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Seroprevalence of hepatitis E virus in Estonia, 1994 to 2006, a pilot study Valentina Tefanova

Seroprevalence of hepatitis E virus in Estonia, 1994 to 2006, a pilot study Valentina Tefanova Tatjana Tallo, Tatiana Kuznetsova, Ljudmilla Priimägi, Jevgenia Epstein, Kullo Kutsar Department of Virology, NIHD, Tallinn, Estonia Estonian Health Board

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Seroprevalence of hepatitis E virus in Estonia, 1994 to 2006, a pilot study Valentina Tefanova

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  1. Seroprevalence of hepatitis E virus in Estonia, 1994 to 2006, a pilot study Valentina Tefanova Tatjana Tallo, Tatiana Kuznetsova, Ljudmilla Priimägi, Jevgenia Epstein, Kullo Kutsar Department of Virology, NIHD, Tallinn, Estonia Estonian Health Board IX Annual Conference of the New VISBY Network on Hepatitis C (HepC 2012) April 1-4, 2012, St.- Petersburg, Russia

  2. Background • Hepatitis E virus infection is an important public–health concern as a major cause of enterically transmitted hepatitis worldwide • The estimates of HEV infection prevalence: In regions of endemicity ranged between 3-26% In non-endemic regions ranges from 1 to 3% • Hepatitis E in developed countries is far more common than previously recognised and was also related with zoonotic transmission V. Chandra et.al, 2008

  3. HEV in Estonia • In Estonia, according to order of Ministry of Social Affairs notification of hepatitis E should be introduced since 1997 • However, HEV diagnostics is not still performed and the prevalence • of anti-HEV antibodies in the general population has never been studied • To establish a starting point for further studies on HEV epidemiology as well as a molecular typing of HEV in Estonia we conducted a retrospective study • on HEV prevalence in Estonia • The objective of the study* • To determine the HEVpresence and prevalence in a population sample fromEstonia • The study was approved by the Tallinn Medical Research Ethics Committee • * Financial support: Estonian Health Board

  4. Materials • Totally 1253 serum samples were randomly selected for study • From those: 763 samples were from patients withclinical signs of acute non-A-non-C hepatitis 176- from hemodialysis patients 163- from health care workers (HCW) with different speciality 151- from healthy individuals from urban and rural areas • None of the tested samples were positive for anti-HIV, HBsAg, anti-HBc or anti-HCV • The samples have been collected between 1994 and 2006 and stored at -70ºC before use at Department of Virology, NIHD

  5. Methods • Serum samples were tested for the presence of HEV IgG using recomWell HEV IgG ELISA kit (Mikrogen, Denmark) • All HEV IgG positive sera were tested for HEV IgM antibodies by the recomWell HEVIgM, Mikrogen, Denmark • Initially reactive samples both for IgG and IgM were retested and those with a repeatedly positive sera were considered positive • For confirmation, positive sera were tested for anti-HEV IgG and IgM with an immunoblot assay (recomLine HEV IgG/IgM, Mikrogen) • The prevalence of anti-HEV antibodies were calculated for each study, age and sex groups • The chi-square test was used to analyze the differences. A P value of <0.05 was considered statistically significant Applied antigens of the G1 and G3

  6. Results 1: Characteristics of studied groups The study cohort composed: 494 males aged 20-91, mean age 46.4±14.8 759 females aged 20-82, mean age 44.4±14.6 37% (459/1253)were older than 50 years, while 63% (794) wereaged 50 years or less

  7. anti-HEV positivity by studied groups 6.0 5.1 % 3.2 2.5 2.4 0 acute VH nAnC dial. pts HCW healthy people Results 2: Prevalence of HEV IgG antibodies in the adult population of Estonia, 1994-2006 • In total, the anti-HEV prevalence was 3.2% (40/1253, 16 males, 24 females) • Anti-HEV IgM was found in 32.5% (13/40, 6 males, 7 females) out of anti-HEV positive samples • Overall, 27 sera samples were positive only for anti-HEV IgG * *Highest HEV prevalence - in healthy subjects (6.0%) followed by hemodialysis patients (5.1%)

  8. 7 5.9 6 5 Males 4 Females 3 Total 2 1 0 20-30 31-40 41-50 51-60 ≥61 years Results: Prevalence of HEV IgG antibodies in the adult population of Estonia according to sex and age, 1994-2006 • a highest prevalence rate (5.9%) - in persons aged 60 years and over, p=0,01 • overall seroprevalence rates for females - 3.16% and 3.24% - for males, p=0,920

  9. Conclusions • The HEV IgG prevalence in adult Estonian population was 3.2%, being significantly higher in those aged 60 years and over • These preliminary results revealed the presence of HEV in Estonia and indicate that HEV should be considered as a possible cause of viral hepatitis • Since HEV diagnostic is not still performed in Estonia, there are urgent needs for introduction of robust protocol for diagnostics of HEV infection • It will be important to investigate whether or not sporadic cases of human hepatitis E exist in Estonia and, if so, which strains of HEV is responsible for them • In future, we plan to study of background HEV presence and prevalence both in the general population and in animals

  10. Thank you for attention!

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