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The study protocol and data utilization were reviewed and approved by the Human Research Ethics Committee of Ethical Review Board of Shanghai Municipal Center for Disease Control and Prevention. This study comprised two components with distinct consent procedures. For the notified hepatitis E case data, we used existing, routinely collected surveillance data from the National Notifiable Infectious Disease Reporting System. All data were anonymized prior to analysis, and no additional data collection was conducted; therefore, informed consent was waived by the ethics committee for this component. For the community-based serological surveys (conducted in 2001, 2004, 2012, 2014, 2018, and 2024), written informed consent was obtained from all adult participants prior to blood collection. For participants under 18 years of age, written informed consent was obtained from their parents or legal guardians. For the early surveys in 2001 and 2004, verbally informed consent was obtained and documented according to the practices of that time, which was approved by the ethics committee. All participants were informed of the study purpose, procedures, potential risks, and their right to withdraw at any time. All data were kept confidential and de-identified prior to analysis.","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1821"}}