Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988-1994.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
The Journal of Infectious Diseases (Impact Factor: 5.78). 08/2009; 200(1):48-56. DOI: 10.1086/599319
Source: PubMed

ABSTRACT Hepatitis E virus (HEV) is prevalent and causes disease worldwide, but its epidemiological profile is only partially understood.
We used an enzyme immunoassay to measure anti-HEV immunoglobulin G antibodies in 18,695 serum samples collected in the Third National Health and Nutrition Examination Survey. We calculated estimates of HEV seroprevalence and examined associations with putative risk factors.
The seroprevalence of HEV in the civilian noninstitutionalized United States (US) population during the period from 1988 through 1994 was 21.0% (95% confidence interval [CI], 19.0%-22.9%). Among US-born individuals, males, non-Hispanic whites, and individuals residing in the Midwest and/or in metropolitan areas had the highest seroprevalence estimates. Having a pet in the home (odds ratio [OR], 1.19 [95% CI, 1.01-1.40]) and consuming liver or other organ meats more than once per month (OR, 1.38 [95% CI, 1.01-1.88]) were significantly associated with increased odds of HEV seropositivity.
Exposure to HEV is common in the US population, although hepatitis E is rarely reported. Having pets and consuming organ meats may play a role in HEV transmission in the United States, but other mechanisms of transmission may also exist. HEV may be considered a possible etiologic agent of acute and chronic hepatitis in US patients reporting no travel history.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Swine hepatitis E virus (HEV) is considered to be a new zoonotic agent due to its close genomic resemblance to the human HEV. The aim of this study was to determine human HEV seroprevalence in eastern Romania and to characterize circulating swine HEV sequences. Methods Serological investigations of human serum samples were done using a commercial ELISA kit (MP Biomedicals). Swine faecal samples were tested to detect the HEV ORF2 sequence by nested reverse transcription PCR. Results One hundred and forty-eight human serum samples were tested for anti-HEV IgG of which 22 were found to be positive. Fresh swine faeces (pools) were collected from five farms in eastern Romania. Six out of 19 pooled samples were positive for HEV RNA. Phylogenetic analysis based on alignment of the ORF2 sequence indicated that the Romanian swine HEV isolates belonged to genotype 3. Conclusions This is the first study showing HEV to be present in Romanian pig herds and that the human population is exposed.
    International Journal of Infectious Diseases 12/2014; 29:232-237. · 2.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A cross-sectional study in Nigeria was undertaken to determine the epidemiology, seroprevalence, and associated risk factors, of hepatitis E virus (HEV). A total of 462 subjects were used for the study, categorized into four groups: apparently healthy persons, pregnant women, HIV positive subjects, and animal handlers. Information was obtained from subjects using interviewer-administered questionnaire. Blood samples were collected and analyzed for HEV antibodies (IgG and IgM) using enzyme-linked immunosorbent assay (ELISA) technique. Results obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 17.0 statistical software. The overall seroprevalence of IgG and IgM was 42.7 and 0.9%, respectively. Animal handlers had the highest seroprevalence (66.7%). The associated risk factors for IgM seroprevalence were rural dwelling (P = 0.039, odds ratio (OR) 3.3, 95% confidence interval (CI) 0.7-15.4), blood transfusion (P < 0.001, OR 9.6, 95% CI 2.6-35.6), attending to animals (P = 0.032, OR 4.9, 95% CI 0.9-26.6), and waste disposal (P < 0.001). Factors associated with IgG were age (P = 0.044), location (P < 0.001), marital status (P < 0.001), formal education (P < 0.001), farming as occupation (P < 0.001), rural dwelling (P = 0.001), waste disposal (P < 0.001), alcohol consumption (P = 0.001, OR 2.4, 95% CI 1.4-4.0), open defecation (P < 0.001, OR 2.9, 95% CI 1.4-5.7), attending to animals (P < 0.001, OR 2.3, 95% CI 1.6-3.4), consuming unwashed fruits/vegetables (P < 0.001, OR 4.2, 95% CI 0.3-54.1), and stream/river as a source of drinking water (P < 0.001, OR 3.6, 95% CI 1.6-7.8). Preventive public health measures should be reinforced among all communities, particularly domestic animal handlers and pregnant women. Potable water should be provided for all communities. Data suggest that HEV remains an under-recognized and significant public health problem, warranting further attention and research.
    Virology: Research and Treatment 01/2014; 5:15-26.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Causality assessment is a critical step in establishing the diagnosis of drug induced liver injury (DILI) during drug development. DILI may resemble almost any type of liver disease, and often presents a serious challenge to clinical investigators and drug makers. The diagnosis of DILI is largely based upon a combination of a compatible clinical course, exclusion of all other reasonable causes, resemblance of clinical and pathological features to known features of liver injury due to the drug (i.e., "drug's signature"), and incidence of liver injury among patients treated with the drug compared to placebo or comparator. Causality assessment for suspected DILI is currently performed using either evaluation by physicians with expertise in liver disorders (i.e., expert opinion) or standardized scoring instruments such as the Roussel Uclaf Causality Assessment Method (RUCAM). Both approaches are widely used in the post marketing setting. Causality assessment based on expert opinion is considered superior to standardized instruments such as RUCAM, in the setting of drug development, and is currently the preferred approach during clinical trials. There is a need for a systematic revision of RUCAM that will render it more suitable for the setting of clinical trials and drug development. Careful monitoring and meticulous data collection during clinical trials are essential in all cases with established liver injury to allow for a proper causality assessment. A workshop was convened to discuss best practices for the assessment of drug-induced liver injury (DILI) in clinical trials. This publication is based on the conclusions of this workshop.
    Drug Safety 11/2014; 37 Suppl 1:47-56. · 2.62 Impact Factor

Full-text (2 Sources)

Available from
Jun 10, 2014