Seroprevalence and Characteristics of Hepatitis E in the United States

Abstract

Hepatitis E is not well-understood in the United States. Seroprevalence, transmission, and subclinical manifestations have either not been studied of been the subject of a small number of studies with limited conclusions. The purpose of this dissertation was to better understand the role of Hepatitis E in the United States. This dissertation updated the seroprevalence estimates in the United States, investigated previous inconsistencies in the seroprevalence, identified potential risk factors, and examined a potential for subclinical liver abnormalities in persons recently infected. We found seroprevalence in the United States has remained stable at 6%. In addition, we found non-Hispanic Asians had especially high seroprevalence compared to other demographic groups. We also determined the difference between seroprevalence estimates from the 1990s compared with modern seroprevalence estimates were largely, but not completely due to differences in diagnostic assays. We were unable to find any association between recent HEV infection and liver inflammation; however, we found a tenuous relationship between past HEV infection and liver fibrosis. While this paper was unable to find risk factors suggesting a causal pathway or a substantial public health impact, it does not diminish the importance of studying HEV in populations at high risk for complications – particularly immunocompromised persons.