Original Article

Hepatitis E Virus Prevalence and Associated Risk Factors in High-Risk Groups: A Cross-Sectional Study

Volume 33 · Issue 7 Publish Date: July 15, 2022
Hatice Yasemin Balaban Abdullah Tarık Aslan Fatma Nur Akdoğan-Kittana Alpaslan Alp Osman Dağ Şefika Nur Ayar Cavanşir Vahabov Cem Şimşek Tolga Yıldırım Hakan Göker Koray Ergünay Yunus Erdem Yahya Büyükaşık Halis Şimşek
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Published In

Turkish Journal of Gastroenterology

Volume 33 · Issue 7

Pages: 615-624

History

Published Online: July 15, 2022

Copyright © 2022 Hatice Yasemin Balaban, Abdullah Tarık Aslan, Fatma Nur Akdoğan-Kittana, Alpaslan Alp, Osman Dağ, Şefika Nur Ayar, Cavanşir Vahabov, Cem Şimşek, Tolga Yıldırım, Hakan Göker, Koray Ergünay, Yunus Erdem, Yahya Büyükaşık, Halis Şimşek

Hatice Yasemin Balaban
Internal Medicine Department, Gastroenterology, Hacettepe University, Medical Faculty
Abdullah Tarık Aslan
Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Fatma Nur Akdoğan-Kittana
Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Alpaslan Alp
Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Osman Dağ
Biostatistics Department, Hacettepe University, Medical Faculty
Şefika Nur Ayar
Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Cavanşir Vahabov
Internal Medicine Department, Gastroenterology, Hacettepe University, Medical Faculty
Cem Şimşek
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Tolga Yıldırım
Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Hakan Göker
Division of Hematology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Koray Ergünay
Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Yunus Erdem
Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Yahya Büyükaşık
Department of Internal Medicine, Hematology and Pathology, Hacettepe University School of Medicine, Ankara
Halis Şimşek
Department of Gastroenterology Hacettepe University Faculty of Medicine, Ankara, Turkey
Balaban, H. Y., Aslan, A. T., Akdoğan-Kittana, F. N., Alp, A., Dağ, O., Ayar, Şefika N., … Şimşek, H. (2022). Hepatitis E Virus Prevalence and Associated Risk Factors in High-Risk Groups: A Cross-Sectional Study. Turkish Journal of Gastroenterology, 33(7), 615–624. https://doi.org/10.5152/tjg.2022.21493
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Abstract

Background: Seroepidemiology, risk factors to hepatitis E virus exposure, and prevalence of hepatitis E virus viremia have not yet been investigated among patients under immunosuppression or with liver disease that are high risk for infection in Turkey. Methods: In this cross-sectional study, 292 consecutive serum samples from renal transplant recipients, allogeneic hematopoietic stem cell transplant recipients, patients with acute hepatitis, and patients with chronic hepatitis C were prospectively collected in a ter- tiary university hospital. Sera were tested for hepatitis E virus immunoglobulin G/immunoglobulin M and hepatitis E virus ribonucleic acid using commercial enzyme-linked immunosorbent assay and in-house nested polymerase chain reaction with Sanger sequencing, respectively. Sociodemographic, clinical, laboratory data, and risk factors were collected using a questionnaire and hospital database. Multiple logistic regression analysis was employed to identify independent predictors for anti-hepatitis E virus seropositivity. Results: Among all patients, only 2 patients (1 renal transplant recipient and 1 patient with acute hepatitis) were identified as having hepatitis E virus genotype 3 viremia. Hepatitis E virus viremia rate was 0.6% in whole group. These patients showed no signs of chronic hepatitis E virus infection for 6 months and were spontaneously seroconverted 6 months after enrollment. Anti-hepatitis E virus IgG was positive in 29 patients yielding a hepatitis E virus seroprevalence of 9.9%. Older age (adjusted odds ratio: 1.03, 95% CI, 1.00-1.06; P = .022) and eating undercooked meat (adjusted odds ratio: 3.11, 95% CI, 1.08-8.92; P = .034) were independent risk factors to anti- hepatitis E virus seropositivity in all patients. Similarly, multiple logistic regression analysis demonstrated that age (adjusted odds ratio: 1.03, 95% CI, 0.99-1.07, P = .058) and eating undercooked meat (adjusted odds ratio: 5.77, 95% CI, 1.49-22.25, P = .011) were indepen- dent risk factors for anti-hepatitis E virus IgG positivity in the liver disease subgroup consisting of acute hepatitis and chronic hepatitis C patients. Conclusion: The hepatitis E virus seroprevalence rate was high (9.9%), despite low viremia rate (0.6%) in high-risk patients. The emer- gence of hepatitis E virus genotype 3 might indicate a serious problem for these patients. Future investigations are needed to elucidate foodborne transmission routes of hepatitis E virus in Turkey. Cite this article as: Balaban HY, Aslan AT, Akdoğan-Kittana FN, et al. Hepatitis E virus prevalence and associated risk factors in high-risk groups: A cross-sectional study. Turk J Gastroenterol. 2022;33(7):615-624.

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Article Info
Published In
Journal Turkish Journal of Gastroenterology
Volume / Issue Volume 33 · Issue 7
Pages 615-624
DOI 10.5152/tjg.2022.21493
History
Published Online July 15, 2022
Copyright
Copyright (c) 2022 Hatice Yasemin Balaban, Abdullah Tarık Aslan, Fatma Nur Akdoğan-Kittana, Alpaslan Alp, Osman Dağ, Şefika Nur Ayar, Cavanşir Vahabov, Cem Şimşek, Tolga Yıldırım, Hakan Göker, Koray Ergünay, Yunus Erdem, Yahya Büyükaşık, Halis Şimşek
Affiliations
Hatice Yasemin Balaban
Internal Medicine Department, Gastroenterology, Hacettepe University, Medical Faculty
Abdullah Tarık Aslan
Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Fatma Nur Akdoğan-Kittana
Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Alpaslan Alp
Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Osman Dağ
Biostatistics Department, Hacettepe University, Medical Faculty
Şefika Nur Ayar
Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Cavanşir Vahabov
Internal Medicine Department, Gastroenterology, Hacettepe University, Medical Faculty
Cem Şimşek
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Tolga Yıldırım
Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Hakan Göker
Division of Hematology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Koray Ergünay
Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Yunus Erdem
Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey
Yahya Büyükaşık
Department of Internal Medicine, Hematology and Pathology, Hacettepe University School of Medicine, Ankara
Halis Şimşek
Department of Gastroenterology Hacettepe University Faculty of Medicine, Ankara, Turkey
Cite this Article
Balaban, H. Y., Aslan, A. T., Akdoğan-Kittana, F. N., Alp, A., Dağ, O., Ayar, Şefika N., … Şimşek, H. (2022). Hepatitis E Virus Prevalence and Associated Risk Factors in High-Risk Groups: A Cross-Sectional Study. Turkish Journal of Gastroenterology, 33(7), 615–624. https://doi.org/10.5152/tjg.2022.21493
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