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We investigated zoonotic transmission of HEV in rural settings of Lao People's Democratic Republic (Lao PDR) where humans are in close contacts with ruminants and where pigs are rare. Villagers with (<jats:italic>n<\/jats:italic>\u00a0=\u00a0171, risk group) and without (<jats:italic>n<\/jats:italic>\u00a0=\u00a0155, control group) cattle were recruited in seven villages in Vientiane Capital. Owners of pigs were excluded. Blood, as well as information on socio\u2010demographics, animal contact, dietary habits and awareness of zoonoses were collected to assess risk factors. Blood and rectal swabs were collected from cattle (<jats:italic>n<\/jats:italic>\u00a0=\u00a0173) and other ruminants (27 goat, 5 buffaloes) to measure anti\u2010HEV antibody and virus prevalence. A similar anti\u2010HEV antibody seroprevalence was found in cattle (6.8%) and other ruminants (8%). HEV RNA was detected in none of the animal rectal swabs and human sera. Anti\u2010HEV IgG seroprevalence was higher in cattle farmers than in the control group (59.1% vs. 43.9%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.008) and increased significantly with age. Other risk factors included male gender, close contact with cattle and consumption of undercooked meat. We find that HEV is highly endemic in rural Laos and provide first evidence that HEV circulates in free\u2010roaming ruminants with open access to village water sources. Despite some awareness about hygiene, villagers are likely constantly exposed to zoonotic diseases by dietary and lifestyle habits. Cattle farmers had a higher risk of HEV infection than other villagers. Our study highlights the need to raise the awareness of the rural population about water\u2010 and food\u2010borne pathogens, and about the role of cattle as a possible source of infection. The knowledge gained on local risk factors and husbandry conditions should guide future awareness raising campaigns and promote appropriate hygienic measures including handwashing and the consumption of safe food and water.<\/jats:p>","DOI":"10.1111\/zph.12483","type":"journal-article","created":{"date-parts":[[2018,6,11]],"date-time":"2018-06-11T04:29:37Z","timestamp":1528691377000},"page":"690-701","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Evidence of increased Hepatitis E virus exposure in Lao villagers with contact to ruminants"],"prefix":"10.1111","volume":"65","author":[{"given":"Silvia E.","family":"Tritz","sequence":"first","affiliation":[{"name":"Department of Infection and Immunity Luxembourg Institute of Health Esch\u2010sur\u2010Alzette Grand\u2010Duchy of Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilaysone","family":"Khounvisith","sequence":"additional","affiliation":[{"name":"Lao\u2010Lux\u2010Laboratory Institute Pasteur du Laos Vientiane Lao People's Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sisavath","family":"Pommasichan","sequence":"additional","affiliation":[{"name":"The Faculty of Agriculture National University of Laos \u2010 Nabong Campus Vientiane Lao People's Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khampasong","family":"Ninnasopha","sequence":"additional","affiliation":[{"name":"The Faculty of Agriculture National University of Laos \u2010 Nabong Campus Vientiane Lao People's Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amphone","family":"Keosengthong","sequence":"additional","affiliation":[{"name":"The Faculty of Agriculture National University of Laos \u2010 Nabong Campus Vientiane Lao People's Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vannaphone","family":"Phoutana","sequence":"additional","affiliation":[{"name":"The Faculty of Agriculture National University of Laos \u2010 Nabong Campus Vientiane Lao People's Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot","family":"Camoin","sequence":"additional","affiliation":[{"name":"Veterinarians without Borders\u2010Canada Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith M.","family":"H\u00fcbschen","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunity Luxembourg Institute of Health Esch\u2010sur\u2010Alzette Grand\u2010Duchy of Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antony P.","family":"Black","sequence":"additional","affiliation":[{"name":"Lao\u2010Lux\u2010Laboratory Institute Pasteur du Laos Vientiane Lao People's Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude P.","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunity Luxembourg Institute of Health Esch\u2010sur\u2010Alzette Grand\u2010Duchy of Luxembourg"},{"name":"Lao\u2010Lux\u2010Laboratory Institute Pasteur du Laos Vientiane Lao People's Democratic Republic"},{"name":"Laboratoire National de Sant\u00e9 Dudelange Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal J.","family":"Snoeck","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunity Luxembourg Institute of Health Esch\u2010sur\u2010Alzette Grand\u2010Duchy of Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6428-3140","authenticated-orcid":false,"given":"Maude","family":"Pauly","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunity Luxembourg Institute of Health Esch\u2010sur\u2010Alzette Grand\u2010Duchy of Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02737-9"},{"key":"e_1_2_9_3_1","unstructured":"Aragon T. 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