{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:59:47Z","timestamp":1790740787033,"version":"4.1.0"},"reference-count":52,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2016,8,6]],"date-time":"2016-08-06T00:00:00Z","timestamp":1470441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>There have been large numbers of studies on anti-HEV IgG seroprevalence in Europe, however, the results of these studies have produced high variability of seroprevalence rates, making interpretation increasingly problematic. Therefore, the aim of this study was to develop a clearer understanding of anti-HEV IgG seroprevalence in Europe and identify risk groups for HEV exposure by a meta-analysis of published studies. Methods: All European HEV-seroprevalence studies from 2003 to 2015 were reviewed. Data were stratified by assay, geographical location, and patient cohort (general population, patients with HIV, solid-organ transplant recipients, chronic liver disease patients, and individuals in contact with swine\/wild animals). Data were pooled using a mixed-effects model. Results: Four hundred thirty-two studies were initially identified, of which 73 studies were included in the analysis. Seroprevalence estimates ranged from 0.6% to 52.5%, increased with age, but were unrelated to gender. General population seroprevalence varied depending on assays: Wantai (WT): 17%, Mikrogen (MG): 10%, MP-diagnostics (MP): 7%, DiaPro: 4%, Abbott 2%. The WT assay reported significantly higher seroprevalence rates across all cohorts (p &lt; 0.001). Individuals in contact with swine\/wild animals had significantly higher seroprevalence rates than the general population, irrespective of assay (p &lt; 0.0001). There was no difference between any other cohorts. The highest seroprevalence was observed in France (WT: 32%, MP: 16%) the lowest in Italy (WT: 7.5%, MP 0.9%). Seroprevalence varied between and within countries. The observed heterogeneity was attributed to geographical region (23%), assay employed (23%) and study cohort (7%). Conclusion: Seroprevalcence rates primarily depend on the seroassy that is used, followed by the geographical region and study cohort. Seroprevalence is higher in individuals exposed to swine and\/or wild animals, and increases with age.<\/jats:p>","DOI":"10.3390\/v8080211","type":"journal-article","created":{"date-parts":[[2016,8,8]],"date-time":"2016-08-08T10:14:38Z","timestamp":1470651278000},"page":"211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":217,"title":["Hepatitis E Seroprevalence in Europe: A Meta-Analysis"],"prefix":"10.3390","volume":"8","author":[{"given":"Johannes","family":"Hartl","sequence":"first","affiliation":[{"name":"First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Otto","sequence":"additional","affiliation":[{"name":"First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richie","family":"Madden","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glynn","family":"Webb","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Woolson","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levente","family":"Kriston","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eik","family":"Vettorazzi","sequence":"additional","affiliation":[{"name":"Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansgar","family":"Lohse","sequence":"additional","affiliation":[{"name":"First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Dalton","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Pischke","sequence":"additional","affiliation":[{"name":"First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany"},{"name":"Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2016,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1016\/S0140-6736(11)61849-7","article-title":"Hepatitis E","volume":"379","author":"Kamar","year":"2012","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1002\/hep.25505","article-title":"The global burden of hepatitis E virus genotypes 1 and 2 in 2005","volume":"55","author":"Rein","year":"2012","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S1473-3099(08)70255-X","article-title":"Hepatitis E: An emerging infection in developed countries","volume":"8","author":"Dalton","year":"2008","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s10096-008-0480-z","article-title":"Autochthonous hepatitis E in Southwest England: A comparison with hepatitis A","volume":"27","author":"Dalton","year":"2008","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1056\/NEJMoa0706992","article-title":"Hepatitis E virus and chronic hepatitis in organ-transplant recipients","volume":"358","author":"Kamar","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3128","DOI":"10.1111\/j.1600-6143.2012.04200.x","article-title":"Chronic hepatitis e in heart transplant recipients","volume":"12","author":"Pischke","year":"2012","journal-title":"Am. J. Transplant."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/tid.12183","article-title":"Course and treatment of chronic hepatitis E virus infection in lung transplant recipients","volume":"16","author":"Pischke","year":"2014","journal-title":"Transpl. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jcv.2010.06.016","article-title":"Hepatitis E virus excretion can be prolonged in patients with hematological malignancies","volume":"49","author":"Tavitian","year":"2010","journal-title":"J. Clin. Virol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1056\/NEJMc0903778","article-title":"Persistent carriage of hepatitis E virus in patients with HIV infection","volume":"361","author":"Dalton","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/apt.13309","article-title":"Hepatitis E virus in patients with decompensated chronic liver disease: A prospective UK\/French study","volume":"42","author":"Madden","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.3201\/eid1511.091094","article-title":"Incident Investigation Team. Hepatitis E outbreak on cruise ship","volume":"15","author":"Said","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1086\/591971","article-title":"The mystery of hepatitis E seroprevalence in developed countries: Is there subclinical infection due to hepatitis E virus?","volume":"47","author":"Shata","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1016\/S0140-6736(14)61034-5","article-title":"Hepatitis E virus in blood components: A prevalence and transmission study in southeast England","volume":"384","author":"Hewitt","year":"2014","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1002\/hep.27611","article-title":"No artifact, hepatitis E is emerging","volume":"62","author":"Zaaijer","year":"2015","journal-title":"Hepatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"851","DOI":"10.7326\/L15-0502","article-title":"Transmission of Hepatitis E Virus by Plasma Exchange: A Case Report","volume":"164","author":"Mallet","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1128\/JCM.01119-12","article-title":"Novel approach for detection of hepatitis E virus infection in German blood donors","volume":"50","author":"Vollmer","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1002\/lt.21958","article-title":"Hepatitis E virus infection as a cause of graft hepatitis in liver transplant recipients","volume":"16","author":"Pischke","year":"2010","journal-title":"Liver Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.3201\/eid1712.110371","article-title":"Hepatitis E virus antibodies in blood donors, France","volume":"17","author":"Mansuy","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jclinepi.2009.06.005","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"62","author":"Moher","year":"2009","journal-title":"J. Clin. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1136\/jech-2013-203104","article-title":"Meta-analysis of prevalence","volume":"67","author":"Barendregt","year":"2013","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting Meta-Analyses in R with The metafor Package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2807\/1560-7917.ES2015.20.19.21127","article-title":"Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011","volume":"20","author":"Mansuy","year":"2015","journal-title":"Euro Surveill."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1097\/QAD.0b013e32833a29ab","article-title":"Hepatitis E virus in HIV-infected patients","volume":"24","author":"Renou","year":"2010","journal-title":"Aids"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/vox.12056","article-title":"Hepatitis E virus in Scottish blood donors","volume":"105","author":"Cleland","year":"2013","journal-title":"Vox Sang."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1002\/hep.27244","article-title":"Decline in hepatitis E virus antibody prevalence in southeastern Germany, 1996\u20132011","volume":"60","author":"Wenzel","year":"2014","journal-title":"Hepatology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1055\/s-0034-1399236","article-title":"Comparison of autochthonous and imported cases of hepatitis A or hepatitis E","volume":"53","author":"Hartl","year":"2015","journal-title":"Z. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jcv.2012.09.010","article-title":"Discrepancy between anti-hepatitis E virus immunoglobulin G prevalence assessed by two assays in kidney and liver transplant recipients","volume":"56","author":"Moal","year":"2013","journal-title":"J. Clin. Virol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1093\/infdis\/jis688","article-title":"Test performance characteristics of Anti-HEV IgG assays strongly influence hepatitis E seroprevalence estimates","volume":"207","author":"Wenzel","year":"2013","journal-title":"J. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Schnegg, A., B\u00fcrgisser, P., Andr\u00e9, C., Kenfak-Foguena, A., Canellini, G., Moradpour, D., Abravanel, F., Izopet, J., Cavassini, M., and Darling, K.E. (2013). An Analysis of the Benefit of Using HEV Genotype 3 Antigens in Detecting Anti-HEV IgG in a European Population. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0062980"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"714","DOI":"10.4269\/ajtmh.15-0159","article-title":"Two Generations of \u201dGold Standards\u201d: The Impact of a Decade in Hepatitis E Virus Testing Innovation on Population Seroprevalence","volume":"93","author":"Kmush","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1002\/jmv.21656","article-title":"A comparison of two commercially available anti-HEV IgG kits and a re-evaluation of anti-HEV IgG seroprevalence data in developed countries","volume":"82","author":"Bendall","year":"2010","journal-title":"J. Med. Virol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.3201\/eid2006.130562","article-title":"Hepatitis E virus infection, Papua New Guinea, Fiji, and Kiribati, 2003\u20132005","volume":"20","author":"Halliday","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1111\/j.1440-1746.2007.04894.x","article-title":"Hepatitis E in new zealand","volume":"22","author":"Dalton","year":"2007","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/j.1423-0410.2011.01583.x","article-title":"Occurrence of hepatitis E virus RNA in plasma donations from Sweden, Germany and the United States","volume":"103","author":"Baylis","year":"2012","journal-title":"Vox Sang."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"20550","DOI":"10.2807\/1560-7917.ES2013.18.31.20550","article-title":"Silent hepatitis E virus infection in Dutch blood donors, 2011 to 2012","volume":"18","author":"Slot","year":"2013","journal-title":"Euro Surveill."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/j.1423-0410.2011.01554.x","article-title":"Detection of hepatitis E virus RNA in plasma mini-pools from blood donors in England","volume":"102","author":"Ijaz","year":"2012","journal-title":"Vox Sang."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/j.1423-0410.2010.01412.x","article-title":"Is there evidence of recent hepatitis E virus infection in English and North Welsh blood donors?","volume":"100","author":"Beale","year":"2011","journal-title":"Vox Sang."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Fischer, C., Hofmann, M., Danzer, M., Hofer, K., Kaar, J., and Gabriel, C. (2015). Seroprevalence and Incidence of hepatitis E in Blood Donors in Upper Austria. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0119576"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.3201\/eid2011.140891","article-title":"Frequent hepatitis E virus contamination in food containing raw pork liver, France","volume":"20","author":"Pavio","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.3201\/eid2011.140791","article-title":"Foodborne transmission of hepatitis E virus from raw pork liver sausage, France","volume":"20","author":"Renou","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_43","unstructured":"Swissinfo.ch Meat Consumption Hits Ten Years High 2011. Available online:http:\/\/www.swissinfo.ch\/eng\/meat-consumption-hits-ten-year-high\/29935790."},{"key":"ref_44","unstructured":"European Commission, Eurostat, Pig Farmer sector, 2014. Available online:http:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php\/Pig_farmer_sector_-_statistica_portrait_2014."},{"key":"ref_45","unstructured":"World Population Data Sheet. Available online: http:\/\/www.prb.org\/pdf13\/2013-population-data-sheet_eng.pdf."},{"key":"ref_46","unstructured":"About the Agriculture and Horticulture Development Board\u2014AHDB 2015. Available online:http:\/\/pork.adhb.org.uk\/prices-stats\/consumption\/total-eu-consumption."},{"key":"ref_47","first-page":"323","article-title":"Coastal clustering of HEV; Cornwall, UK","volume":"28","author":"Hunter","year":"2015","journal-title":"EJGH"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1056\/NEJMra1204512","article-title":"Hepatitis E","volume":"367","author":"Hoofnagle","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1086\/591970","article-title":"Time trend of the prevalence of hepatitis E antibodies among farmers and blood donors: A potential zoonosis in Denmark","volume":"47","author":"Christensen","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1111\/trf.13028","article-title":"Declining prevalence of hepatitis E antibodies among Danish blood donors","volume":"55","author":"Holm","year":"2015","journal-title":"Transfusion"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1055\/s-0031-1273394","article-title":"Hepatitis E: An emerging infectious disease in Germany?","volume":"49","author":"Pischke","year":"2011","journal-title":"Z. Gastroenterol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"3092","DOI":"10.1111\/trf.12733","article-title":"Past and present of hepatitis E in The Netherlands","volume":"54","author":"Hogema","year":"2014","journal-title":"Transfusion"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/8\/8\/211\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:27:54Z","timestamp":1760210874000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/8\/8\/211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8,6]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2016,8]]}},"alternative-id":["v8080211"],"URL":"https:\/\/doi.org\/10.3390\/v8080211","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8,6]]}}}