraemic donors. In addition, 5,239 donors were tested for presence of anti-HEV IgG and IgM and for HEV RNA when IgM-positive. Of the 5,239 donations, 1,401 (27%) tested repeat-positive for HEV IgG, of which 49 (3.5%) also tested positive for anti-HEV IgM. Four of the HEV IgM-positive donors tested positive for HEV RNA. HEV IgG seroprevalence ranged from 13% among donors younger than 30 years to 43% in donors older than 60 years. The finding of 17 HEV RNA-positive donations among 45,415 donations corresponds to one HEV-positive blood donation per day in the Netherlands. For 16 of the 17 HEV RNA-positive donors, genotyping succeeded, revealing HEV genotype 3, which is circulating among Dutch pigs. Apparently, silent HEV infection is common in the Netherlands, which possibly applies to larger parts of Europe.

Hepatitis E in New Zealand

Locally acquired hepatitis E virus (HEV) infection has been described in a number of developed countries and is thought to be zoonotic from pigs. Little is known about hepatitis E in humans in New Zealand (NZ) but 90% of NZ pigs show evidence of HEV infection. The aim of this study was to investigate the epidemiology of hepatitis E infection in NZ by documenting HEV immunoglobulin (Ig) G seroprevalence in NZ blood donors, testing patients with unexplained hepatitis for HEV, and comparing genetic sequences of human HEV with local porcine isolates. In total, 265 blood donors were tested for HEV IgG and 77 patients with unexplained hepatitis were tested for HEV. Viral sequences were compared with known HEV isolates including those from NZ pigs. The HEV IgG seroprevalence was 4%. HEV genotype 3 was isolated in four patients with unexplained hepatitis. Clinical and sequencing data suggest that two cases were acquired in Europe and two in NZ. All cases were in elderly patients, one of whom was asymptomatic and initially misdiagnosed as a drug reaction. The NZ-acquired cases were most similar to HEV from Japan, and bore little sequence homology to HEV isolated from NZ pigs. Hepatitis E does occur in NZ in patients who have not traveled to endemic areas and seems to affect the elderly. The seroprevalence data suggest that subclinical/unrecognized infection is common. Sequencing data suggest that some reservoir other than pigs could be the source of HEV in NZ. It is recommend that all patients with unexplained hepatitis, whatever their age or travel history, are tested for HEV.