Hepatitis E virus seroprevalence and determinants in various study populations in the Netherlands

PLoS One. 2018 Dec 17;13(12):e0208522. doi: 10.1371/journal.pone.0208522. eCollection 2018.


Background: The epidemiology of hepatitis E virus (HEV) is not fully understood. In this study, we assessed putative risk factors for HEV seropositivity in various study populations in the Netherlands.

Methods: Data and samples from five different study populations were analysed: (A) blood donors (n = 5,239), (B) adults reporting a vegetarian life style since the age of 12 years (n = 231), (C) residents of Amsterdam, the Netherlands, with different ethnic backgrounds (n = 1,198), (D) men who have sex with men (MSM) (HIV positive and HIV negative) (n = 197), and (E) persons who use drugs (PWUD) (HIV positive and HIV negative) (n = 200). Anti-HEV immunoglobulin M (IgM) and immunoglobulin G (IgG) testing was performed using ELISA test (Wantai).

Results: HEV IgM seroprevalence was low across all study populations (<1% to 8%). The age and gender-adjusted HEV IgG seroprevalence was 24% among blood donors (reference group) and 9% among the vegetarian group (adjusted Relative Risk [aRR]:0.36, 95%CI:0.23-0.57). Among participants of different ethnic backgrounds, the adjusted HEV IgG seroprevalence was 16% among participants with a Dutch origin (aRR:0.64, 95%CI:0.40-1.02), 2% among South-Asian Surinamese (aRR:0.07, 95%CI:0.02-0.29), 3% among African Surinamese (aRR:0.11, 95%CI:0.04-0.34), 34% among Ghanaian (aRR:1.53, 95%CI:1.15-2.03), 19% among Moroccan (aRR:0.75, 95%CI:0.49-1.14), and 5% among Turkish (aRR:0.18, 95%CI:0.08-0.44) origin participants. First generation Moroccans had a higher risk for being IgG HEV seropositive compared to second generation Moroccan migrants. The statistical power to perform these analyses in the other ethnic groups was too low. In the MSM group the IgG HEV seroprevalence was 24% (aRR:0.99, 95%CI:0.76-1.29), and among PWUD it was 28% (aRR:1.19, 95%CI:0.90-1.58). The number of sexual partners in the preceding six months was not significantly associated with IgG HEV seropositivity in MSM. The association between HIV status and HEV seropositivity was significant in PWUD, yet absent in MSM. HIV viral load and CD4 cell count were not associated with HEV seropositivity in HIV positive MSM and PWUD.

Conclusions: Vegetarians were significantly less often HEV seropositive. Ethnic origin influenced the risk for being IgG HEV seropositive. MSM and PWUD were not at higher risk for being IgG HEV seropositive than blood donors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Donors
  • Emigrants and Immigrants
  • Female
  • Hepatitis Antibodies / blood
  • Hepatitis E / diagnosis
  • Hepatitis E / epidemiology*
  • Hepatitis E / virology
  • Hepatitis E virus / immunology*
  • Homosexuality, Male
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin M / blood
  • Life Style
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Risk
  • Seroepidemiologic Studies
  • Substance-Related Disorders / pathology
  • Vegetarians


  • Hepatitis Antibodies
  • Immunoglobulin G
  • Immunoglobulin M