Epidemiology of hepatitis E in South-East Europe in the "One Health" concept

Table 1 Prevalence of hepatitis E in different population groups

Country	Population	Sample size	Method	anti-HEV	HEV RNA (%)/genotype (subtype)	Ref.
Albania	Refugees in Greece (pregnant women)	500	EIA	2%1	NT	Malamitsi-Puchner et al[16]
	Refugees in Greece (adult population)	350	EIA/IB	4.85%1	NT	Dalekos et al[17]
	General population	ND	ND	IgG 9.7%	NT	Adhami et al[18]
	Thalassemic children	ND	ND	IgG 0%	NT
	Patients with chronic liver disease	109	EIA	36.6%1	NT	Kondili et al[19]
	Patients with no apparent liver disease	190	EIA	12.1%1	NT
Bulgaria	Patients with symptoms of acute hepatitis	806	EIA	IgM/IgG 2.48%	NT	Baymakova et al[23]
	Hospitalized patients with clinical symptoms of hepatitis and outpatients with laboratory data of liver dysfunction	325	EIA	IgM 13.2%	NT	Stoykova et al25]
				IgG 20.9%	NT
	Patients with acute hepatitis E (IgM positive)	105	RT-PCR	NT	G3 98% (3e 62%; 3f 24%; 3c 13%); G1 2%	Bruni et al[26]
	Patients conducting ambulatory examination due to various reasons	741	EIA	IgM/IgG 1.48%		Teoharov et al[27]
				IgG 9.04%
Croatia	Patients with clinical symptoms of hepatitis negative for HAV/HBV/HCV	504	EIA/IB/RT-PCR	IgM/IgG 10.7%	IgM positive 35.7%	Đaković Rode et al[31]
	HIV-infected patients	88	EIA/IB	IgG 1.1%	NT
	Liver transplant recipients	242	EIA	IgG 24.5%	NT	Mrzljak et al[32]
	Alcohol abusers	56	EIA/IB	IgG 8.9%	NT	Vilibic-Cavlek et al[33]
	Patients with PTSD	35	EIA/IB	IgG 8.1%	NT
	Injecting drug users	49	EIA/IB	IgG 6.1%	NT
	Persons with risk sexual behaviour	37	EIA/IB	IgG 0%	NT
	Forest workers	37	EIA/IB	IgG 8.1%	NT	Jeličić et al[34]
	Healthcare workers	50	EIA/IB	IgG 2.0%	NT	Jeličić et al[34]
	Pregnant women	68	EIA/IB	IgG 2.9%	NT	Jeličić et al[35]
	Hunters	25	EIA/IB	IgG 4.0%	NT	Jeličić et al[35]
	General population	87	EIA/IB	IgG 3.4%	NT	Jeličić et al[34]
	Blood donors	1036	EIA/IB EIA	IgM 1.7% IgG 20.3%	NT	Miletic Lovric et al[36]
Greece	Transplant patients	76	RT-PCR	NT	1 positive/1.3% G3	Sinakos et al[45]
	Transfusion dependent thalassaemia	96	EIA	IgG 0%	0%	Klonizakis et al[44]
	Blood donors	1 200	EIA	IgG 2.9%	NT	Zervou et al[49]
	HIV patients	243	EIA	IgG 7.3%	NT	Politou et al[48]
	Blood donors (South Greece)	265	EIA	IgG 9.43	NT	Pittaras et al[47]
	Patients after open-heart surgery	204	EIA	IgG 5.4%	NT	Zervou et al[43]
	Patients on haemodialysis	351	EIA	IgG 4.8%	NT	Stefanidis et al[46]
	Non-A,-B hepatitis patients	198	EIA/RT-PCR	IgG 7.6% IgM 1%	1 positive	Psichogiou et al[42]
	Healthy controls	316	EIA/RT-PCR	IgM 0%/IgG 2.2%	NT
Epirus region	Healthy blood donors	2636	EIA/IB	IgG 0.23%	NT	Dalekos et al[17]
	Refugees from southern Albania	350	EIA/IB	IgG 4.85%	NT
	Children	165	EIA/IB	IgG 0%	NT
	Injecting drug users	65	EIA/IB	IgG 0%	NT
	Multiply transfused patients	62	EIA/IB	IgG 0%	NT
	Patients with chronic viral hepatitis	75	EIA/IB	IgG 5.30%	NT
	Chronic haemodialysis patients	149	EIA/IB	IgG 1.34%	NT
Agrinion area	Healthy blood donors	380	EIA/IB	IgG 0.53%	NT
	Chronic hemodialysis patients	62	EIA/IB	IgG 9.7%	NT
Kosovo	Kosovar refugees	104	EIA/RT-PCR	IgM 7.7%	0%	Rey et al[56]
Montenegro	Patients with acute viral hepatitis	400	EIA	IgM 6%	NT	Terzić et al[57]
Romania	Patients with hepatitis B or C	25	EIA	IgG 12%	NT	Anita et al[59]
	Students	40	EIA	IgG 12.5%	NT	Voiculescu et al[60]
	Doctors and nurses	93	EIA	IgG 13.98%	NT	Voiculescu et al[60]
	Persons undergoing routine hematological tests	148	EIA	IgG 14.86%	NT	Anita et al[61]
	General population	67	EIA	IgG 5.9%	NT	Savuta G et al[62]
Serbia	Blood donors	200	EIA RT-PCR	IgG 15%	0%	Petrović et al[66]
Slovenia	Acute/recent hepatitis E (IgM antibodies)	10	RT-PCR	NT	3/10 (G3e and G1)	Steyer et al[74]

¹Total anti-hepatitis E virus antibodies. HEV: Hepatitis E virus; EIA: Enzyme immunoassay; IB: Immunoblot; RT-PCR: Reverse-transcriptase polymerase chain reaction; NT: Not tested; ND: No data.

Table 2 Prevalence of hepatitis E in different animal species

Country	Population	Sample size	Method	anti-HEV	HEV RNA (%)/genotype (subtype)	Ref.
Bulgaria	Piglets	44	EIA	IgG 50%	NT	Pishmisheva et al[28]
	Fattening pigs	41	EIA	IgG 29.2%	NT
Croatia	Domestic pigs	848	RT-PCR	NT	24.5% (G3)	Prpić et al[40]
	Wild boars	536	RT-PCR	NT	12.3% (G3)
	Molluscs (mussels, oysters)	538	RT-PCR	NA	0%
	Cattle	32	RT-PCR	NT	0%
	Red fox	50	RT-PCR	NT	0%
	Deer	320	RT-PCR	NT	0%
	Muflons	12	RT-PCR	NT	0%
	Ferrets	8	RT-PCR	NT	0%
	Martens	10	RT-PCR	NT	0%
	Pigs (serum samples)	60	EIA/RT-PCR	IgG 91.7%	13.3% 8.1%	Lipej et al [39]
	Pigs (bile samples)	60	RT-PCR	NA	8.1%
	Pigs, domestic	1424	EIA/RT-PCR	IgG 32.94%	0%	Jemeršić et al[41]
	Wild boars	1000	EIA/RT-PCR	IgG 31.10%	11.33%
Greece	Mussels	51	RT-PCR	NT	0%	Diez-Valcarce et al55]
	Black rats/Norway rats	20	RT-PCR	NT	10%	Ryll et al[50]
Romania	Farm pigs	50	EIA/IB	IgG 50%	NT	Savuta et al[62]
	Backyard pigs	95	EIA/IB	IgG 38.94%
	Backyard pigs	112	EIA	IgG 49.27%	NT	Savuta et al[58]
	Pigs (2-4 mo) stool samples	19	RT-PCR	NT	31.58% (G3)	Anita et al[61]
	Wild boars	52	EIA	9.61%1	NT	Porea et al[63]
	Wild boars	68	EIA	IgG 10.29%	NT	Porea et al[63]
	Wild boars	50	RT-PCR	NT	18% (G3)	Porea et al[65]
Serbia	Farm pigs (pooled stool samples)	30	RT-PCR	NT	30%	Petrovic et al[67]
	Farm pigs (polled tissue samples)	20	RT-PCR	NT	45%
	Backyard pigs (pooled tissue samples)	15	RT-PCR	NT	0%
	Wild boars (pooled stool samples)	10	RT-PCR	NT	0%
	Backyard pigs	315	EIA	IgG 34.6%	NT	Lupulovic et al[68]
	Pigs (liver samples)	50	NT	NT	26%	Savic et al[69]
	Fattening pigs	95	NT	NT	7.37%	Petrović et al[71]
	Piglets (8 wk)	50	NT	NT	64%
	Pigs (blood samples)	55	EIA	IgG 54.54%	NT	Lupulovic et al[70]
	Pigs (meat juice samples)	55	EIA	IgG 20%	NT
Slovenia	Black rats/Norway rats	17/1	RT-PCR	NT	0%	Ryll et al[50]
	Domestic pigs	85	RT-PCR	NT	20.3%	Steyer et al[74]
	Suckling pigs (0-3 wk)	38	RT-PCR	NT	5.3%
	Weanling pigs (3-10 wk)	21	RT-PCR	NT	28.6%
	Fattening pigs (> 10 wk)	26	RT-PCR	NT	26.9%
	Wild boars	288	EIA/RT-PCR	30.21%1	0.35%	Žele et al[75]
	Pigs (stool samples)	811	RT-PCR	NT	5.4%	Raspor Lainšček et al[76]
	Pigs (bile samples)	811	RT-PCR	NT	4.9%
	Pigs (liver samples)	811	RT-PCR	NT	5.3% (G3a, 3b, 3c, 3e)

¹Total anti-hepatitis E virus antibodies. HEV: Hepatitis E virus; EIA: Enzyme immunoassay; IB: Immunoblot; RT-PCR: Reverse-transcriptase polymerase chain reaction; NT: Not tested; NA: Not applicable.

Table 3 Prevalence of hepatitis E virus RNA in different environmental samples

Country	Sample	Sample size	HEV RNA (%)/ genotype (subtype)	Ref.
Greece	Vegetable leafy greens	Pooled samples	4.76%1 3.2%1	Kokkinos et al[51]
	Sewage	48	0%	Kokkinos et al[54]
	Sewage	5	0%	Clemente-Casares et al[53]
Serbia	Vegetable leafy greens	Pooled samples	4.76%1 3.2%1	Kokkinos et al[51]
	Berry fruits	Pooled samples	2.5%1	Maunula et al[15]
	Surface waters	60	16.67%	Lazić et al[73]
	Urban sewage	6	0%
Slovenia	Waste water treatment plant	12	0%	Steyer et al[77]
	Swabs from the different site on the slaughter line	62	3.2% (G3)	Raspor Lainšček et al[76]
	Minced meat	22	0%
	Bratwurst	30	0%
	Surface water	60	3.3% (G3)	Steyer et al[74]

¹Pooled samples. HEV: Hepatitis E virus; EIA: Enzyme immunoassay; IB: Immunoblot; NT: Not tested.