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Seroprevalence of hepatitis E virus (HEV) in humans living in high pig density areas of Germany

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Abstract

An increase in acute autochthonous hepatitis E virus (HEV) infections has been recorded in Germany. These are suspected to be zoonotically transmitted from wild boar, deer and domestic pig. The latter may represent a major reservoir for HEV. In this study, 537 sera from humans living in Westphalia and Lower Saxony, representing areas of high pig density in Germany, were tested for the presence of HEV-specific antibodies. Among them were 302 individuals with occupational, direct contact to pigs and 235 individuals without direct contact to pigs. Two commercial tests and one in-house assay were applied for the detection of HEV-specific immunoglobulin G (IgG) antibodies. Sera were also tested in an assay that detects all classes of HEV-specific antibodies. Depending on the test used, the seroprevalence ranged from 4.1 to 27.9 %. Exposition to pigs was found to be associated with a significantly higher seroprevalence in subjects with contact to pigs (13.2–32.8 %) compared with that in non-exposed humans (7.7–21.7 %). In particular, individuals younger than 40 years with occupational exposure exhibited a markedly higher HEV seroprevalence compared with non-exposed individuals of that age group. In general, HEV seroprevalence increased with age resulting in a similar prevalence level in the age group of ≥50 years for exposed and non-exposed individuals. Analysis of all sera by a commercial anti-HEV IgM ELISA revealed 35 positive and 25 borderline samples. However, only one positive serum could be confirmed by an IgM line assay. Selected samples from IgM and/or IgG as well as total HEV antibody-positive individuals were also tested for the presence of HEV RNA. In one of the 78 samples, the only IgM ELISA positive and IgM line assay confirmed sample, RNA of HEV genotype 3 was detected. This sequence has high similarity to HEV sequences obtained from wild boars and domestic pigs from Germany and The Netherlands. This study demonstrates that in addition to the consumption of raw or undercooked meat, direct contact to pigs has to be considered as an additional risk factor for HEV infection.

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Acknowledgments

Mikrogen GmbH and Diasorin S.p.A. have supported this study by free delivery of assays A and B. The authors would like to thank all members of the German Red Cross Blood Donation Centres, Münster and Springe for excellent cooperation as well as all subjects for delivery of blood samples. The authors are indebted to Martina Müller, Christa Rothmann, Dörte Kaufmann and Ute Polster-Brylla for their technical assistance. The support of Silvia Dorn and Michael Dawideit is also cordially acknowledged. This study was supported by a grant of the Foundation of the Paul-Ehrlich-Society for Chemotherapy awarded to A.K.

Conflict of interest

Mikrogen and Diasorin had no influence on testing of samples and interpretation of data as well as on writing of the manuscript. Results of this study have been presented at meetings of the Society of Virology and of the German Research Platform for Zoonoses.

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Authors and Affiliations

  1. Institute for Infection Medicine, Christian Albrecht University of Kiel and University Medical Center Schleswig-Holstein, Campus Kiel, Brunswiker Strasse 4, 24105, Kiel, Germany

    Andi Krumbholz

  2. Department of Virology and Antiviral Therapy, Jena University Hospital, Friedrich Schiller University Jena, 07740, Jena, Germany

    Andi Krumbholz, Sebastian Joel, Anne Neubert, Jeannette Lange, Peter Wutzler, Andreas Sauerbrei & Roland Zell

  3. Institute for Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493, Greifswald-Insel Riems, Germany

    Paul Dremsek & Rainer G. Ulrich

  4. Federal Institute for Risk Assessment, 10589, Berlin, Germany

    Reimar Johne

  5. IDT Biologika GmbH, 06861, Dessau Rosslau, Germany

    Ralf Dürrwald

  6. Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Friedrich Schiller University Jena, 07740, Jena, Germany

    Mario Walther

  7. German Red Cross Blood Donation Service NSTOB, 31830, Springe, Germany

    Thomas H. Müller

  8. Center for Transfusion Medicine, German Red Cross Blood Donation Service West, 48151, Münster, Germany

    Detlef Kühnel

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  1. Andi Krumbholz
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Correspondence to Andi Krumbholz.

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Andi Krumbholz and Sebastian Joel have contributed equally to this study.

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Krumbholz, A., Joel, S., Dremsek, P. et al. Seroprevalence of hepatitis E virus (HEV) in humans living in high pig density areas of Germany. Med Microbiol Immunol 203, 273–282 (2014). https://doi.org/10.1007/s00430-014-0336-3

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