title: Hepatitis E virus: Western Cape, South Africa.
abstract: OBJECTIVE
  To conduct a prospective assessment of anti-hepatitis E virus (HEV) IgG seroprevalence in the Western Cape Province of South Africa in conjunction with evaluating risk factors for exposure.
  
  
  METHODS
  Consenting participants attending clinics and wards of Groote Schuur, Red Cross Children's Hospital and their affiliated teaching hospitals in Cape Town, South Africa, were sampled. Healthy adults attending blood donor clinics were also recruited. Patients with known liver disease were excluded and all major ethnic/race groups were included to broadly represent local demographics. Relevant demographic data was captured at the time of sampling using an interviewer-administered confidential questionnaire. Human immunodeficiency virus (HIV) status was self-disclosed. HEV IgG testing was performed using the Wantai®assay.
  
  
  RESULTS
  HEV is endemic in the region with a seroprevalence of 27.9% (n= 324/1161) 95%CI: 25.3%-30.5% (21.9% when age-adjusted) with no significant differences between ethnic groups or HIV status. Seroprevalence in children is low but rapidly increases in early adulthood. With univariate analysis, age ≥ 30 years old, pork and bacon/ham consumption suggested risk. In the multivariate analysis, the highest risk factor for HEV IgG seropositivity (OR = 7.679, 95%CI: 5.38-10.96,P< 0.001) was being 30 years or older followed by pork consumption (OR = 2.052, 95%CI: 1.39-3.03,P< 0.001). A recent clinical case demonstrates that HEV genotype 3 may be currently circulating in the Western Cape.
  
  
  CONCLUSIONS
  Hepatitis E seroprevalence was considerably higher than previously thought suggesting that hepatitis E warrants consideration in any patient presenting with an unexplained hepatitis in the Western Cape, irrespective of travel history, age or ethnicity.
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Richie G
authors.initials: RG
authors.lastname: Madden
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wallace
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Sonderup
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Korsman
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Tawanda
authors.initials: T
authors.lastname: Chivese
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Gavine
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Aniefiok
authors.initials: A
authors.lastname: Edem
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Roxy
authors.initials: R
authors.lastname: Govender
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Nathan
authors.initials: N
authors.lastname: English
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Christy
authors.initials: C
authors.lastname: Kaiyamo
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Odelia
authors.initials: O
authors.lastname: Lutchman
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Annemiek A
authors.initials: AA
authors.lastname: van der Eijk
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Suzan D
authors.initials: SD
authors.lastname: Pas
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Glynn W
authors.initials: GW
authors.lastname: Webb
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Palmer
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goddard
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Sean
authors.initials: S
authors.lastname: Wasserman
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
authors.affiliation: Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom.
authors.forename: C Wendy
authors.initials: CW
authors.lastname: Spearman
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood*; D016751:Hepatitis E / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000276:immunology* / Q000472:pathogenicity; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012698:Serologic Tests; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006508:Hepatitis Antibodies; D007074:Immunoglobulin G
keywords: Genotype; Hepatitis E; Pork consumption; Seroprevalence; South Africa