Prevalence of antibodies to hepatitis E in two rural Egyptian communities.

Abstract

Abstract. A population-based serosurvey in two rural Egyptian communities was used to assess age-specific prevalence of antibody to hepatitis E virus (anti-HEV). One community is in the Nile Delta (11,182 inhabitants; 3,997 participants) and the other in Upper Egypt (10,970 inhabitants; 6,029 participants). Samples were tested for anti-HEV with a commercial enzyme-linked immunoassay (ELISA) based on antigens derived from open reading frame (ORF)2 and ORF3. Although there was a clear difference in sensitivity among the lots of the commercial test used, it was still possible to determine the seroprevalence. The seroprevalence of anti-HEV exceeded 60% in the first decade of life, peaked at 76% in the second decade and remained above 60% until the eighth decade. Prevalence of this magnitude is among the highest reported in the world, with an age-specific pattern more similar to hyperendemic hepatitis A virus transmission than generally described. Lot-to-lot variation in the sensitivity of the commercial ELISA kit highlights a problem when comparing seroepidemiologic studies of different populations.

Population Seroprevalence of Hepatitis E Virus Antibodies in Rural Bangladesh

“…The 22.5% prevalence of antibodies to HEV using a highly sensitive and specific research assay documents that HEV is endemic in this population. 26 These findings confirm recent clinical studies identifying HEV as an etiologic agent contributing to substantial hepatitis morbidity in Bangladesh. 18,27,28 The rural population prevalence is lower than the 60.1% proposed by a recent urban study of 273 apparently healthy adults, 19 but similar to the 27% estimates of anti-HEV IgG prevalence in a study of 105 Bangladeshi peacekeepers participating in the United Nations Mission in Haiti in 1996.…”

“…These data contrast sharply from the higher seroprevalence rates (> 60%) shown in a rural Egyptian population. 26 Thus, despite the absence of reported large seasonal outbreaks of HEV in this population, our seroprevalence estimates in Bangladesh are remarkably similar to neighboring epidemic-prone countries.…”

Characterization of hepatitis E-specific cell-mediated immune response using IFN-γ ELISPOT assay

“…However, HEV-caused AVH is very rare in the US. A similar situation exists in Egypt where up to 80% of the inhabitants of rural villages have anti-HEV with very little or no evidence that the infection causes acute hepatitis in the subjects in these community-based studies (Fix et al, 2000;Meky et al, 2006;, although, just as in the US, sporadic cases of acute hepatitis E infections are reported (Zakaria et al, 2007). The reasons for this discrepancy are unclear.…”

Hepatitis E: Epidemiology and Natural History

“…Also, the differences in antibody prevalence rates between countries at times do not fit in well with other available data. For instance, the seroprevalence rates in India 53 are lower than those in Egypt, 54 even though outbreaks of hepatitis E are common in the former and are virtually unknown in the latter. The reason for this is unclear.…”