Seroprevalence of hepatitis E virus infection in pregnant women: a systematic review and meta-analysis

Abstract

Background: Hepatitis E virus (HEV) infection has emerged as a global public health problem that affects millions of people every year.

Objective: Systematically review data on the prevalence of HEV IgG antibody among pregnant women around the world.

Data sources: Potentially relevant studies were identified by a search of PubMed and ScienceDirect, and by a manual search of the reference lists of identified studies.

Study selection: Observational studies in English with no age or area restriction. Reviews, duplicate, book chapters, and other irrelevant studies were excluded.

Data extraction: Independent searching by two investigators (TA, THM).

Data synthesis: In the 6137 retrieved studies, 15 studies met the inclusion criteria. The studies included 7160 pregnant subjects from 11 countries. Most studies were from Africa. Of the 7160 subjects, 1182 were positive to anti-HEV IgG antibody, and only 66 were anti-HEV IgM antibody positive. The highest seroprevalence of anti-HEV IgG antibody (61.29%) was reported in Sudan and the lowest (3.41%) was reported in Italy. The overall pooled prevalence was 16.51% (95% CI: 0.10-0.23). The heterogeneity level was I ² = 98%; P≤.01.

Conclusion: The seroprevalence of anti-HEV IgG antibody among pregnant women differs by geographic location. Further studies are recommended to evaluate incidence, morbidity, and mortality in those areas where the disease is prevalent.

Limitations: Seroprevalence was only determined for the anti-HEV IgG antibody, which mostly indicates past infection. Heterogeneity was high among the studies in the analysis.

Conflict of interest: None.

Graphical abstract

Figure 1.

The prevalence of HEV IgG antibody among pregnant women around the world (≤10; 11-15%; 16-20%, ≥20%).

Figure 2.

Flow chart showing the processing of the included studies based on PRISMA guidelines.

Figure 3.

Forest plot meta-analysis of HEV IgG antibody prevalence in pregnant women around the world.

Figure 4.

Forest plot of subgroup analysis of HEV IgG antibody prevalence by region.

Figure 5.

Forest plot of subgroup analysis of HEV IgG antibody prevalence by publication year.

Figure 6.

Forest plot of subgroup analysis of HEV IgG antibody prevalence by commercial assay method.

Figure 7.

Forest plot of subgroup analysis of HEV IgG antibody prevalence by sample size.

Figure 8.

Funnel plot to assess publication bias.

Figure S1.

Forest plot of HEV IgM antibody among pregnant women around the world

Figure S2.

Meta-regression analysis by year of publication (P=.582)

Figure S3.

Meta-regression analysis by sample size (P=.003)

Figure S4.

Forest plot of sensitivity analysis.

Figure S5.

Sensitivity analysis.