title: Two Generations of "Gold Standards": The Impact of a Decade in Hepatitis E Virus Testing Innovation on Population Seroprevalence.
abstract: Hepatitis E virus (HEV) is a global pathogen responsible for approximately 20 million infections every year in developing countries, yet remains under-recognized. In this population-based cohort study, 1,025 randomly selected participants were enrolled from Matlab, Bangladesh (2004-2005). All participants were tested for HEV antibodies and total immunoglobulin (Ig), using an in-house enzyme immunoassay developed by Walter Reed Army Institute of Research (WRAIR). In 2014, we retested the banked sera of 1,009 of those participants using the Wantai anti-HEV IgG enzyme-linked immunosorbent assay (ELISA). The WRAIR assay estimated the overall population seroprevalence as 26.6% (95% confidence interval [CI]: 24.0, 29.5), whereas the Wantai assay produced significantly higher estimated seroprevalence, 46.7% (95% CI: 43.5-49.8) (P < 0.001). However, the two tests give nearly identical findings in those 5 years and under (N = 94) with a 98% agreement between the tests. Retesting populations with modern assays is necessary to establish better population-level estimates of disease burden.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Kmush
authors.forename: Alain B
authors.initials: AB
authors.lastname: Labrique
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
authors.forename: Zabed B
authors.initials: ZB
authors.lastname: Ahmed
authors.forename: John R
authors.initials: JR
authors.lastname: Ticehurst
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Heaney
authors.forename: Kenrad E
authors.initials: KE
authors.lastname: Nelson
authors.forename: Khalequ
authors.initials: K
authors.lastname: Zaman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016751:Hepatitis E / Q000175:diagnosis / Q000453:epidemiology*; D016752:Hepatitis E virus; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D016036:Seroepidemiologic Studies; D055815:Young Adult