Faber M, Willrich N, Schemmerer M, Rauh C, Kuhnert R, Stark K, Wenzel J J
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany.
J Viral Hepat. 2018 Jun;25(6):752-758. doi: 10.1111/jvh.12868. Epub 2018 Mar 1.
A steep rise in Hepatitis E diagnoses is currently being observed in Germany and other European countries. The objective of this study was (i) to assess whether this trend mirrors an increase in infection pressure or is caused by increased attention and testing and (ii) estimate individual and population-based Hepatitis E Virus (HEV) seroconversion and seroreversion rates for Germany. We measured anti-HEV IgG prevalence in 10 407 adults participating in two linked, population-representative serosurveys (total n = 12 971) conducted in 1998 and 2010. In this period, we found a moderate but statistically significant decline of overall anti-HEV IgG prevalence from 18.6% to 15.3%. At both time points, seroprevalence increased with age and peaked in persons born between 1935 and 1959 suggesting a past period of increased infection pressure. Paired samples of individuals participating in 1998 and 2010 (n = 2564) revealed respective seroconversion and seroreversion rates of 6.2% and 22.6% among seronegative and seropositive individuals during 12 years, or 5.2 and 2.9 per 1000 inhabitants per year. This corresponds to a total of 417 242 [95%CI: 344 363-495 971] new seroconversions per year in the German population. While anti-HEV seroprevalence has decreased in the last decade, infection pressure and seroincidence remains high in Germany. Continuously rising numbers of Hepatitis E diagnoses in Europe are likely due to an increased awareness of clinicians and indicate that still there is a gap between incident and diagnosed cases. Studies on the true burden of the disease, specific risk factors and sources of autochthonous infections as well as targeted prevention measures are urgently needed.
目前在德国和其他欧洲国家，戊型肝炎的诊断数量急剧上升。本研究的目的是：（i）评估这一趋势是反映了感染压力的增加，还是由关注度和检测的提高所导致；（ii）估计德国基于个体和人群的戊型肝炎病毒（HEV）血清转化和血清逆转率。我们测量了1998年和2010年参与两项相关的、具有人群代表性的血清学调查（总样本量n = 12971）的10407名成年人中抗HEV IgG的流行率。在此期间，我们发现总体抗HEV IgG流行率从18.6%适度下降至15.3%，但具有统计学意义。在两个时间点，血清阳性率均随年龄增长而增加，并在1935年至1959年出生的人群中达到峰值，这表明过去曾有过感染压力增加的时期。参与1998年和2010年调查的配对个体样本（n = 2564）显示，在12年期间，血清阴性和血清阳性个体的血清转化率和血清逆转率分别为6.2%和22.6%，即每年每1000名居民中有5.2例血清转化和2.9例血清逆转。这相当于德国人群每年共有417242例[95%置信区间：344363 - 495971]新的血清转化。虽然在过去十年中抗HEV血清阳性率有所下降，但德国的感染压力和血清发病率仍然很高。欧洲戊型肝炎诊断数量的持续上升可能是由于临床医生的认识提高，这表明在发病病例和诊断病例之间仍然存在差距。迫切需要对该疾病的真实负担、特定风险因素、本土感染源以及有针对性的预防措施进行研究。
