Investigation of the Hepatitis E Virus Seroprevalence in Cases Admitted to Hacettepe University Medical Faculty Hospital

Abstract

Hepatitis E virus (HEV), classified in Hepeviridae family, Hepevirus genus, is a non-enveloped virus with icosahedral capsid containing single-stranded positive sense RNA genome. HEV infections may be asymptomatic especially in children, however it may present as fulminant hepatitis in pregnant women, as well as chronic hepatitis in immunocompromised patients. There are four well-known genotypes of HEV that infect humans and many mammalian species. Genotype 1 and 2 are frequently responsible for water-borne infections transmitted by fecal-oral way in developing countries, while genotype 3 and 4 cause zoonotic infections in developed countries. Turkey is considered as an endemic country with a total seroprevalence rate of 6.3% for normal population, showing significant variation (0-73%) according to the regions and study groups. The aims of this study were to investigate the HEV seropositivity in cases admitted to Hacettepe University Medical Faculty Hospital (HUMFH), to evaluate the results according to the demographic features of patients, and to determine the current HEV seroprevalence in our region, contributing seroepidemiological data in Turkey. A total of 1043 serum samples (514 female, 529 male; age range: 1-90 years, mean age: 38.03) obtained from 327 blood donors (32 female, 295 male; age range: 19-59 years, mean age: 31.1) who were admitted to HUMFH Blood Center, and 716 sera (482 female, 234 male; age range: 1-90 years, mean age: 41.7) that were sent to HUMFH Central Laboratory from various outpatient/inpatient clinics, between November 2012 to November 2013, were included in the study. The presence of HEV-IgG antibodies in serum samples was detected by a commercial ELISA method (Euroimmun, Germany), and the presence of HEV-IgM antibodies was also investigated in the sera with IgG-positive results. The overall HEV-IgG seropositivity rate was determined as 4.4% (46/1043), and the seropositivity rates for blood donors and in/outpatients were as 0.92% (3/327) and 6.0% (43/716), respectively. HEV-IgM antibody was not detected in any of the cases. The HEV-IgG seropositivity was 3.2% among male, and 5.6% among female, yielding no statistically significant difference between the gender (p= 0.056). HEV-IgG antibodies were detected in none (0/118) of the pediatric age group (0-18 years), while the seropositivity rates were 1.9% (14/731) and 16.5% (32/194) in 19-55 and ≥ 56 years-old groups, respectively. The difference between the age groups was statistically significant (p< 0.001), indicating the age-related pattern of HEV exposure. In conclusion, the total HEV seroprevalence rate found as 4.4% in our study, is comparable to the average results reported from Turkey. Our data is also in agreement with the result of a previous report (3.8%) that performed from Ankara province in 2002 with similar study groups, emphasizing that there was no significant changes for HEV exposure have occured over more than the last decade in Ankara, Cental Anatolia, Turkey.

HEV seroprevalence in blood donors in Turkey by two commercial total anti‐HEV Ab ELISA kits

“…Two cities from central Turkey, namely Ankara and Kayseri, were included in the present study. In Ankara, several studies performed in adults showed various anti‐HEV seropositivity results, ranging from 0.92% to 16% . In a recent study, performed in blood donors, anti‐HEV‐IgG seropositivity was found to be 0.92% (3 of 327), which is extremely low when compared with our results (12.5% and 12%).…”

“…In Ankara, several studies performed in adults showed various anti‐HEV seropositivity results, ranging from 0.92% to 16% . In a recent study, performed in blood donors, anti‐HEV‐IgG seropositivity was found to be 0.92% (3 of 327), which is extremely low when compared with our results (12.5% and 12%). Since, the study groups are blood donors in both studies, these conflicting results in anti‐HEV seropositivity might be explained by the low performance of the commercial ELISA assay (Euroimmun, Germany) used in the study.…”

“…In Ankara, several studies performed in adults showed various anti-HEV seropositivity results, ranging from 0.92% to 16%. [30][31][32][33][34][35] In a recent study, performed in blood donors, anti-HEV-IgG seropositivity was found to be 0.92% (3 of 327), 30 These relatively low seroprevalence rates in the early studies might be due to increased HEV seroprevalence in these regions over years as well as the poor sensitivity of the first generation HEV ELISA assays used.…”

Hepatitis E virus infection in Turkey: a systematic review

“…HEV seroprevalence is lower in children than in adults and the children lack antibodies. HEV seroprevalence is low, even zero in some pediatric series although HAV seroprevalence, another fecal–oral transmitted virus is high [ 10 , 14 , 18 , 20 , 22 ].…”

Current knowledge on Hepatitis E virus infection

“…References study Country Year of publication Investigated BD (n) HEV positive BD (%) Macedo et al 44 Portugal 1998 50 4.0 Tarrago et al 45 Spain 2000 863 2.9 Olsen et al 46 Sweden 2006 108 9.3 Boutrouille et al 47 France 2007 1998 3.2 Dalton et al 48 England 2008 500 16-25 Mansuy et al 49 France 2008 529 16.6 Christensen et al 50 Denmark 2008 169 20.6 Mansuy et al 51 France 2011 512 52.5 Kaufmann et al 52 Switzerland 2011 550 4.9 Dremsek et al 53 Germany 2012 301 11.0 Fogeda et al 54 Spain 2012 2305 1.08 Cleland et al 55 Scotland 2013 1559 4.7 Slot et al 56 Netherlands 2013 5239 26.7 Juhl et al 57 Germany 2014 1019 6.8 Petrovic et al 58 Serbia 2014 200 15.0 Fischer et al 59 Austria 2015 1203 13.55 Holm et al 60 Denmark 2015 504 10.7 Mansuy et al 61 France 2015 3353 39.1 Puttini et al 62 Italy 2015 132 9.1 Aydin et al 63 Turkey 2015 327 0.92 Ricco et al 64 Italy 2016 199 7.0 Mansuy et al 65 France 2016 10569 22.4 Lucarelli et al 66 Italy 2016 313 49.0 Lange et al 67 Norway 2017 1200 14.0…”