Hepatitis E seroprevalence and associated risk factors in Croatian liver transplant recipients

Mrzljak, Anna; Dinjar-Kujundzic, Petra; Vilibic-Cavlek, Tatjana; Jemersic, Lorena; Prpic, Jelena; Dakovic-Rode, Oktavija; Kolaric, Branko; Vince, Adriana

doi:10.1590/0037-8682-0302-2019

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Short Communication • Rev. Soc. Bras. Med. Trop. 52 • 2019 • https://doi.org/10.1590/0037-8682-0302-2019 copy

Hepatitis E seroprevalence and associated risk factors in Croatian liver transplant recipients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION

Solid-organ transplant recipients are at risk of hepatitis E virus (HEV) infection. We analyzed the seroprevalence/risk factors of HEV in Croatian liver transplant recipients.

METHODS

Two hundred forty-two serum samples were tested for HEV immunoglobuline IgG/IgM and HEV RNA. Sociodemographic data and risk factors were collected using a questionnaire.

RESULTS

HEV IgG seroprevalence rate was 24.4%. Positive/equivocal HEV IgM were found in two patients. HEV RNA was not detected. Logistic regression showed that older age, female gender, rural area/farm, water well, and septic tank were associated with HEV seropositivity.

CONCLUSIONS

This study revealed a high exposure rate to HEV in Croatian liver recipients.

Keywords:
Hepatitis E vírus; Seroprevalence; Risk factors; Liver transplant recipientes; Croatia

Characteristics	HEV IgG negative N (%)	HEV IgG positive N (%)	p
Gender			0.003
Male	136 (81.4)	31 (18.6)
Female	47 (62.7)	28 (37.3)
Age at sampling, yrs median	59 (32-80)	62 (40-75)	0.010
Time after transplant, yrs median	6 (3-22)	5 (3-14)	0.609
Etiology of liver disease before LT			0.241
Hepatitis B or C	39 (21.3)	10 (16.9)
Alcoholic cirrhosis	94 (51.4)	28 (47.5)
Autoimmune cirrhosis	19 (10.4)	9 (15.3)
Metabolic diseases	8 (4.4)	0
Cryptogenic liver disease	12 (6.6)	8 (13.6)
Other liver diseases	11 (6.0)	4 (6.8)
Geographic region			0.210
Continental	124 (67.8)	39 (66.1)
Coastal	59 (32.2)	19 (32.2)
Educational level*			0.024
ISCED 1	37 (22.0)	18 (33.3)
ISCED 2	89 (53.0)	30 (55.6)
ISCED 3-4	13 (7.7)	5 (9.3)
ISCED 5-6	29 (17.3)	1 (1.9)
Number of household members
1	14 (8.3)	3 (5.6)	0.809
2-4	127 (75.6)	41 (75.9)
5 or more	26 (15.5)	10 (18.5)
Type of living area			0.159
Urban area	89 (53)	22 (40.7)
Rural area	79 (47)	32 (59.3)
Farm within a household	36 (21.4)	18 (33.3)	0.100
Food/eating habits
Consumption of cured meat products	126 (75)	40 (74.1)	0.859
Occupational exposure	22 (13.1)	7 (13)	>0.999
Source of drinking water
Public water supply system	134 (79.8)	37 (68.5)	0.249
Water tank	1 (0.6)	1 (1.9)
Water well	13 (7.7)	8 (14.8)
Bottled water	13 (7.7)	7 (13)
Natural spring	7 (4.2)	1 (1.9)
Sewage system
Public sewage system	104 61.9	24 (44.4)	0.027
Septic tank	64 38.1	30 (55.6	0.027
Travelling history (within the last 3 years)	57 33.9	9 (16.7)	0.017

Exposure group/variables	OR	OR 95% CI	AOR^a	AOR 95% CI
Sex (female vs. male)	2.61	1.42-4.81
Age at sampling, yrs	1.05	1.01-1.09
Time after transplant, yrs	0.95	0.86-1.05	0.93	0.84-1.03
Etiology of liver disease before LT
Hepatitis B or C	Ref		Ref
Alcoholic cirrhosis	1.16	0.51-2.61	1.32	0.57-3.08
Autoimmune cirrhosis	1.84	0.64-5.30	1.88	0.58-6.04
Metabolic diseases	2.6	0.83-8.07	2.08	0.63-6.8
Cryptogenic liver disease	1.42	0.37-5.41	1.27	0.30-5.39
Geographic region (coastal vs. continental)	1.02	0.55-1.92	1.17	0.611-2.24
Educational level (ISCED)**
ISCED 1	Ref		Ref
ISCED 2	0.69	0.35-1.39	0.72	0.33-1.53
ISCED 3-4	0.79	0.24-2.56	1.06	0.31-3.63
ISCED 5-6	0.07	0.01-0.56	0.05	0.01-0.43
Number of people living in a household
1	Ref		Ref
2-4	1.51	0.41-5.05	1.34	0.35-5.2
5 or more	1.80	0.42-7.61	1.60	0.35-7.30
Type of living area (rural vs. urban)	1.64	0.88-3.05	2.17	1.10-4.27
Farm within a household (yes vs. no)	1.83	0.93-3.60	2.79	1.31-5.92
Consumption of cured meat products (yes vs. no)	0.95	0.47-1.92	1.43	0.66-3.09
Occupational exposure (yes vs.no)	0.98	0.39-2.46	1.76	0.66-4.69
Source of drinking water
Public water supply system	Ref		Ref
Water tank	3.62	0.22-59.29	4.17	0.24-71.58
Water well	2.23	0.86-5.78	3.09	1.11-8.57
Bottled water	1.95	0.73-5.24	1.23	0.43-3.57
Natural spring	0.52	0.061-4.34	0.61	0.069-5.41
Sewage system
Public sewer system	Ref		Ref
Septic tank	2.03	1.09-3.78	3.38	1.64-6.95
Travelling experience within the last 3 years (yes vs. no)	0.39	0.18-0.85	0.39	0.17-0.88

Exposure group/variables	OR	95% CI	p
Age, (one year increase)	1.07	1.02-1.11	0.004
Sex (female vs. male)	5.65	2.60-12.28	<0.001
Sewage system (public sewer system vs. septic tank)	3.05	1.39-6.66	0.005
Educational level**
ISCED 1	Ref
ISCED 2	0.94	0.42-2.09	0.886
ISCED 3-4	1.99	0.52-7.55	0.308
ISCED 5-6	0.084	0.09-0.73	0.005

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[1] Corresponding author: Anna Mrzljak e-mail:anna.mrzljak@mef.hr