Hepatitis E virus infection in Turkey: a systematic review

Area of Science:

• Hepatology
• Virology
• Public Health

Background:

• Hepatitis E virus (HEV) is a significant cause of hepatitis globally, transmitted via the fecal-oral route and zoonotically.
• While Hepatitis B (HBV) and C (HCV) are well-documented in Turkey, HEV epidemiology remains unclear.
• HEV can cause severe hepatitis, particularly in vulnerable populations like pregnant women and immunocompromised individuals.

Purpose of the Study:

• To systematically review existing studies on HEV in Turkey.
• To determine the current prevalence and epidemiological status of HEV in the country.
• To identify limitations in current research and suggest future study directions.

Main Methods:

• Systematic review of published HEV studies from Turkey.
• Analysis of reported HEV prevalence data across various demographic and clinical groups.
• Assessment of study limitations regarding population representation and inclusion criteria.

Main Results:

• HEV prevalence in Turkey ranged from 0% to 12.4% across studies.
• Higher HEV prevalence was noted in adults compared to children.
• Specific high-risk groups showed elevated prevalence: pregnant women (7-8%), chronic HBV patients (13%), chronic HCV patients (54%), chronic renal failure patients (13.9-20.6%), and agricultural workers (≈35%).
• HEV seroprevalence was also reported in Turkish immigrants in Europe (10.3% in Italy, 33.4% in the Netherlands).

Conclusions:

• HEV prevalence appears high in certain risk groups within Turkey, suggesting potential endemicity.
• Existing studies have limitations, including insufficient sample sizes for population representation and exclusion of key vulnerable groups (immunosuppressed, transplant recipients).
• Further comprehensive research is required to accurately define HEV epidemiology in Turkey, including non-A, non-B hepatitis prevalence.