Published online Jul 7, 2019. doi: 10.3748/wjg.v25.i25.3168
Peer-review started: March 11, 2019
First decision: May 9, 2019
Revised: May 16, 2019
Accepted: May 31, 2019
Article in press: June 1, 2019
Published online: July 7, 2019
The significance of hepatitis E virus (HEV) as an important public health problem is rising. Until a decade ago, cases of HEV infection in Eur-ope were mainly confined to returning travelers, but nowadays, hepatitis E represents an emerging zoonotic infection in many European countries. The aim of this manuscript is to perform a systematic review of the published literature on hepatitis E distribution in humans, animals and environmental samples ("One Health" concept) in the South-Eastern European countries. Comparison of the available data showed that the anti-HEV seroprevalence in the South-Eastern Europe varies greatly, depending on the population studied, geographical area and methods used. The IgG seroprevalence rates in different population groups were found to be 1.1%-24.5% in Croatia, up to 20.9% in Bulgaria, 5.9-%17.1% in Romania, 15% in Serbia, up to 9.7% in Greece and 2%-9.7% in Albania. Among possible risk factors, older age was the most significant predictor for HEV seropositivity in most studies. Higher seroprevalence rates were found in animals. HEV IgG antibodies in domestic pigs were detected in 20%-54.5%, 29.2%-50%, 38.94%-50% and 31.1%-91.7% in Serbia, Bulgaria, Romania and Croatia, respectively. In wild boars seroprevalence rates were up to 10.3%, 30.3% and 31.1% in Romania, Slovenia and Croatia, respectively. A high HEV RNA prevalence in wild boars in some countries (Croatia and Romania) indicated that wild boars may have a key role in the HEV epidemiology. There are very few data on HEV prevalence in environmental samples. HEV RNA was detected in 3.3% and 16.7% surface waters in Slovenia and Serbia, respectively. There is no evidence of HEV RNA in sewage systems in this region. The available data on genetic characterization show that human, animal and environmental HEV strains mainly belong to the genotype 3.
Core tip: In South-East Europe, the hepatitis E virus (HEV) prevalence as in other parts of Europe varies greatly, depending on the studied population, geographical area and methods used. Seroprevalence rates were found to be 0%-36% in humans and 10.3%-54.5% in animals. Human studies showed sporadic detection of HEV RNA in patients with acute hepatitis and in transplant population. HEV RNA was detected in up to 31.6% pigs and 16.7% environmental samples. Studies on phylogenetic characterization in human, animal and environmental samples showed that HEV strains from the south-eastern European countries mainly belong to the genotype 3.