Seroprevalence of hepatitis E antibodies and risk profile of HEV seropositivity in The Netherlands, 2006-2007

Hepatitis E virus (HEV) is now considered an endemic pathogen in industrialized countries, leading to acute and sometimes chronic hepatitis, mostly in vulnerable people. The endemic sources are unclear. A survey in The Netherlands in 2006-2007 showed a 1.9% seroprevalence of HEV antibodies measured by ELISA and confirmed by immunoblot in a nationwide sample. Overall, in 134/7072 (1.9%) seropositive individuals, older age (P<0.01), being male (P<0.01), working with patients (P=0.03), working with animals (P=0.07), recent diarrhoeal complaints (P=0.07) and adhering to a religion that considers pigs unclean (P<0.01) were independently associated with seropositivity in multivariate analysis. Sub-analysis of 59/4022 (1.5%) anti-HEV antibody-positive subjects with probable endemic exposure showed independent association with youngest household member being aged <5 years or between 19 and <65 years (P=0.05) in multivariate analysis. These findings may contribute to a better understanding of the sources of endemic HEV exposure, and also highlight the need for systematic epidemiological and serological evaluation of new cases.