Current hepatitis E virus seroprevalence in Swiss blood donors and apparent decline from 1997 to 2016

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Background and aim

Hepatitis E virus (HEV) is a virus of emerging importance to transfusion medicine. Studies from several European countries, including Switzerland, have reported high seroprevalence of hepatitis E as a consequence of endemic infections. Published HEV seroprevalence estimates within developed countries vary considerably; primarily due to improved diagnostic assays. The purpose of this study was to investigate the seroprevalence of anti-HEV IgG in Swiss blood donations. Methods: We used the highly sensitive Wantai HEV IgG EIA and assessed regional distribution patterns. We analysed age- and sex-matched archive plasma dating back 20 years from canton Bern to investigate recent changes in HEV seroprevalence levels. Results: On average, 20.4% (95% confidence intervals: 19.1–21.8) of the 3,609 blood samples collected in 2014–16 were anti-HEV IgG positive; however, distinct differences between geographical regions were observed (range: 12.8–33.6%). Seroprevalence increased with age with 30.7% of males and 34.3% of women being positive donors over > 60 years old. Differences between sexes may be attributed to dissimilarities in the average age of this group. Within the specified region of the Bern canton, overall prevalence has declined over two decades from 30.3% in 1997/98 to 27.0% in 2006 and 22.3% in 2015/6. Conclusions: HEV seroprevalence in Switzerland is high, but has declined over the last decades. The result shows that primarily endemic HEV infections occur and that current blood products may pose a risk to vulnerable transfusion recipients. Nucleic acid screening of all blood products for HEV will begin in November 2018.

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A comparison of two commercially available anti-HEV IgG kits and a re-evaluation of anti-HEV IgG seroprevalence data in developed countries.

Harry Dalton, Rachel Ali, Samreen Ijaz … (2010)

In developed countries, the incidence of hepatitis E virus (HEV) infection and the resulting seroprevalence are uncertain. Published estimates of seroprevalnce in these populations range from 0.26% to 31%, which may in part reflect the variety of assays used by different studies. This study compared the performance of two commercial assays (Genelabs [Singapore] and Wantai 'Beijing, China' HEV IgG EIA kits) and reviewed published estimates of anti-HEV seroprevalence in developed countries. The assays were compared using the WHO anti-HEV reference serum, sera from UK-acquired cases of genotype 3 HEV infections and 500 UK blood donor sera. The PE2 assay was found to be more sensitive than the GL assay (lower limit of detection for HEV IgG 0.25 vs. 2.5 WHO units/ml); it was positive in more sera from proven cases (98% vs. 56%), remained positive for longer post infection and resulted in a substantially higher estimate of seroprevalence in blood donors (16.2% vs. 3.6%). these results suggest that published studies of HEV seroprevalence using the GL assay have underestimated the true figure and that a properly validated method is required to make meaningful comparisons of HEV seroprevalence between populations. (c) 2010 Wiley-Liss, Inc.

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Hepatitis E Seroprevalence in Europe: A Meta-Analysis

Maximilian Johannes Hartl, Benjamin Otto, Richie Guy Madden … (2016)

There have been large numbers of studies on anti-HEV IgG seroprevalence in Europe, however, the results of these studies have produced high variability of seroprevalence rates, making interpretation increasingly problematic. Therefore, the aim of this study was to develop a clearer understanding of anti-HEV IgG seroprevalence in Europe and identify risk groups for HEV exposure by a meta-analysis of published studies. Methods: All European HEV-seroprevalence studies from 2003 to 2015 were reviewed. Data were stratified by assay, geographical location, and patient cohort (general population, patients with HIV, solid-organ transplant recipients, chronic liver disease patients, and individuals in contact with swine/wild animals). Data were pooled using a mixed-effects model. Results: Four hundred thirty-two studies were initially identified, of which 73 studies were included in the analysis. Seroprevalence estimates ranged from 0.6% to 52.5%, increased with age, but were unrelated to gender. General population seroprevalence varied depending on assays: Wantai (WT): 17%, Mikrogen (MG): 10%, MP-diagnostics (MP): 7%, DiaPro: 4%, Abbott 2%. The WT assay reported significantly higher seroprevalence rates across all cohorts (p < 0.001). Individuals in contact with swine/wild animals had significantly higher seroprevalence rates than the general population, irrespective of assay (p < 0.0001). There was no difference between any other cohorts. The highest seroprevalence was observed in France (WT: 32%, MP: 16%) the lowest in Italy (WT: 7.5%, MP 0.9%). Seroprevalence varied between and within countries. The observed heterogeneity was attributed to geographical region (23%), assay employed (23%) and study cohort (7%). Conclusion: Seroprevalcence rates primarily depend on the seroassy that is used, followed by the geographical region and study cohort. Seroprevalence is higher in individuals exposed to swine and/or wild animals, and increases with age.

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Zoonotic and foodborne transmission of hepatitis E virus.

Jin Meng (2013)

Hepatitis E is an important disease in many developing countries of Asia and Africa with large explosive outbreaks and is also endemic with sporadic or cluster cases of hepatitis in many industrialized countries. The causative agent, hepatitis E virus (HEV), is currently classified in the family Hepeviridae. Thus far, four putative genera of HEV representing mammalian, avian, and fish species have been identified and characterized worldwide. Within the mammalian HEV that infects humans, genotypes 1 and 2 are associated with epidemics and restricted to humans, whereas genotypes 3 and 4 are zoonotic and associated with sporadic and cluster cases of hepatitis E. As a fecal-orally transmitted disease, waterborne transmission is still an important route of HEV transmission especially for large outbreaks associated with genotypes 1 and 2. However, genetic identification of numerous animal strains of HEV and the demonstrated ability of cross-species infection by these animal strains have significantly broadened the host range and diversity of HEV and raised public health concerns for zoonosis and food safety associated with genotypes 3 and 4 HEV infection. Pigs and likely other animal species serve as reservoirs for HEV. Direct contact with infected pigs and other animals and consumption of contaminated animal meat and meat products pose risks for HEV infection. In this article, the current understanding of the zoonotic and foodborne transmissions of HEV as well as strategies to prevent zoonosis and ensure food safety is discussed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Author and article information

Journal

Journal ID (nlm-ta): Euro Surveill

Journal ID (iso-abbrev): Euro Surveill

Journal ID (publisher-id): eurosurveillance

Title: Eurosurveillance

Publisher: European Centre for Disease Prevention and Control (ECDC)

ISSN (Print): 1025-496X

ISSN (Electronic): 1560-7917

Publication date (Print): 30 August 2018

Volume: 23

Issue: 35

Electronic Location Identifier: 1700616

Affiliations

[1 ]Interregional Blood Transfusion SRC, Berne Switzerland

[2 ]Servizio Trasfusionale CRS della Svizzera Italiana, Lugano, Switzerland

[3 ]Blood Transfusion Service SRC, Fribourg, Switzerland

[4 ]Blood Transfusion Service Beider Basel, Basel, Switzerland

[5 ]Blood Transfusion Service SRC Neuchâtel/Jura, Neuchâtel, Switzerland

[6 ]Blood Transfusion Service SRC, Aargau/Solothurn, Switzerland

[7 ]Blood Transfusion Service SRC Nordostschweiz, St. Gallen, Switzerland

[8 ]Blood Transfusion Service SRC, Geneva, Switzerland

[9 ]Blood Transfusion Service SRC Zentralschweiz, Luzern, Switzerland

[10 ]Blood Transfusion Service SRC Thurgau, Münsterlingen, Switzerland

Author notes

Correspondence: Christoph Niederhauser ( christoph.niederhauser@ 123456itransfusion.ch )

Article

Publisher ID: 1700616 Publisher ID: 1700616 Other ID: 1700616

DOI: 10.2807/1560-7917.ES.2018.23.35.1700616

PMC ID: 6124188

PubMed ID: 30180927

SO-VID: bbbda1c8-909e-4f40-b2b1-3b828c9b84a6

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.