title: Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988-1994.
abstract: BACKGROUND
  Hepatitis E virus (HEV) is prevalent and causes disease worldwide, but its epidemiological profile is only partially understood.
  
  
  METHODS
  We used an enzyme immunoassay to measure anti-HEV immunoglobulin G antibodies in 18,695 serum samples collected in the Third National Health and Nutrition Examination Survey. We calculated estimates of HEV seroprevalence and examined associations with putative risk factors.
  
  
  RESULTS
  The seroprevalence of HEV in the civilian noninstitutionalized United States (US) population during the period from 1988 through 1994 was 21.0% (95% confidence interval [CI], 19.0%-22.9%). Among US-born individuals, males, non-Hispanic whites, and individuals residing in the Midwest and/or in metropolitan areas had the highest seroprevalence estimates. Having a pet in the home (odds ratio [OR], 1.19 [95% CI, 1.01-1.40]) and consuming liver or other organ meats more than once per month (OR, 1.38 [95% CI, 1.01-1.88]) were significantly associated with increased odds of HEV seropositivity.
  
  
  CONCLUSIONS
  Exposure to HEV is common in the US population, although hepatitis E is rarely reported. Having pets and consuming organ meats may play a role in HEV transmission in the United States, but other mechanisms of transmission may also exist. HEV may be considered a possible etiologic agent of acute and chronic hepatitis in US patients reporting no travel history.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Kuniholm
authors.forename: Robert H
authors.initials: RH
authors.lastname: Purcell
authors.forename: Geraldine M
authors.initials: GM
authors.lastname: McQuillan
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Engle
authors.forename: Annemarie
authors.initials: A
authors.lastname: Wasley
authors.forename: Kenrad E
authors.initials: KE
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D005843:Geography; D006306:Health Surveys; D016751:Hepatitis E / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D016036:Seroepidemiologic Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult