Hepatitis E seroprevalences in pregnant and non-pregnant women in a southern region of Brazil

Hepatitis E was known to be a disease occurring mainly in Asian and African countries and to

cause liver failure in pregnant women. A variety of different transmission modes were characterized in recent years. Genotype 3 infection has been recognized in industrial countries with severe chronic infections in immunocompromized individuals and serious HEV-associated autoimmune disorders. The anti-HEV prevalence and HEV genotype distributions in South America are not well defined.

We aimed to study risk factors and the seroprevalence of hepatitis E in a group of pregnant women in Brazil.

Methods: A group of 209 pregnant women and 199 female blood donors, paired by age, were recruited from 2002 to 2003, in Clinics Hospital, Federal University of Paraná, Brazil. A broad questionnaire evaluating risk factors was applied. The serum was kept frozen at -80 °C since then and analyzed in Germany in 2014 where the samples were tested for anti-HEV IgG (Wantai – ELISA assay), anti-HBc, HBsAg and Anti-HCV, sponsored by the DZIF HepNet Study-House. HEV PCR was tested by an in house method.

Results: A total of 40 (19%) pregnant women and 51 (26%) female blood donors tested positive for anti-HEV IgG.

None of the women tested positive for HEV RNA. Anti-HEV seropositivity was associated with age but not with history of blood transfusion, ethnicity or income.

In total four (2 in each group) samples were tested HBsAg positive (0.96%), 25 pregnant women showed an anti-HBc reaction (11.9%), compared to 3% (n = 2) blood donors. No correlation could be detected between anti HBc and anti HEV positivity. None of the women tested positive for anti HCV.

Conclusion: This is the first report on HEV seroprevalence rates in pregnant women and female blood donors in a Southern Region of Brazil using the Wantai assay. The overall prevalence of anti-HEV was comparable to western and central European countries. Importantly no sample tested positive for HEV RNA indicating that acute HEV infection is not a major threat for pregnant women in Brazil.

The lack of association with other viral hepatitis markers, income, education degree and ethnicity suggests that HEV is transmitted beyond socioeconomic barriers. Furthermore eating habits are not included in this study and may play a role. More studies are needed to determine the health burden associated with this infection.