Hepatitis E virus antibody prevalence in hunters from a district in Central Germany, 2013: a cross-sectional study providing evidence for the benefit of protective gloves during disembowelling of wild boars

Abstract

BackgroundIn Germany, 17 % of the general human population have antibodies to hepatitis E virus (HEV) (recomLine HEV-IgG/IgM immunoassay [Mikrogen GmbH]). Wild boars represent an animal reservoir for HEV genotype 3, which is the common genotype in Germany. We estimated the seroprevalence among hunters with contact to wild boars to identify factors that may be associated with past or present HEV infection.MethodsIn 2013, the local veterinarian authority in a district in Central Germany attended meetings of hunters who provided blood specimens and completed a questionnaire collecting information on age, sex, hunting-related activities and consumption of wild boar meat. Specimens of wild boars were taken during drive hunts in this district during the season 2012/2013. All specimens were tested for HEV RNA and anti-HEV IgM and IgG antibodies. Log-binomial regression was used to estimate prevalence ratios (PR) for the hunters.ResultsOf 126 hunters (median age 55; 94 % male) 21 % tested positive for anti-HEV IgG antibodies (95 % confidence interval [CI] 13–28 %) (recomWell HEV IgG assay [Mikrogen GmbH]). Anti-HEV prevalence was highest in the age group of the 70–79-year-olds (67 %; 95 % CI 39–95 %). Wild boars showed an average anti-HEV prevalence of 41 %. HEV RNA was detected in 4/22 (18 %) liver specimens and in 1/22 (4.5 %) muscle specimens. Most wild boars were tested positive for HEV RNA (3/10; 30 %) and HEV-specific antibodies (7/15; 47 %) in the southwestern part of the district. Hunters preferring this hunting ground had a lower anti-HEV prevalence when gloves were frequently used during disembowelling of wild boars compared to hunters using gloves never or infrequently (age-adjusted PR 0.12; 95 % CI 0.02–0.86).ConclusionsHunters may benefit from wearing gloves when in contact with blood or body fluids of HEV animal reservoirs. Anti-HEV prevalence among the hunters of this study did not significantly differ from that of the general population suggesting that other factors play a major role in the epidemiology of HEV in Germany.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1199-y) contains supplementary material, which is available to authorized users.

Performance of Hepatitis E Virus (HEV)-antibody tests: a comparative analysis based on samples from individuals with direct contact to domestic pigs or wild boar in Germany

“…IgG prevalence estimates obtained with the Mikrogen EIA are comparable to two other German studies applying the same test to individuals with professional exposure to pigs [34] and hunters [31]. More than half of slaughterers and classifiers/veterinarians/meat inspectors younger than 40 years exhibited HEV IgG antibodies based on the Wantai assay, which was higher compared to hunters (14.3%) (see Supplementary Fig.…”

“…The previous publications reported a remarkably high HEV seroprevalence in domestic pigs and wild boar in Germany reaching values of more than 60% [28][29][30][31]. Again, these estimates depend on the used assay [28].…”

“…Higher prevalence estimates were demonstrated for professional risk groups with direct contact to domestic pigs as well as for hunters and forestry workers [33][34][35][36][37][38]. A protective effect of wearing gloves during disembowelling [31] provides indirect evidence for the risk of exposure due to direct contact with wild boar. Only few studies have specifically compared seroprevalence in people with direct contact to wild boar (i.e., hunters) and domestic pigs [35,38].…”

Differences in hepatitis E virus (HEV) presence in naturally infected seropositive domestic pigs and wild boars - an indication of wild boars having an important role in HEV epidemiology

“…the possibility of prolonged viraemia in wild boars emphasizes the need for further investigations, mostly regarding the duration of viraemia in natural conditions. this is not included in our study because the sampling was conducted from shot wild boars, but this also stresses the importance of implementing adequate prevention measures, such as the use of protective gloves (SChIeLke et al, 2015), especially when handling wild boar carcasses.…”

Comment on: Acute and chronic hepatitis E virus infection in human immunodeficiency virus‐infected U.S. women

“…(2) Having provided HIV and hepatology patient care in both Baltimore and Pennsylvania (a state with a large rural hunting population), we are routinely reminded of the many demographic differences among these populations. And though data regarding geographical risk are conflicting, (3,4) based on our experience it is unsurprising that the only other U.S. case of chronic HEV cited by the authors resides in Pennsylvania. (5) In conclusion, Kuniholm et al present …”