Hepatitis E Seroprevalence in Europe: A Meta-Analysis

Area of Science:

• Epidemiology
• Virology
• Public Health

Background:

• Hepatitis E virus (HEV) IgG seroprevalence studies in Europe exhibit considerable variability, complicating interpretation.
• A comprehensive understanding of HEV IgG seroprevalence and identification of at-risk populations are crucial for public health strategies.

Purpose of the Study:

• To conduct a meta-analysis of published European studies to clarify anti-HEV IgG seroprevalence.
• To identify specific risk groups associated with HEV exposure across diverse European populations.

Main Methods:

• A systematic review and meta-analysis of European HEV seroprevalence studies published between 2003 and 2015.
• Data were stratified by diagnostic assay (Wantai, Mikrogen, MP-diagnostics, DiaPro, Abbott), geographical location, and patient cohort (general population, HIV patients, transplant recipients, liver disease patients, individuals with animal contact).
• A mixed-effects model was employed for data pooling and analysis.

Main Results:

• Out of 432 initially identified studies, 73 were included. Seroprevalence estimates ranged from 0.6% to 52.5%, increasing with age but not gender.
• Significant variations in seroprevalence were observed based on the assay used, with Wantai (WT) assay reporting higher rates (17%) compared to Mikrogen (MG) (10%), MP-diagnostics (MP) (7%), DiaPro (4%), and Abbott (2%).
• Individuals with contact to swine/wild animals showed significantly higher seroprevalence (p < 0.0001) irrespective of the assay. France reported the highest seroprevalence (WT: 32%, MP: 16%), while Italy reported the lowest (WT: 7.5%, MP: 0.9%). Heterogeneity was attributed to geographical region (23%), assay (23%), and cohort (7%).

Conclusions:

• HEV IgG seroprevalence is predominantly influenced by the diagnostic assay employed, followed by geographical region and study cohort.
• Individuals with occupational or recreational exposure to swine and/or wild animals exhibit a higher risk of HEV infection.
• Seroprevalence increases with age, highlighting the importance of age-related risk assessment in HEV surveillance.