Seroprevalence of Hepatitis E Among Boston Area Travelers, 2009-2010

Seroprevalence of hepatitis E virus antibodies in adults and children from upstate New York: A cross-sectional study

Hepatitis E virus (HEV) is a major cause of viral hepatitis around the world, especially in developing countries. Recently, HEV has also been recognized as important cause of hepatitis in Europe and Japan, however, there is a paucity of clinical data from the United States. The overall seroprevalence of HEV antibodies is around 10% in the United States, but considerable variation is seen based on geographic location, year, and assay used. In this study, 63 adults and 417 children from New York State were tested for anti-HEV IgG antibodies using the commercially available Wantai IgG assay. The overall seroprevalence of HEV antibodies among adult participants was 9.52% (95% CI: 3.58–19.59%). Positive adults tended to be older than HEV negative adults, all positive adults were female. Only 3 (0.7%, 95% CI:: 0.15–2.09%) of the children were positive, all positive children were male. These results are consistent with global and United States trends in HEV seroprevalence.

Prevalence and Impact of Hepatitis E Virus Infection Among Persons With Chronic Hepatitis B Living in the US and Canada

Background

Patients with chronic hepatitis B virus (HBV) may experience spontaneous biochemical flares of liver disease activity. This study aimed to determine (i) the prevalence of prior and possible acute hepatitis E virus (HEV) infection among persons with chronic HBV and (ii) whether HEV infection is associated with liver disease flares among persons with chronic HBV.

Methods

Serum from a random sample of 600 adults in the Hepatitis B Research Network Cohort Study was tested for HEV RNA and anti-HEV IgM and IgG. Logistic regression models were used to estimate crude and adjusted odds ratios of anti-HEV prevalence for participant characteristics.

Results

Anti-HEV IgG and IgM seroprevalence was 28.5% and 1.7%, respectively. No participants had detectable HEV RNA. Of the 10 anti-HEV IgM+ participants, only 1 had elevated serum ALT at seroconversion. The odds of anti-HEV seropositivity (IgG+ or IgM+) were higher in older participants, males, Asians, less educated people, and those born outside the United States and Canada.

Conclusions

Acute HEV infection is a rare cause of serum ALT flares among persons with chronic HBV. The high seroprevalence of anti-HEV IgG among the chronic HBV patients is strongly associated with various demographic factors in this largely Asian American cohort.

Hepatitis E in Long-Term Travelers from the Netherlands to Subtropical and Tropical Countries, 2008-2011

Hepatitis E virus (HEV) is a common cause of acute viral hepatitis. Virus genotypes 1 and 2 infect humans in developing countries by the fecal-oral route. To assess attack rates and disease incidence for travelers, we prospectively studied 604 long-term travelers to subtropical and tropical countries. Participants donated blood samples pretravel and posttravel and kept a diary. A total of 89/604 (15%) pretravel samples were positive for HEV IgG by ELISA, suggesting previous HEV infection. Seroconversion for HEV was found for 19/515 travelers (attack rate 3.7%, incidence 1.8 cases/1,000 person-weeks). We believe there is a substantial risk for acquiring HEV infection among long-term travelers. Although HEV infection does not seem to be a major problem in this healthy cohort, hygienic measures should be stressed in all pretravel health advice, particularly for pregnant women and immunocompromised travelers who are at risk for severe disease.