{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:08:59Z","timestamp":1767179339977,"version":"build-2238731810"},"update-to":[{"DOI":"10.1371\/journal.pntd.0012746","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T00:00:00Z","timestamp":1736208000000}}],"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-039469"],"award-info":[{"award-number":["INV-039469"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Global Disease Eradication Fund","award":["2020-2025"],"award-info":[{"award-number":["2020-2025"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatitis E virus (HEV) causes acute jaundice and poses an important public health problem in low- and middle-income countries. Limited surveillance capacity and suboptimal access to diagnostics leads to under-reporting of HEV infections in affected countries, including Nepal. Serum antibodies against HEV are indicative of past infection. We analyzed existing samples from a nationally representative serosurvey to describe the geospatial distribution and factors associated with HEV seroprevalence in Nepal, as a proxy for infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology\/Principle findings<\/jats:title>\n                    <jats:p>A nationally representative cross-sectional serosurvey of 3,922 individuals \u22652 years old from 975 households spread across 65 wards throughout Nepal was conducted between November 2021 and January 2022. Bio-banked samples were tested for anti-HEV IgG. Seroprevalence and its 95% confidence interval were estimated by age, sex, ecological region, municipality type, and other waterborne-disease related risk factors. Bayesian geostatistical models were fitted to observed seroprevalence data and used to generate high-resolution maps of seroprevalence across Nepal. Available samples from 3,707 participants were tested for anti-HEV IgG, and 3,703 were used for final analysis. We found 20.8% (95% CI: 19.5\u201322.2) of participants had evidence of prior HEV infection. HEV seroprevalence increased with age, and was higher in males (23.5%, 95% CI: 21.5\u201325.5) than in females (18.6%, 95% CI: 16.9\u201320.3). Seroprevalence in hilly (28.9%, 95% CI: 26.6\u201331.2) and mountain (24.6%, 95% CI: 18.8\u201330.5) regions were significantly higher than in terai (14.2%, 95% CI: 12.7\u201315.8). While there was no significant difference between urban and rural populations, the predicted seroprevalence was highest in Kathmandu, the capital of Nepal, reaching seroprevalence of 50% in some selected area. No statistically significant differences were found for wealth quintile, water source, and toilet facility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides population-based serologic evidence that HEV is endemic in Nepal, with the greatest risk of infection in Kathmandu.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0012746","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T13:47:52Z","timestamp":1734961672000},"page":"e0012746","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-7302","authenticated-orcid":true,"given":"Chulwoo","family":"Rhee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Dighe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nishan","family":"Katuwal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haeun","family":"Cho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramzi","family":"Mraidi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dipesh","family":"Tamrakar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline KyungAh","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nimesh","family":"Poudyal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Il-Yeon","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deok Ryun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritu","family":"Amatya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew S.","family":"Azman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Lynch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"issue":"1","key":"pntd.0012746.ref001","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1055\/s-0033-1338111","article-title":"Epidemiology of hepatitis E in low- and middle-income countries of Asia and Africa","volume":"33","author":"B Kmush","year":"2013","journal-title":"Semin Liver Dis"},{"key":"pntd.0012746.ref002","article-title":"Hepatitis E.","author":"World Health Organization"},{"issue":"4","key":"pntd.0012746.ref003","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S2468-1253(16)30152-2","article-title":"Hepatitis E: a neglected virus","volume":"1","author":"The Lancet Gastroenterology Hepatology","year":"2016","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"7","key":"pntd.0012746.ref004","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1111\/liv.14468","article-title":"The global epidemiology of hepatitis E virus infection: A systematic review and meta-analysis","volume":"40","author":"Pengfei Li","year":"2020","journal-title":"Liver Int"},{"issue":"4","key":"pntd.0012746.ref005","first-page":"530","article-title":"Hepatitis E in Nepal.","volume":"4","author":"SM Shrestha","year":"2006","journal-title":"Kathmandu Univ Med J (KUMJ)."},{"issue":"1","key":"pntd.0012746.ref006","first-page":"40","article-title":"Epidemiology of Viral Hepatitis and Liver Diseases in Nepal.","volume":"5","author":"A. 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