Hepatitis E virus seroepidemiology among Malaysian blood donors: Prevalence and associated risk factors

Hepatitis E virus (HEV) is a recognized transfusion-transmissible pathogen with significant impact in immunocompromised recipients. Data from Southeast Asia are limited, and the epidemiology of HEV in Muslim-majority populations with low pork consumption remains poorly characterized. This study aimed to determine anti-HEV immunoglobulin G (IgG) and immunoglobulin M (IgM) seroprevalence and associated demographic, dietary, environmental, zoonotic and knowledge-related factors among Malaysian blood donors.

A prospective cross-sectional study was conducted among 500 consecutive blood donors at the Universiti Malaya Medical Centre. Anti-HEV IgG and IgM were measured using enzyme-linked immunosorbent assay. A structured questionnaire assessed demographic, dietary, environmental and zoonotic exposures. Univariate and multivariable logistic regression identified predictors of anti-HEV IgG seropositivity.

Anti-HEV IgG seroprevalence was 2.8% (14/500), and IgM positivity was 0.6% (3/500). IgG seropositivity increased with age but showed no association with dietary exposures, including pork consumption. Knowledge of HEV was low, with a median score of 1 out of 12. Multivariable analysis identified freshwater recreational exposure (adjusted odds ratio [aOR] 20.04; p = 0.017) and direct rodent contact (aOR 13.36; p = 0.030) as factors associated with anti-HEV IgG seropositivity; however, these findings were based on small numbers of exposed individuals and should be interpreted cautiously.

HEV seroprevalence in Malaysian blood donors was low, indicating a limited burden of previous HEV infection. The observed epidemiological profile suggests that environmental and zoonotic exposures may be associated with HEV seropositivity, although these findings require cautious interpretation. These findings provide baseline data for continued surveillance and future evaluation of transfusion-transmitted HEV risk in Malaysia.