HEPATITIS E VIRUS EPIDEMIOLOGY IN ADULT POPULATION IN EDIRNE PROVINCE, TURKEY

Hepatitis E virus (HEV) clinical presentations range from asymptomatic infection to fulminant hepatitis which is frequently seen in pregnant women. Epidemics due to HEV mostly originate from contaminated water and the virus is transmitted by fecal oral way. Its frequency is closely related to the socioeconomical status of the community. The aim of this first community-based study performed in Edirne province (located at Trace region of Turkey) was to determine the seroprevalence of HEV and the risk factors in the city center. Five hundred eighty two people (273 men, 309 women) over age 15 years, representing the population of Edirne city center were included in the study. Anti-HEV IgG antibodies were investigated in the serum samples by ELISA method. Anti-HEV antibodies were detected in a total of 14 cases (11 women, 3 men) and HEV infection prevalence was found to be 2.4%. The mean age of seropositive people was 50.86 +/- 16.76 years while it was 40.7 +/- 16.9 years in seronegative people (p= 0.027). This result was attributed to the better water supply and sanitation conditions in Edirne province in comparison to other parts of Turkey and shift of HEV seropositivity in older ages. No statistically significant difference was detected between seropositive and seronegative cases in terms of socioeconomical conditions, both groups being in high socioeconomical level. The analysis of the risk factors revealed that the rate of people living in houses built with materials other than reinforced concrete (p= 0.044), dealing with stockbreeding (p= 0.046) and consuming fruits and vegetables without proper washing (p= 0.015) were significantly higher in the seropositive group. No statistically significant difference was detected for the other risk factors such as the number of household, presence of city water supply and sewage system in the house, location of the water closet outside house, lack of hand-washing habits, sharing utensils, consumption of raw vegetables, history of blood transfusion, surgery, dental intervention, jaundice, contact with a case of hepatitis, abortion/stillbirth and suspicious sexual contact. While the HEV seropositivity rate (2.4%) detected in Edirne was lower than the average of Turkey (6%), it was similar to the results reported from western part of the country. High rates of seropositivity among people with individual incompatibility to the hygiene rules denotes that personal hygiene is an important factor for prevention from HEV infection. High rate of seropositivity among people dealing with stockbreeding also suggests that there may be different ways of HEV transmission other than contaminated water in sporadic cases.