Prevalence of hepatitis E in Latin America and the Caribbean: A systematic review and meta-analysis

Objective: To estimate the prevalence of hepatitis E virus (HEV) infection by the presence of anti-HEV IgG antibodies in Latin America and the Caribbean (LAC). Study design: Systematic review and meta-analysis. Methods: Systematic searches were conducted in the Medline, Lilacs and Embase databases, selecting 81 studies comprising 38,951 individuals in accordance with the PRISMA Statement. Analyses were performed by using the random-effects model. Data analysis considered study cohort and geographic location. Results: The prevalence of hepatitis E in LAC ranged from 0 % to 36 % and the overall prevalence was 9.0 %, with important heterogeneity (I-2 = 97.3 %). Meta-analysis of subgroups showed prevalence of hepatitis E of 9.0 % in the general population, 6.0 % in blood donors, 9.0 % in rural population, 21.0 % in occupational exposure to pigs, 9.0 % in pregnant women, 7.0 % in immunocompromised individuals, 12.0 % in individuals with chronic liver disease and 9.0 % in individuals with acute hepatitis. According to geographic location, the prevalence of hepatitis E was 7.0 % in Argentina, 16.0 % in Bolivia, 7.0 % in Brazil, 17.0 % in Colombia and 24.0 % in Cuba. The generated funnel plot appeared asymmetric, with evidence of bias according to Egger (p = 0.000) and Begg (p = 0.003) tests. In the analysis, which included only studies with a quality score >5, the prevalence of hepatitis E was 8.0 %. When analysing studies with sample sizes greater than 200 and 500, we identified prevalences of 8.0 % and 7.0 %, respectively. Conclusions: The information obtained in this review warns about the current consolidated prevalence of hepatitis E in LAC, which can be a tool for planning prevention strategies.