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Performance of Hepatitis E Virus (HEV)-antibody tests: a comparative analysis based on samples from individuals with direct contact to domestic pigs or wild boar in Germany

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Abstract

In Europe, Hepatitis E virus (HEV) genotype 3 causes most human infections, and domestic pigs and wild boar represent the main reservoirs. Contact to these animals represents one source of human infection. However, interpretation of studies is challenged in the absence of a serological gold standard. Hence, this study compared results of different HEV immunoassays. Plasma samples from 139 individuals who had professional contact to pigs (veterinarians, meat inspectors, slaughterhouse workers; n = 114) or hunted regularly (n = 25) were tested with assays specific for HEV IgG, HEV IgM, HEV IgA, and total HEV immunoglobulin as well as for viral RNA. Furthermore, overall HEV IgG was defined (i.e., two of three IgG assays reveal the same result) to compare serological findings. Borderline results were always quoted as positive. For IgG, apparent prevalence was higher in Wantai (48.2%) compared to Euroimmun (11.5%) and Mikrogen assays (17.3%) (p = 0.0001). The overall IgG prevalence was estimated to be 18.7%. For total Ig, Wantai (40.3%) also yielded higher prevalence than Euroimmun (15.8%) (p = 0.0001). The HEV IgM prevalence ranged from 0% (Euroimmun) to 4.3% (Mikrogen). Four percent of individuals tested IgA positive, whilst none harboured HEV RNA. Our results support previous studies that the higher IgG prevalence estimated with the Wantai assay result from a higher sensitivity of this test. However, further studies are needed to verify specificity given the challenge of defining true negative samples. The high percentage of individuals with HEV IgG observed in this study underlines that direct contact to pigs represents a risk factor for HEV infection.

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Acknowledgements

The authors would like to thank all individuals for participation in our study. In particular, the support by Jörg Altemeier (Tönnis-Lebensmittel GmbH & Co. KG, Rheda-Wiedenbrück), Peter Kremer (Samtgemeinde Sögel), Dr. Simone Schöning (Kreisverwaltung Gütersloh, Veterinärwesen und Lebensmittelüberwachung), and Hagen Wirth (Berufsgenossenschaft Nahrungsmittel und Gastgewerbe) is acknowledged. Moreover, the authors would cordially thank the physicians Dr. Andreas Dammann, Dr. Andreas Gernhold, Ludger Senker, Lutz Stiebel, and Dr. Klaus Burghard for collecting the plasma samples. Furthermore, authors are indebted to Mikrogen GmbH, Euroimmun AG and Altona Diagnostics GmbH for free delivery of test kits. Representatives of Mikrogen and Euroimmun read the manuscript draft before submission but had no influence on testing of samples, test results, and wording of the manuscript.

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  1. Institut für Infektionsmedizin, Christian-Albrechts-Universität zu Kiel und Universitätsklinikum Schleswig-Holstein, Brunswiker Straße 4, 24105, Kiel, Germany

    Frauke Mara Sommerkorn, Helmut Fickenscher & Andi Krumbholz

  2. Institut für Community Medicine, Universitätsmedizin Greifswald, Walther-Rathenau-Straße 48, 17475, Greifswald, Germany

    Birgit Schauer

  3. Lehrstuhl für Marketing and Customer Insight, Universität Hamburg, Welckerstraße 8, 20354, Hamburg, Germany

    Thomas Schreiner

  4. Labor Dr. Krause and Kollegen MVZ GmbH, Steenbeker Weg 23, 24106, Kiel, Germany

    Andi Krumbholz

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Sommerkorn, F.M., Schauer, B., Schreiner, T. et al. Performance of Hepatitis E Virus (HEV)-antibody tests: a comparative analysis based on samples from individuals with direct contact to domestic pigs or wild boar in Germany. Med Microbiol Immunol 206, 277–286 (2017). https://doi.org/10.1007/s00430-017-0503-4

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