Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Sep;14(3):223-235.
doi: 10.1007/s12560-022-09530-3. Epub 2022 Aug 29.

Hepatitis E Virus in Water Environments: A Systematic Review and Meta-analysis

G R Takuissu  1 , S Kenmoe  2 , L Ndip  2 , J T Ebogo-Belobo  3 , C Kengne-Ndé  4 , D S Mbaga  5 , A Bowo-Ngandji  5 , M G Oyono  6 , R Kenfack-Momo  7 , S Tchatchouang  8 , J Kenfack-Zanguim  7 , R Lontuo Fogang  9 , E Zeuko'o Menkem  10 , G I Kame-Ngasse  3 , J N Magoudjou-Pekam  7 , S Nkie Esemu  2 , C Veneri  11 , P Mancini  11 , G Bonanno Ferraro  11 , M Iaconelli  11 , E Suffredini  12 , G La Rosa  13
Affiliations
Meta-Analysis

Hepatitis E Virus in Water Environments: A Systematic Review and Meta-analysis

G R Takuissu et al. Food Environ Virol. 2022 Sep.

Abstract

Hepatitis E virus (HEV) is responsible for acute hepatitis in humans, through foodborne, zoonotic, and waterborne transmission routes. This study aimed to assess the prevalence of HEV in water matrices. Six categories were defined: untreated and treated wastewater, surface water (river, lake, and seawater), drinking water, groundwater, and other water environments (irrigation water, grey water, reservoir water, flood water, and effluent of pig slaughterhouse). We searched PubMed, Web of Science, Global Index Medicus, and Excerpta Medica Database. Study selection and data extraction were performed by at least two independent investigators. Heterogeneity (I2) was assessed using the χ2 test on the Cochran Q statistic and H parameter. Sources of heterogeneity were explored by subgroup analysis. This study is registered with PROSPERO, number CRD42021289116. We included 87 prevalence studies from 58 papers, 66.4% of which performed in Europe. The overall prevalence of HEV in water was 9.8% (95% CI 6.4-13.7). The prevalence was higher in untreated wastewater (15.1%) and lower in treated wastewater (3.8%) and in drinking water (4.7%). In surface water, prevalence was 7.4%, and in groundwater, the percentage of positive samples, from only one study available, was 8.3%. Overall, only 36.8% of the studies reported the genotype of HEV, with genotype 3 (HEV-3) prevalent (168 samples), followed by HEV-1 (148 sample), and HEV-4 (2 samples). High-income countries were the most represented with 59/87 studies (67.8%), while only 3/87 (3.5%) of the studies were performed in low-income countries. The overall prevalence obtained of this study was generally higher in industrialized countries. Risk of bias was low in 14.9% of the studies and moderate in 85.1%. The results of this review showed the occurrence of HEV in different waters environments also in industrialized countries with sanitation and safe water supplies. While HEV transmission to humans through water has been widely demonstrated in developing countries, it is an issue still pending in industrialized countries. Better knowledge on the source of pollution, occurrence, survival in water, and removal by water treatment is needed to unravel this transmission path.

Keywords: HEV; Hepatitis E; Prevalence; Water matrices.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Screening diagram of prevalence of HEV in various water sources
Fig. 2
Fig. 2
Global prevalence estimate of HEV in various water matrices
Fig. 3
Fig. 3
Global repartition of prevalence estimate of HEV in various water matrices
See this image and copyright information in PMC

References

    1. Abravanel F, Lhomme S, Rostaing L, Kamar N, Izopet J. Protracted fecal shedding of HEV during ribavirin therapy predicts treatment relapse. Clinical Infectious Diseases. 2015;60:96–99. doi: 10.1093/cid/ciu742. - DOI - PubMed
    1. Aggarwal R. Clinical presentation of hepatitis E. Virus Research. 2011;161:15–22. doi: 10.1016/j.virusres.2011.03.017. - DOI - PubMed
    1. Agresti A, Coull BA. Approximate is better than “Exact” for interval estimation of binomial proportions. The American Statistician. 1998;52:119–126.
    1. Ahmad T, Waheed Y, Tahir S, Safi SZ, Fatima K, Afzal MS, Qadri I. Frequency of HEV contamination in sewerage waters in Pakistan. Journal of Infection in Developing Countries. 2010;4:842–845. doi: 10.3855/jidc.612. - DOI - PubMed
    1. Alfonsi, V., Romanò, L., Ciccaglione, A. R., La Rosa, G., Bruni, R., Zanetti, A., Della Libera, S., Iaconelli, M., Bagnarelli, P., Capobianchi, M. R., Garbuglia A. R., Riccardo, F., Tosti, M. E., Collaborating Group Hepatitis E in Italy: 5 years of national epidemiological, virological and environmental surveillance, 2012 to 2016. Eurosurveillance. 2018;23:1700517. - PMC - PubMed