Seroprevalence of hepatitis E in adults in Brazil: a systematic review and meta-analysis

Abstract

BackgroundHepatitis E virus (HEV) is a member of the Hepeviridae family; it has four main genotypes and one serotype. While genotypes 1 and 2 cause epidemic hepatitis and are transmitted via water and the fecal-oral route, genotypes 3 and 4 are zoonotic. In the various seroprevalence studies of hepatitis E in Brazil, the numbers reported vary widely and are difficult to interpret. The aim of this study was to analyze existing seroprevalence studies of hepatitis E in adults in Brazil.Main textWe searched the PubMed, Latin American and Caribbean Health Sciences and Embase databases for studies published from inception to May 12, 2018 concerning infection by HEV in Brazil without time period or language restrictions. We included studies that presented data concerning hepatitis E seroprevalence in adults in Brazil, had a sample size ≥50 patients and whose method used for the detection of anti-HEV was standardized and commercialized. We also evaluated the quality of the articles using a list of criteria that totalized 9 items. Of the 20 studies ultimately analyzed, 10 (50%) were from the southeast region of Brazil, 3 (15%) were from the central-west region, 3 (15%) were from the northern region, 2 (10%) were from the northeast region and 2 (10%) were from the southern region. Regarding the quality evaluation of the studies, the mean score was 5.6 (range: 4–8). The estimated overall seroprevalence of HEV infection in the adult population was 6.0% (95% CI: 5.0–7.0); in subgroup analyses, we observed that the prevalence of anti-HEV antibodies in blood donors was 7.0% (95% CI: 5.0–8.0), whereas in the general population, it was 3.0% (95% CI: 2.0–4.0).ConclusionsThe results of this systematic review indicate that there should be national investment in the prevention of hepatitis E virus infection in Brazil, including the implementation of improvements in basic sanitation and guidance regarding the appropriate handling of animal waste and the optimal cooking of vegetables, meat and their derivatives.Electronic supplementary materialThe online version of this article (10.1186/s40249-018-0514-4) contains supplementary material, which is available to authorized users.

Low seroprevalence of hepatitis E on Reunion island

“…The figures observed in our study are in strong contrast with the seroprevalence averaging 25% in hyperendemic industrialized countries from the northern hemisphere, including France, Germany, the Netherlands and China [15,17]. They are more in agreement with seroprevalence below 10% reported, for instances, from Brazilian or Finnish communities [16,18].…”

“…Together with the scarcity of clinical cases, hallmark of a low incidence, and the low proportion of HEV IgG antibodies previously reported in blood donors [11], the low seroprevalence (raw and weighted) observed herein suggest that Reunion Island is a low endemic area for HEV transmission. Few HEV seroepidemiological studies have been conducted within general populations, as compared to studies among blood donors [[15], [16], [17]]. The figures observed in our study are in strong contrast with the seroprevalence averaging 25% in hyperendemic industrialized countries from the northern hemisphere, including France, Germany, the Netherlands and China [15,17].…”

Seroprevalence of hepatitis E virus in risk populations and blood donors in a referral hospital in the south of Brazil

“…The overall prevalence in Brazil seems to be lower if compared to European data. A recent meta-analysis demonstrated a 6% prevalence rate 9 . However, the prevalence in blood donors is around 10% 10 , 11 .…”

A Systematic Review of the Extra-Hepatic Manifestations of Hepatitis E Virus Infection

“…Genotype 1 is the most common cause of acute hepatitis in Asian countries, especially in India. Genotype 2 is seen commonly in Africa and Central America, Genotype 3 is prevalent in western countries, as well as in Asia and North America, while genotype 4 is detected in Asian and European countries [3]. HEV infection is one of the most common causes of acute hepatitis globally with 20 million infections annually and an estimated 70,000 deaths attributed to genotypes 1 and 2 [4].…”