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HEPATITIS E VIRUS INFECTION AS A MARKER FOR CONTAMINATED COMMUNITY DRINKING WATER SOURCES IN TIBETAN VILLAGES

In April–May 2001, a study was conducted to determine the prevalence of antibodies against hepatitis E virus (HEV) among 426 persons 8–49 years of age randomly selected from two groups of rural villages in central Tibet. Group 1 villages were assessed in 1998 as having poor quality water sources; new water systems were then constructed prior to this study. Group 2 villages had higher quality water and were not designated as priority villages for new systems prior to the study. No participants tested positive for IgM; only IgG was detected in the analyzed samples. Overall, 31% of the participants had ever been infected with HEV (95% confidence interval [CI] = 26.7–35.7%). The rate was higher in men (36.6%) than women (26.3%) and highest in those 30–39 years of age (49.1%). The rate of past infection was higher in group 1; the risk ratio was 2.77 (95% CI = 1.98–3.88). This difference is most likely the result of the poor quality of the original water sources in these villages. In resource-poor countries, HEV may be a useful health indicator reflecting the degree of contamination in village water sources. This may be especially important in rural areas (such as Tibet) where maternal mortality ratios are high because HEV may be an important cause of deaths during pregnancy in disease-endemic areas.

Received April 7, 2005. Accepted for publication August 20, 2005.

Acknowledgments: We thank Dr. Tuden Dawa (Director of the Shigatse Municipality Health Bureau) and Rick Callahan, Harry Beyer, and Adam Joyner (Tibet Primary Health Care and Water Supply Project) for their assistance, and Dr. Andrew Clift who performed the first ill-fated study.

Financial support: This study was supported by the Australian Agency for International Development (AusAID) as part of the Tibet Primary Health Care and Water Supply Project.

Disclosure: All but one of the authors work for either the Burnet Institute or (at the time of the study) the Australian Red Cross, which was contracted by AusAID to implement the above project. AusAID had no role in analyzing the study data. The Burnet Institute helped develop the ELISA used in this study; however, the institute has no commercial interest in promoting the test. The authors have no conflicts of interest in conducting this study.

^* Address correspondence to Michael J. Toole, Burnet Institute, GPO Box 2284, Melbourne, Victoria 3001, Australia. E-mail: toole{at}burnet.edu.au

Authors’ addresses: Michael J. Toole, David A. Anderson, Christopher Morgan, Brad Otto, and Tony Stewart, Burnet Institute for Medical Research and Public Health, Melbourne, Victoria 3001, Australia, E-mails: toole{at}burnet.edu.au, anderson{at}burnet.edu.au, emorgan{at}burnet.edu.au, blotto{at}blotto.org, and tonys{at}burnet.edu.au. Frances Claridge, Australian Red Cross, Melbourne, Victoria, Australia, E-mail: clar{at}ruralnet.net.au. Hui Zhuang, Department of Microbiology, Peking University Health Science Centre, Beijing, People’s Republic of China, E-mail: zhuanghu{at}publica.bj.cninfo.net.