title: Hepatitis E virus infection: an emerging occupational risk?
abstract: BACKGROUND
  Hepatitis E virus (HEV) infection is endemic in many developing countries, causing substantial morbidity. Transmission is primarily faeco-oral and is associated with both sporadic infections and epidemics in areas where poor sanitation and weak public health infrastructures exist. Recently, it has become clear that HEV is also an endemic disease in industrialized countries. Moreover, a porcine reservoir and growing evidence of zoonotic transmission have been reported in these countries, suggesting the possibility of occupational transmission to man.
  
  
  OBJECTIVE
  To summarize the current knowledge on the epidemiology and prevention of transmission of HEV infection in occupational settings.
  
  
  METHODS
  The following key words were used to explore PubMed: hepatitis E, disease, epidemiology, profession(al), occupation(al).
  
  
  RESULTS
  After screening of the results, 107 publications were retained. In non-endemic regions, seroprevalence varied from a few per cent (2-7.8%) in Europe, Japan and South America to 18.2-20.6% in the USA, Russia, UK, southern France and Asia. A meta-analysis of 12 cross-sectional studies evaluating HEV immunoglobulin G (IgG) seroprevalence in individuals occupationally exposed to swine showed greater odds of seropositivity in the exposed group but also a high degree of heterogeneity. A funnel plot suggested publication bias.
  
  
  CONCLUSIONS
  There was a significant association between occupational exposure to swine and HEV IgG seroprevalence, but the level of prevalence detected depended also on the type of HEV IgG kits used. Further research, including on mechanisms and risk factors for infection, as well as the development of better serological tests for identification of infection, is required.
authors.affiliation: IDEWE Occupational Health Services, 3001 Leuven, Belgium, Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium, antoon.deschryver@uantwerpen.be.
authors.forename: A
authors.initials: A
authors.lastname: De Schryver
authors.affiliation: Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: De Schrijver
authors.affiliation: Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: François
authors.affiliation: Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Hambach
authors.affiliation: Epidemiology and Social Medicine, University of Antwerpen, Campus Drie Eiken DR 224, Universiteitsplein 1, 2610 Antwerpen, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: van Sprundel
authors.affiliation: Department of Health Sciences, University of Milan and International Centre for Rural Health, University Hospital San Paolo of Milan, 20142 Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tabibi
authors.affiliation: Department of Health Sciences, University of Milan and International Centre for Rural Health, University Hospital San Paolo of Milan, 20142 Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Colosio
mesh_terms: D000822:Animal Husbandry; D000818:Animals; D001208:Asia / Q000453:epidemiology; D021821:Communicable Diseases, Emerging / Q000517:prevention & control / Q000635:transmission / Q000821:virology*; D004197:Disease Reservoirs; D005060:Europe / Q000453:epidemiology; D005260:Female; D016751:Hepatitis E / Q000517:prevention & control / Q000635:transmission*; D016752:Hepatitis E virus / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000517:prevention & control / Q000821:virology*; D016273:Occupational Exposure / Q000517:prevention & control*; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D013552:Swine; D013553:Swine Diseases / Q000453:epidemiology / Q000635:transmission / Q000821:virology*
keywords: Disease; epidemiology; hepatitis E; occupation; profession(al).