The prevalence of immunoglobulin G (IgG) anti-hepatitis E virus (anti-HEV) antibodies was studied with a representative sample of 1,249 healthy children aged between 6 and 15 years. IgG anti-HEV antibodies were detected in 57 (4.6%) of the 1,249 samples analyzed, suggesting that some children are exposed to HEV in early childhood.Hepatitis E virus (HEV) infection is endemic in parts of the developing world, and large outbreaks occur in areas with poor water sanitation. It is rare in developed countries, although increasing numbers of autochthonous cases have been reported in recent years (3,11,13,16,19).The objective of this study was to analyze the seroprevalence of HEV infection in a representative sample of healthy Spanish children and determine the sociodemographic and medical factors associated with HEV infection.A sample of schoolchildren aged 6 to 15 years was obtained from 30 randomly selected schools in Catalonia, a region in the northeast of Spain, between January and May 2001. The sample size, calculated taking into account a prevalence of immunoglobulin G (IgG) anti-HEV antibodies of 3% in young adults (4), an ␣ error of 5%, and a precision of Ϯ0.0087, was 1,477. Informed consent to obtain blood samples and study variables was obtained from parents.The sociodemographic variables assessed were age, sex, place of birth, habitat (urban or rural), and social class, classifying children into three groups according to the parent's profession and the English classification of social classes (14).The medical variables were history of accidents causing bleeding wounds, surgical interventions, dental extractions, and history of acute viral hepatitis.IgG anti-HEV antibodies were detected using a commercial immunoenzymatic method (Bioelisa HEV IgG; BIOKIT, Barcelona, Spain). Samples with IgG anti-HEV antibodies were tested for IgM anti-HEV antibodies by an immunoenzymatic method (Bioelisa HEV IgM; BIOKIT, Barcelona, Spain). IgG anti-hepatitis A virus (anti-HAV) antibodies and anti-surface hepatitis B virus antigen were detected by automatic chemiluminescent immunoassay methods (Vitros ECi; Ortho-Clinical Diagnostics, High Wycombe, United Kingdom).The prevalences of anti-HEV antibodies and 95% confidence intervals (CI) were determined by the binomial exact method for different socioeconomic groups. The prevalences of antibodies in different groups were compared using the chi-square test. Statistical significance was established at P values of Ͻ0.05.IgG anti-HEV antibodies were detected in 57 (4.6%; 95% CI, 3.4 to 5.8) of the 1,249 samples studied. The prevalence of anti-HEV antibodies was higher in girls (5.8%; 95% CI, 4.0 to 7.7) than in boys (3.4%; 95% CI, 2.2 to 5.1) (P ϭ 0.6). Figure 1 shows the distribution according to age and sex. The prevalence of IgG anti-HEV antibodies slightly and nonsignificantly decreased with age, from 4.6% (95% CI, 2.2 to 8.3) in children aged 6 to 9 years to 3.8% (95% CI, 2.4 to 5.7) in children aged 13 to 15 years (P ϭ 0.4).The prevalence was higher in children living in urban ar...
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