The Epidemiology of Hepatitis E in Israel and Potential Risk Factors: A Cross-Sectional Population-Based Serological Survey of Hepatitis E Virus in Northern Israel

Abstract

Hepatitis E Virus (HEV) has gained public health attention as one of the causative agents of viral hepatitis. Our study aimed to provide data about HEV seropositivity in the Israeli general population, including its seroprevalence geographical distribution, and to identify variables as possible risk factors for HEV exposure. A seroprevalence cross-sectional study was conducted: HEV serological status was determined in 716 blood samples collected from the routine check-up blood samples. Demographic information was available for all samples. The overall prevalence of HEV IgG in an apparently healthy population in the north of Israel was 10.5%, with no evidence of positive HEV IgM. There was a significant association between HEV seropositivity and elderly age and low socioeconomic status (SES). The age-adjusted seroprevalence was significantly lower among Jews compared to Arabs with a rate ratio of 2.02. We identified clusters (hot spots) of HEV infection in three regions under study. Our results confirmed a high prevalence of anti-HEV in the country where clinical hepatitis E is not endemic. For the first time, this study showed that a hot spot analysis was able to provide new knowledge about actual exposure zones. As HEV infection is not a notifiable disease, it is probably underdiagnosed. Thus, better awareness among physicians is warranted.

Keywords: general population; hepatitis E virus; hot spot analysis; seroprevalence.

Figure 1

Hot spot classification by applying the Getis-Ord Gi* approach in the study area. Each circle represents a region, and the larger the circle, the higher the seroprevalence. The circle color represents the Gi* p-value ranges.