Hepatitis E seroprevalence in Belgium

Introduction: Hepatitis E virus (HEV) typically causes waterborne outbreaks of acute hepatitis in parts of the world with poor sanitation. However, HEV infection is now increasingly recognized as a cause of hepatitis in developed countries as well. This autochthonous hepatitis E is usually caused by genotype 3, which has been shown to have a high prevalence in pig populations worldwide and which may be transmitted zoonotically. Previous seroprevalence studies in Western Europe have yielded widely differing estimates, probably because of the variability in analytical performance of the assay used for detection of anti-HEV antibodies. The goal of this study is to provide an estimate of the seroprevalence of HEV in Belgium, since data for our country are currently lacking. Patients and methods: One hundred patients presenting to our hospital without gastroenterological problems were randomly selected to be tested for anti-HEV IgG antibodies. This was done using a sensitive indirect ELISA (Biorex, Antrim, United Kingdom) and, in the case of a borderline result, a strip immunoassay (Mikrogen, Neuried, Germany) for confirmation. Results: The anti-HEV IgG seroprevalence was found to be 14%. Discussion: Published seroprevalence rates of HEV in other Western European countries are as follows: 3.2% to 16.6% in France, 2.0% to 15.5% in Germany, 1.1% to 6.0% in the Netherlands, 5.3% to 16.2% in the UK and 0.8% to 7.3% in Spain. As pigs may serve as a reservoir for HEV infection in humans, we calculated pig/inhabitant ratios by dividing the number of pigs by the number of inhabitants for these countries (data from 2009). The pig/inhabitant ratio was 0.59 in Belgium, 0.23 in France, 0.33 in Germany, 0.73 in the Netherlands, 0.08 in the UK and 0.57 in Spain. It is clear from these data that a simple linear correlation between the seroprevalence of HEV and the pig/inhabitant ratio does not exist. However, it should be kept in mind that HEV seroprevalence rates from different studies are difficult to compare due to large differences in the analytical sensitivity of the available anti-HEV IgG assays. Conclusions: The observed seroprevalence rate suggests that HEV infection is not an uncommon event in Belgium. Comparisons with published seroprevalence data of other Western European countries should be made with caution due to differences in the analytical performance of anti-HEV IgG assays.

Publication year:2012