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Meta-Analysis
. 2020 Jul;40(7):1516-1528.
doi: 10.1111/liv.14468. Epub 2020 Apr 24.

The global epidemiology of hepatitis E virus infection: A systematic review and meta-analysis

Pengfei Li  1 , Jiaye Liu  1 , Yang Li  1 , Junhong Su  1   2 , Zhongren Ma  2 , Wichor M Bramer  3 , Wanlu Cao  1 , Robert A de Man  1 , Maikel P Peppelenbosch  1 , Qiuwei Pan  1   2
Affiliations
Meta-Analysis

The global epidemiology of hepatitis E virus infection: A systematic review and meta-analysis

Pengfei Li et al. Liver Int. 2020 Jul.

Abstract

Background and aims: Hepatitis E virus (HEV), as an emerging zoonotic pathogen, is a leading cause of acute viral hepatitis worldwide, with a high risk of developing chronic infection in immunocompromised patients. However, the global epidemiology of HEV infection has not been comprehensively assessed. This study aims to map the global prevalence and identify the risk factors of HEV infection by performing a systematic review and meta-analysis.

Methods: A systematic searching of articles published in Medline, Embase, Web of science, Cochrane and Google scholar databases till July 2019 was conducted to identify studies with HEV prevalence data. Pooled prevalence among different countries and continents was estimated. HEV IgG seroprevalence of subgroups was compared and risk factors for HEV infection were evaluated using odd ratios (OR).

Results: We identified 419 related studies which comprised of 1 519 872 individuals. A total of 1 099 717 participants pooled from 287 studies of general population estimated a global anti-HEV IgG seroprevalence of 12.47% (95% CI 10.42-14.67; I2 = 100%). Notably, the use of ELISA kits from different manufacturers has a substantial impact on the global estimation of anti-HEV IgG seroprevalence. The pooled estimate of anti-HEV IgM seroprevalence based on 98 studies is 1.47% (95% CI 1.14-1.85; I2 = 99%). The overall estimate of HEV viral RNA-positive rate in general population is 0.20% (95% CI 0.15-0.25; I2 = 98%). Consumption of raw meat (P = .0001), exposure to soil (P < .0001), blood transfusion (P = .0138), travelling to endemic areas (P = .0244), contacting with dogs (P = .0416), living in rural areas (P = .0349) and receiving education less than elementary school (P < .0001) were identified as risk factors for anti-HEV IgG positivity.

Conclusions: Globally, approximately 939 million corresponding to 1 in 8 individuals have ever experienced HEV infection. 15-110 million individuals have recent or ongoing HEV infection. Our study highlights the substantial burden of HEV infection and calls for increasing routine screening and preventive measures.

Keywords: epidemiology; hepatitis E virus; prevalence; risk factors; seroprevalence.

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Conflict of interest statement

The authors do not have any disclosures to report.

Figures

FIGURE 1
FIGURE 1
Study selection
FIGURE 2
FIGURE 2
(A) The global seroprevalence of anti‐HEV IgG antibody (B) The global seroprevalence of anti‐HEV IgM antibody (C) The global prevelence of HEV RNA prositivity
FIGURE 3
FIGURE 3
Hepatitis E virus genotype distribution in our study
FIGURE 4
FIGURE 4
Anti‐hepatitis E virus (HEV) IgG seroprevalence among six subgroups
See this image and copyright information in PMC

Comment in

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