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: 6). 08/2009; 200(1):48-56. DOI: 10.1086/599319
Source: PubMed


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.

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Available from: Ronald E Engle, May 20, 2014
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    • "In endemic areas, similar to hepatitis A infection, it has been described a high seroprevalence of HEV and a more severe hepatitis related to HEV infection in patients with pre-existing chronic liver disease (CLD) due to hepatitis B virus (HBV) or hepatitis C virus (HCV) [27]. Moreover, in USA, a significant association between HEV seropositivity and antibodies to HCV has been also reported [28]. More recently, a study performed by Pischke et al revealed a high anti-HEV IgG rate in patients diagnosed with autoimmune hepatitis, suggesting that hepatitis E infection could have triggered immune events in those patients [29]. "
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    ABSTRACT: BackgroundAcute and chronic hepatitis E have been associated with high mortality and development of cirrhosis, particularly in solid-organ recipients and patients infected by human immunodeficiency virus. However, data regarding the epidemiology of hepatitis E in special populations is still limited.AimsInvestigate seroprevalence and possible factors associated with HEV infection in a large cohort of immunosuppressed patients.MethodsCross-sectional study testing IgG anti-HEV in serum samples from 1373 consecutive individuals: 332 liver-transplant, 296 kidney-transplant, 6 dual organ recipients, 301 non-transplanted patients with chronic liver disease, 238 HIV-infected patients and 200 healthy controls.ResultsIgG anti-HEV was detected in 3.5% controls, 3.7% kidney recipients, 7.4% liver transplant without cirrhosis and 32.1% patients who developed post-transplant cirrhosis (p<0.01). In patients with chronic liver disease, IgG anti-HEV was also statistically higher in those with liver cirrhosis (2% vs 17.5%, p<0.01). HIV-infected patients showed an IgG anti-HEV rate of 9.2%, higher than those patients without HIV infection (p<0.03). Multivariate analysis showed that the factors independently associated with anti-HEV detection were liver cirrhosis, liver transplantation and HIV infection (OR: 7.6, 3.1 and 2.4). HCV infection was a protective factor for HEV infection (OR: 0.4).ConclusionsHEV seroprevalence was high in liver transplant recipients, particularly those with liver cirrhosis. The difference in anti-HEV prevalence between Liver and Kidney transplanted cases suggests an association with advanced liver disease. Further research is needed to ascertain whether cirrhosis is a predisposing factor for HEV infection or whether HEV infection may play a role in the pathogeneses of cirrhosis.
    Full-text · Article · Jul 2014 · PLoS ONE
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    • "In the US, anti-HHEV rose with age up to 45% among adult men aged over 60 years in a survey performed by the National Institutes of Health and the Centers for Disease Control at the national level. The rate among adults would have been expected higher in areas close to the Mexican border than in the rest of the country, but the data available show actually the very opposite (1.6 versus 42%) [10, 42]. Though Mexico is usually included in the list of highly endemic countries for hepatitis E, this is just based on the report of an epidemics developing 26 years ago that was attributed to a unique HHEV2 strain (genotype 2a) [43] never found again. "
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    ABSTRACT: Human hepatitis E virus (HHEV) spreads early in life among the population in areas endemic for genotype 1 and infects mainly adults in areas endemic for genotype 3, where it would be responsible for about 10% of cases of suspected acute viral hepatitis of unknown etiology and for a number of subclinical, unrecognized infections. The overall prevalence of antibody to HHEV is high in most of the former areas and low in most of the later ones, but wide regional differences have been recorded in both cases. "Hot spots" of HHEV infection would exist for both types of strains in particular regions or among particular populations of the world. Studies on pork derivatives, shellfish bivalves, and vegetables for HHEV contamination at the sale point need to be extended for evaluating the impact of the agent on food safety, and the meaning of the finding of HHEV genotype 1 genomes in urban sewage from developed countries should be established through active surveillance. Consensus about technical issues in regard to anti-HEV testing would improve the knowledge of the HHEV epidemiology. Studies in particular regions and populations, and introduction of molecular diagnosis in the clinical setting as a routine tool, would also be required.
    Full-text · Article · Feb 2014
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    • "HEV genotypes 3 and 4 infect pigs and other mammalian animals in both developing and developed countries (autochthonous infection); humans are accidental hosts [7]. Although HEV infections in developed countries are less common, seroprevalence varies widely from 1% to >20%, depending on the diagnostic kit used for detection [8], [9]. Over the past decade, there has been an emergence of HEV infections and zoonotic transmission in developed countries, particularly in Japan [10] and Europe [11]. "
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    ABSTRACT: Hepatitis E virus (HEV) is an emerging pathogen. We evaluated the seroprevalence of HEV infection among swine farmers and the general population in Taiwan, a nonendemic country. We conducted a cross-sectional seroepidemiologic study in rural Taiwan in 2012 and 2013. The study included swine farmers, health examination attendees, pregnant women, and students. A commercial enzyme-linked immunosorbent assay was used to detect immunoglobulin G (IgG) and IgM against HEV. Pertinent information was collected using a questionnaire. In total, 660 participants were enrolled in the study, including 156 swine farmers, 314 health examination attendees, 100 pregnant women, and 90 students. IgG anti-HEV was detected in 29.5% of swine farmers, 11.5% of health examination attendees, 2% of pregnant women, and 1.1% of students. Two subjects were positive for IgM anti-HEV. Logistic regression analysis revealed that swine farmers had an approximately 3.5-fold increased risk (odds ratio [OR], 3.46; 95% confidence interval [CI], 1.91-6.27; p<0.0001) for being seropositive for IgG anti-HEV as compared to the general population. Age was positively associated with seropositive rate (OR, 1.07 per year; 95% CI, 1.05-1.09; p<0.0001). HEV infection is prevalent in Taiwan. The seroprevalence of HEV infection is high in swine farmers and in the elderly population.
    Full-text · Article · Jun 2013 · PLoS ONE
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