Download This Paper
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
The Global Burden of Hepatitis E Virus Infection: A Systematic Review and Meta-Analysis
36 Pages Posted: 20 Jun 2019
More...Abstract
Background: Hepatitis E virus (HEV) as an emerging zoonotic pathogen is a leading cause of acute viral hepatitis worldwide, with a high risk of developing chronic infection in immunocompromised patients. However, the global burden of HEV infection has not been comprehensively assessed. This study aims to map the global prevalence and identify the risk factors of HEV infection by performing a systematic review and meta-analysis.
Methods: We conducted a systematic searching of articles published in Medline, Embase, Web of science, Cochrane and Google scholar databases till February 2019 to identify studies with prevalence data about HEV. Two independent researchers extracted data and assessed quality and risk of bias. DerSimonian-Laired random-effects model with Freeman-Tukey double arcsine transformation was used to pool the estimates of HEV prevalence. Pooled estimated odd ratios (OR) analysis was used to investigate the risk factors for HEV infection in general cohort.
Findings: We identified 443 related studies which comprised of 2122985 individuals. A total of 1097874 participants from 286 general population studies pooled estimated a globally anti-HEV IgG seroprevalence of 12·45% (95% CI 10·40-14·66; I2=100%). The pooled estimates of anti-HEV IgM seroprevalence based on 97 studies is 1·51% (95% CI 1·15-1·93; I2=99%). The overall estimate of HEV viral RNA positive rate in general population is 0·20% (95% CI 0·15-0·26; I2=98%). Consumption of raw meat (p=0·0001), exposure to soil (p<0·0001), blood transfusion (p=0·0138), traveling to endemic areas (p=0·0244), contacting with dogs (p=0·0416), living in rural areas (p=0·0349) and receiving education less than elementary school (p<0·0001) were identified as risk factors for HEV infection.
Interpretation: Globally, approximately 937 million individuals corresponding to 1 in 8 individuals have ever experienced HEV infection. 15-114 million individuals have recent or ongoing HEV infection. Our study highlights the substantial burden of HEV infection and calls for increasing routine screening and preventive measures.
Funding Statement: This research is supported by the KWF (Dutch Cancer Society) Young Investigator grant (No. 10140) and a VIDI grant (No. 016.196.300) from the Netherlands Organisation for Scientific Research (NWO) to Q. Pan, and the China Scholarship Council for funding PhD fellowship to P. Li (201808370170), J. Liu (201606240079), Y. Li (201703250073), J. Su (201708535017), W. Cao (201307060013).
Declaration of Interests: All the authors declare no competing interests.
Ethics Approval Statement: This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). No institutional review board approval was required for this meta-analysis because our study only included data which had been published previously.
Keywords: Hepatitis E virus; Prevalence; Global burden; Risk factor
Suggested Citation: Suggested Citation