title: High prevalence of anti-hepatitis E virus antibodies in outpatients with chronic liver disease in a university medical center in Germany.
abstract: OBJECTIVE
  Hepatitis E virus (HEV) is an emerging disease in developed countries. HEV seroprevalence ranges from 3.2 to 10% in Europe, but is higher in endemic areas such as southern France. In Germany, an increasing incidence of HEV infections has been reported recently. Risk factors for the acquisition of HEV are incompletely understood.
  
  
  METHODS
  We screened 295 consecutive patients with chronic liver disease attending the outpatient department at Charité University Hospital for HEV seroprevalence. Epidemiological characteristics were analyzed and patients were questioned for risk factors using a standardized questionnaire. A total of 78 patients without known liver disease were also tested for HEV IgG.
  
  
  RESULTS
  Out of 295 screened patients, 62 tested positive for HEV-IgG. Overall, 50% of the HEV-positive patients were women and 23.8% had underlying liver cirrhosis. HEV-positive patients were older than HEV-negative patients (mean age 56 vs. 48.6 years). Seroprevalence increased with age from 13% in patients 30-39 years of age to 36.4% in patients 70-79 years of age. Of the total, 46.7% of HEV-IgG-positive patients had contact with domestic animals and 38.3% had received blood transfusions. A total of 50% of the HEV-IgG-positive patients had regularly consumed uncooked meat and 45% had regularly consumed wild game or wild boar, which was significantly more frequent than in HEV-IgG-negative patients.
  
  
  CONCLUSIONS
  HEV-IgG seroprevalence was 21% in a cohort of patients with chronic liver disease and 24.4% in a cohort of patients without known liver disease. The higher seroprevalence found among elderly patients suggests a lifetime accumulation of risk of exposure to HEV. The results from this study imply that regular testing should be performed for HEV in developed countries in case of liver disease of unknown etiology.
authors.affiliation: aDepartment of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin bDepartment of Virology, Labor Berlin, Charité-Vivantes GmbH.
authors.forename: Marten
authors.initials: M
authors.lastname: Schulz
authors.forename: Daniel
authors.initials: D
authors.lastname: Beha
authors.forename: Kristina
authors.initials: K
authors.lastname: Plehm
authors.forename: Caroline
authors.initials: C
authors.lastname: Zöllner
authors.forename: Jörg
authors.initials: J
authors.lastname: Hofmann
authors.forename: Eckart
authors.initials: E
authors.lastname: Schott
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000818:Animals; D002908:Chronic Disease; D004032:Diet / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006508:Hepatitis Antibodies / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000453:epidemiology*; D016751:Hepatitis E / Q000453:epidemiology* / Q000276:immunology; D016752:Hepatitis E virus / Q000276:immunology; D019693:Hepatitis, Autoimmune / Q000453:epidemiology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000821:virology; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology; D008105:Liver Cirrhosis, Biliary / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology / Q000821:virology; D008297:Male; D008460:Meat; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D010045:Outpatients; D015995:Prevalence; D066256:Raw Foods; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D034421:Sus scrofa
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M