Hepatitis E Seroprevalence Rates in the United States and Latin America

Hepatitis E
Hepatitis E
Investigators sought to determine whether socioeconomic status is associated with HEV exposure in the United States and South America.

Hepatitis E virus (HEV) is not limited to countries with low sanitary standards, and a higher socioeconomic status does not protect populations from HEV exposure, according to a systematic review and meta-analysis published in Liver International.

While knowledge about HEV is common in Europe, familiarity with the epidemiology of HEV infections in the United States and Latin America is limited. Therefore, a literature search was performed using articles published in PubMed from January 1994 to December 2016 and prevalence was estimated using a mixed-effects model, which was then compared with previously published European seroprevalence rates. 

The researchers were surprised to find that anti-HEV seroprevalence was significantly higher in the United States than in Latin America (P =.03), with people living in the United States having a more than doubled estimated seroprevalence (up to 9%) compared with people living in Brazil (up to 4.2%; P =.007) and various countries in the Caribbean (up to 1%; P =.04). In addition, anti-HEV seroprevalence in the United States and Europe did not differ significantly (P =.25), while the rate in South America was significantly lower than that in Europe (P =.04).

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This appears to be the first study comparing HEV exposure in North and South America. “In summary, people in the USA have a higher risk of acquiring an HEV infection than people in South American countries (especially in Brazil and the Mixed Caribbean region). Although the USA has improved sanitary and health conditions relative to its poorer South American neighbors, the risk of HEV exposure was more than double in the USA compared with many South American states, particularly Brazil,” concluded the investigators. Thus, better tests are needed to help physicians determine whether hepatitis E is relevant in patients with liver disease of unknown origin.


Horvatits T, Ozga AK, Westhoelter D, et al. Hepatitis E seroprevalence in the Americas: A systematic review and meta‐analysis [published online April 16, 2018]. Liver Int. doi:10.1111/liv.13859