Anna Mrzljak1,2, Petra Dinjar-Kujundzic3, Mladen Knotek3,4, Boris Kudumija5, Mario Ilic6, Marijana Gulin7, Lada Zibar8,9, Irena Hrstic10, Zeljka Jurekovic3, Branko Kolaric11,12, Lorena Jemersic13, Jelena Prpic13, Morana Tomljenovic12,14, Tatjana Vilibic-Cavlek4,15. 1. Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia. anna.mrzljak@mef.hr. 2. School of Medicine, University of Zagreb, Zagreb, Croatia. anna.mrzljak@mef.hr. 3. Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia. 4. School of Medicine, University of Zagreb, Zagreb, Croatia. 5. Policlinic for Internal Medicine and Dialysis B. Braun Avitum, Zagreb, Croatia. 6. Department of Internal Medicine, General Hospital Dubrovnik, Dubrovnik, Croatia. 7. Department of Internal Medicine, General Hospital Sibenik, Sibenik, Croatia. 8. Department of Internal Medicine, University Hospital Centre Osijek, Osijek, Croatia. 9. Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia. 10. Department of Internal Medicine, General Hospital Pula, Pula, Croatia. 11. Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia. 12. Faculty of Medicine, University of Rijeka, Rijeka, Croatia. 13. Croatian Veterinary Institute, 10000, Zagreb, Croatia. 14. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden. 15. Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia.
Abstract
PURPOSE: Data on the seroprevalence of hepatitis E virus (HEV) in heamodialysis (HD) patients are conflicting, ranging from 0 to 44%. The aim of this study was to determine the HEV seroprevalence and risk factors among HD patients in Croatia. METHODS: A total of 394 HD patients from six medical facilities in five Croatian cities (three sites in the continental and three sites in the coastal region) were tested for HEV IgM/IgG antibodies using an enzyme-linked immunosorbent assay. Additionally, all samples were tested for HEV RNA by RT-PCR. Sociodemographic data and risk factors were collected using a questionnaire. RESULTS: HEV IgG antibodies were detected in 110 (27.9%) patients. The seroprevalence varied significantly between dialysis centres, ranging from 5.2 to 43.4% (p = 0.001). HEV IgM antibodies were found in 0.04% of IgG positive patients. All patients tested negative for HEV RNA. Factors associated with HEV IgG seropositivity were age > 60 years (OR 8.17; 95% CI 1.08-62.14), living in the continental parts of the country (OR 2.58; 95% CI 1.55-4.30), and transfusion of blood products (OR 1.66; 95% CI 1.01-2.73). After adjusting for age and gender, patients from continental regions had higher odds of HEV seropositivity compared to patients from coastal regions (OR 2.88; 95% CI 1.71-4.85) and those who had RBC transfusions (OR 1.70, 95% CI 1.02-2.69) compared to those who did not. CONCLUSION: The study showed a high HEV seropositivity among HD patients in Croatia, with significant variations between geographical regions. Continental area of residence and RBC transfusion were the most significant risk factors for HEV seropositivity. Due to the high seroprevalence, routine HEV screening among HD patients, especially in transplant candidates should be considered.
PURPOSE: Data on the seroprevalence of hepatitis E virus (HEV) in heamodialysis (HD) patients are conflicting, ranging from 0 to 44%. The aim of this study was to determine the HEV seroprevalence and risk factors among HD patients in Croatia. METHODS: A total of 394 HD patients from six medical facilities in five Croatian cities (three sites in the continental and three sites in the coastal region) were tested for HEV IgM/IgG antibodies using an enzyme-linked immunosorbent assay. Additionally, all samples were tested for HEV RNA by RT-PCR. Sociodemographic data and risk factors were collected using a questionnaire. RESULTS:HEV IgG antibodies were detected in 110 (27.9%) patients. The seroprevalence varied significantly between dialysis centres, ranging from 5.2 to 43.4% (p = 0.001). HEV IgM antibodies were found in 0.04% of IgG positive patients. All patients tested negative for HEV RNA. Factors associated with HEV IgG seropositivity were age > 60 years (OR 8.17; 95% CI 1.08-62.14), living in the continental parts of the country (OR 2.58; 95% CI 1.55-4.30), and transfusion of blood products (OR 1.66; 95% CI 1.01-2.73). After adjusting for age and gender, patients from continental regions had higher odds of HEV seropositivity compared to patients from coastal regions (OR 2.88; 95% CI 1.71-4.85) and those who had RBC transfusions (OR 1.70, 95% CI 1.02-2.69) compared to those who did not. CONCLUSION: The study showed a high HEV seropositivity among HD patients in Croatia, with significant variations between geographical regions. Continental area of residence and RBC transfusion were the most significant risk factors for HEV seropositivity. Due to the high seroprevalence, routine HEV screening among HD patients, especially in transplant candidates should be considered.
Entities:
Keywords:
Haemodialysis; Hepatitis E virus; Risk factors; Seroprevalence
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