title: Hepatitis E Seroprevalence in Europe: A Meta-Analysis.
abstract: There have been large numbers of studies on anti-HEV IgG seroprevalence in Europe, however, the results of these studies have produced high variability of seroprevalence rates, making interpretation increasingly problematic. Therefore, the aim of this study was to develop a clearer understanding of anti-HEV IgG seroprevalence in Europe and identify risk groups for HEV exposure by a meta-analysis of published studies.
  
  
  
  All European HEV-seroprevalence studies from 2003 to 2015 were reviewed. Data were stratified by assay, geographical location, and patient cohort (general population, patients with HIV, solid-organ transplant recipients, chronic liver disease patients, and individuals in contact with swine/wild animals). Data were pooled using a mixed-effects model.
  
  
  
  Four hundred thirty-two studies were initially identified, of which 73 studies were included in the analysis. Seroprevalence estimates ranged from 0.6% to 52.5%, increased with age, but were unrelated to gender. General population seroprevalence varied depending on assays: Wantai (WT): 17%, Mikrogen (MG): 10%, MP-diagnostics (MP): 7%, DiaPro: 4%, Abbott 2%. The WT assay reported significantly higher seroprevalence rates across all cohorts (p < 0.001). Individuals in contact with swine/wild animals had significantly higher seroprevalence rates than the general population, irrespective of assay (p < 0.0001). There was no difference between any other cohorts. The highest seroprevalence was observed in France (WT: 32%, MP: 16%) the lowest in Italy (WT: 7.5%, MP 0.9%). Seroprevalence varied between and within countries. The observed heterogeneity was attributed to geographical region (23%), assay employed (23%) and study cohort (7%).
  
  
  
  Seroprevalcence rates primarily depend on the seroassy that is used, followed by the geographical region and study cohort. Seroprevalence is higher in individuals exposed to swine and/or wild animals, and increases with age.
authors: First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany. j.hartl@uke.de.
authors: Johannes
authors: J
authors: Hartl
authors: First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany. b.otte@uke.de.
authors: Benjamin
authors: B
authors: Otto
authors: Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK. richie@forfey.com.
authors: Richie Guy
authors: RG
authors: Madden
authors: Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK. glynn.webb@students.pcmd.ac.uk.
authors: Glynn
authors: G
authors: Webb
authors: Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK. kathy.woolson@nhs.net.
authors: Kathy Louise
authors: KL
authors: Woolson
authors: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany. l.kriston@uke.de.
authors: Levente
authors: L
authors: Kriston
authors: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany. e.vettorazzi@uke.de.
authors: Eik
authors: E
authors: Vettorazzi
authors: First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany. alohse@uke.de.
authors: Ansgar W
authors: AW
authors: Lohse
authors: Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK. Harry.Dalton@rcht.cornwall.nhs.uk.
authors: Harry Richard
authors: HR
authors: Dalton
authors: First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany. s.pischke@uke.de.|Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK. s.pischke@uke.de.
authors: Sven
authors: S
authors: Pischke
mesh_terms: D005060:Europe / Q000453:epidemiology; D006508:Hepatitis Antibodies / Q000097:blood*; D016751:Hepatitis E / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D016273:Occupational Exposure; D012307:Risk Factors; D016036:Seroepidemiologic Studies
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G
keywords: Europe; anti-HEV IgG; assay; developing countries; genotype 3; hepatitis E; seroprevalence; serosurvey