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Therefore, the characterization of major potential sources of human HEV exposure is important to inform risk assessment and public health policy. A systematic review was conducted, including a comprehensive search in six electronic bibliographic databases, verified by hand\u2010searching reference lists of HEV reviews, and a grey literature search, of the broad research question \u2018what is the evidence of the association between predictors of human HEV exposure, and HEV IgG seropositivity, in non\u2010endemic countries?\u2019 Using forms designed a priori, captured studies were appraised at first\u2010level screening, second\u2010level characterization, and third\u2010level data extraction and risk of bias assessment. Meta\u2010analysis yielded summary estimates of association between potential predictors and odds of HEV seropositivity. Meta\u2010analysis and meta\u2010regression of the odds of HEV seroprevalence in specific groups characterized potential sources of HEV exposure. From 4,163 captured citations, 245 relevant studies underwent data extraction, investigating HEV seroprevalence or predictors in both healthy subjects and targeted patient groups. Across these groups, increasing age was a predictor of HEV IgG seropositivity. Both human immunodeficiency virus patients and haemodialysis patients had significantly increased odds of HEV seropositivity relative to the general population. Working with pigs, in forestry, or in hospitals, was significantly associated with increased odds of HEV seropositivity, as were consumption of meat, pork or game meat, or hunting. Chronological time was not associated with HEV seropositivity within our data sets. Further study of the distribution of potential dietary or behavioural predictors between high and lower prevalence areas within non\u2010endemic countries could improve our understanding of the relative importance of specific HEV transmission pathways.<\/jats:p>","DOI":"10.1111\/zph.12698","type":"journal-article","created":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T18:27:37Z","timestamp":1584728857000},"page":"391-406","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A systematic review and meta\u2010analysis of predictors of human hepatitis E virus exposure in non\u2010endemic countries"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4289-1353","authenticated-orcid":false,"given":"Barbara","family":"Wilhelm","sequence":"first","affiliation":[{"name":"Big Sky Health Analytics Vermilion AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Waddell","sequence":"additional","affiliation":[{"name":"Public Health Risk Sciences Division National Microbiology Laboratory Public Health Agency of Canada Guelph ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judy","family":"Greig","sequence":"additional","affiliation":[{"name":"Public Health Risk Sciences Division National Microbiology Laboratory Public Health Agency of Canada Guelph ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Young","sequence":"additional","affiliation":[{"name":"School of Occupational and Public Health Ryerson University Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,3,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2016.06.010"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2013-203104"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2307\/2533446"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470743386"},{"key":"e_1_2_9_6_1","volume-title":"Donor questionnaire","author":"Canadian Blood Services","year":"2019"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/v10060285"},{"key":"e_1_2_9_8_1","volume-title":"HIV in the United States and dependent areas","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1086\/655898"},{"key":"e_1_2_9_10_1","volume-title":"The epidemiology of HIV in Canada","author":"Community AIDS Treatment Information Exchange (CATIE)","year":"2018"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1904.121792"},{"key":"e_1_2_9_12_1","first-page":"2015","volume-title":"R for dummies","author":"Vries A.","year":"2015"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1386-6346(03)00233-X"},{"key":"e_1_2_9_14_1","volume-title":"Veterinary epidemiologic research","author":"Dohoo I.","year":"2009"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0006-341X.2000.00455.x"},{"key":"e_1_2_9_16_1","first-page":"4886","article-title":"Scientific Opinion on the public health risks associated with hepatitis E virus (HEV) as a food\u2010borne pathogen","volume":"15","author":"EFSA BIOHAZ Panel (EFSA Panel on Biological Hazards)","year":"2017","journal-title":"European Food Safety Authority (EFSA) Journal"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_9_18_1","volume-title":"OR2RR","author":"EpiGear","year":"2017"},{"key":"e_1_2_9_19_1","volume-title":"Hepatitis E in the EU\/EEA, 2005\u20132015","author":"European Centre for Disease Prevention and Control (ECDC)","year":"2017"},{"issue":"19","key":"e_1_2_9_20_1","first-page":"1","article-title":"Case\u2010control study on risk factors for acute hepatitis E in Germany, 2012 to 2014","volume":"23","author":"Faber M.","year":"2018","journal-title":"Euro Surveillance"},{"key":"e_1_2_9_21_1","volume-title":"Package \u2018robumeta\u2019","author":"Fisher Z.","year":"2017"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1214\/aoms\/1177729756"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.14285"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2012.01.028"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.23463"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61034-5"},{"key":"e_1_2_9_27_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions. 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