Hepatitis E virus infection in the United States: Seroprevalence, risk factors and the influence of immunological assays

María Belén Pisano, Christopher Campbell, Chimaobi Anugwom, Viviana Elizabeth Ré, José D. Debes

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


In the United States (U.S.), a hepatitis E virus (HEV) seroprevalence between 6 and 21% has been described, with a decreasing trend. We aimed to investigate HEV infection in the U.S. population from 2009 to 2016, and examine the differences in seroprevalence using different assays. We used data from the National Health and Nutrition Examination Survey (NHANES-CDC) to estimate HEV seroprevalence and analyze demographic variables related to the infection. Additionally, we compared 4 serological tests used. The estimated HEV seroprevalence between 2009–2016 was 6.1% (95% CI: 5.6%-7.0%) for IgG and 1.02% (0.8%-1.2%) for IgM. Higher HEV IgG prevalences were found in older people, females, non-Hispanic Asians and those born outside of the U.S. The in-house immunoassay and the Wantai HEV-IgG ELISA presented the highest sensitivity values in the tested population. The highest specificity values corresponded to the DSI-EIA-ANTI-HEV-IgG assay. The kappa statistical values showed concordances no greater than 0.64 between the assays. HEV prevalence in our study was similar to previously reported, and a decline in the prevalence was observed through the NHANES assessments (from 1988 to 2016). The sensitivity and specificity of the assays varied widely, making comparisons difficult and highlighting the need to develop a gold standard assay.

Original languageEnglish (US)
Article numbere0272809
JournalPloS one
Issue number8
StatePublished - Aug 2022

Bibliographical note

Funding Information:
This work was supported by Robert Wood Johnson Foundation, Harold Amos Medical Faculty Development Program, University of Minnesota AIRP grant, and NIH National Center for Advancing Translational Sciences [grant UL1TR002494] all to JDD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH National Center for Advancing Translational Sciences.

Publisher Copyright:
© 2022 Pisano et al. 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.


  • Aged
  • Female
  • Hepatitis Antibodies
  • Hepatitis E
  • Hepatitis E virus
  • Humans
  • Immunoglobulin G
  • Immunoglobulin M
  • Nutrition Surveys
  • Risk Factors
  • Seroepidemiologic Studies
  • United States/epidemiology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural


Dive into the research topics of 'Hepatitis E virus infection in the United States: Seroprevalence, risk factors and the influence of immunological assays'. Together they form a unique fingerprint.

Cite this