Volume 93, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Hepatitis E virus (HEV) is a global pathogen responsible for approximately 20 million infections every year in developing countries, yet remains under-recognized. In this population-based cohort study, 1,025 randomly selected participants were enrolled from Matlab, Bangladesh (2004–2005). All participants were tested for HEV antibodies and total immunoglobulin (Ig), using an in-house enzyme immunoassay developed by Walter Reed Army Institute of Research (WRAIR). In 2014, we retested the banked sera of 1,009 of those participants using the Wantai anti-HEV IgG enzyme-linked immunosorbent assay (ELISA). The WRAIR assay estimated the overall population seroprevalence as 26.6% (95% confidence interval [CI]: 24.0, 29.5), whereas the Wantai assay produced significantly higher estimated seroprevalence, 46.7% (95% CI: 43.5–49.8) ( < 0.001). However, the two tests give nearly identical findings in those 5 years and under ( = 94) with a 98% agreement between the tests. Retesting populations with modern assays is necessary to establish better population-level estimates of disease burden.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Rein DB, Stevens G, Theaker J, Wittenborn JS, Wiersma ST, , 2012. The global burden of hepatitis E virus. Hepatology 55: 988997. [Google Scholar]
  2. Seriwatana J, Shrestha MP, Scott RM, Tsarev SA, Vaughn DW, Myint KS, Innis BL, , 2002. Clinical and epidemiological relevance of quantitating hepatitis E virus-specific immunoglobulin M. Clin Diagn Lab Immunol 9: 10721078. [Google Scholar]
  3. Myint KS, Endy TP, Gibbons RV, Laras K, Mammen MP, Jr Sedyaningsih ER, Seriwatana J, Glass JS, Narupiti S, Corwin AL, , 2006. Evaluation of diagnostic assays for hepatitis E virus in outbreak settings. J Clin Microbiol 44: 15811583. [Google Scholar]
  4. Innis BL, Seriwatana J, Robinson RA, Shrestha MP, Yarbough PO, Longer CF, Scott RM, Vaughn DW, Myint KS, , 2002. Quantitation of immunoglobulin to hepatitis E virus by enzyme immunoassay. Clin Diagn Lab Immunol 9: 639648. [Google Scholar]
  5. Labrique AB, Zaman K, Hossain Z, Saha P, Yunus M, Hossain A, Ticehurst J, Kmush B, Nelson KE, , 2013. An exploratory case control study of risk factors for hepatitis E in rural Bangladesh. PLoS One 8: e61351. [Google Scholar]
  6. Li RC, Ge SX, Li YP, Zheng YJ, Nong Y, Guo QS, Zhang J, Ng MH, Xia NS, , 2006. Seroprevalence of hepatitis E virus infection, rural southern People's Republic of China. Emerg Infect Dis 12: 16821688. [Google Scholar]
  7. Bendall R, Ellis V, Ijaz S, Ali R, Dalton H, , 2010. A comparison of two commercially available anti-HEV IgG kits and a re-evaluation of anti-HEV IgG seroprevalence data in developed countries. J Med Virol 82: 799805. [Google Scholar]
  8. Mansuy JM, Bendall R, Legrand-Abravanel F, Saune K, Miedouge M, Ellis V, Rech H, Destruel F, Kamar N, Dalton HR, Izopet J, , 2011. Hepatitis E virus antibodies in blood donors, France. Emerg Infect Dis 17: 23092312. [Google Scholar]
  9. Mansuy JM, Legrand-Abravanel F, Calot JP, Peron JM, Alric L, Agudo S, Rech H, Destruel F, Izopet J, , 2008. High prevalence of anti-hepatitis E virus antibodies in blood donors from south west France. J Med Virol 80: 289293. [Google Scholar]
  10. van Ginniken J, Bairagi R, de Francisco A, , 1998. Health and Demographic Surveillance in Matlab: Past, Present and Future Dhaka, Bangladesh: icddr,b special publication no. 72. [Google Scholar]
  11. Labrique AB, Zaman K, Hossain Z, Saha P, Yunus M, Hossain A, Ticehurst J, Nelson KE, , 2009. Population seroprevalence of hepatitis E virus antibodies in rural Bangladesh. Am J Trop Med Hyg 81: 875881. [Google Scholar]
  12. Labrique AB, Zaman K, Hossain Z, Saha P, Yunus M, Hossain A, Ticehurst JR, Nelson KE, , 2010. Epidemiology and risk factors of incident hepatitis E virus infection in rural Bangladesh. Am J Epidemiol 172: 952961. [Google Scholar]
  13. StataCorp, 2009. Stata Statistical Software. College Station, TX: StataCorp. [Google Scholar]
  14. Verghese VP, Robinson JL, , 2014. A systematic review of hepatitis E virus infection in children. Clin Infect Dis 59: 689697. [Google Scholar]
  15. Labrique AB, Kuniholm MH, Nelson KE, Scheld WM, Grayson ML, Hughes JM, , 2010. The global impact of hepatitis E: new horizons for an emerging virus. , eds. Emerging Infections, 9th edition. Washington, DC: ASM Press, 5393. [Google Scholar]
  16. Halliday JS, Harrison GL, Brown A, Hunter JG, Bendall R, Penny D, Toatu T, Abdad MY, Klenerman P, Barnes E, Dalton HR, , 2014. Hepatitis E virus infection, Papua New Guinea, Fiji, and Kiribati, 2003–2005. Emerg Infect Dis 20: 10571058. [Google Scholar]
  17. Dalton HR, Fellows HJ, Gane EJ, Wong P, Gerred S, Schroeder B, Croxson MC, Garkavenko O, , 2007. Hepatitis E in New Zealand. J Gastroenterol Hepatol 22: 12361240. [Google Scholar]
  18. Kmush B, Wierzba T, Krain L, Nelson K, Labrique AB, , 2013. Epidemiology of hepatitis E in low- and middle-income countries of Asia and Africa. Semin Liver Dis 33: 1529. [Google Scholar]

Data & Media loading...

  • Received : 25 Feb 2015
  • Accepted : 12 May 2015
  • Published online : 07 Oct 2015

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error