Introduction Locally acquired hepatitis E virus (HEV) infection is an emerging infection in developed countries. South West France has a high incidence of HEV and has reported a large number of chronic cases of HEV infection. We previously estimated the HEV seroprevalence in blood donors in Midi-Pyrénées to be 16.6%, very much higher than the rate seen in Northern France (3.2%). However, comparison between seroprevalence studies is difficult. There is no gold-standard for measuring HEV antibodies and commercial assays vary in performance. A recent study has suggested poor sensitivity in a commonly used HEV IgG assay, which underestimates seroprevalence by a factor of 4.51. Since this assay was used in our previous study of HEV seroprevalence in Midi-Pyrénées, we repeated the study using a more sensitive assay previously validated against sera from cases of HEV genotype 3 infection.
Aim To re-examine the seroprevalence of anti-HEV IgG using a sensitive, validated assay.
Method Sera from 512 blood donors (aged 18–65 yrs) and 50 children (aged 2–4 yrs) were tested for anti-HEV IgG (Wantai, Beijing, China). Demographic data and putative risk factors for HEV acquisition were collected using a structured questionnaire.
Results The HEV seroprevalence in blood donors was 52.5%. 63.1% of donors from rural areas and 42.9% of donors from urban ones were positive for anti-HEV IgG (p<0.01). The HEV seroprevalence increased gradually with the age from 32.8% in donors aged 18–27 years to 70% in donors aged 58–65 years (p<0.01). The prevalence of anti-HEV in men (51.4%) and women (54.7%) was similar. In children aged 2–4 years the HEV seroprevalence was 2%, suggesting that the high seroprevalence seen in the blood donors was not due to cross-reacting antibodies. Multivariate analysis identified age, rural residence, contact with cats and hunting as the factors independently associated with anti-HEV IgG positivity.
Conclusion HEV is highly endemic in South West France, and the seroprevalence approaches that found in many developing countries where HEV is endemic. Seroepidemiological studies of hepatitis E which use less sensitive assays may not produce a valid assessment of the relevant risk factors.
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