Hepatitis E virus seroprevalence in Polish soldiers serving in harsh environmental conditions
Abstract
Background: Hepatitis E virus (HEV) is an under-recognised aetiological factor of viral hepatitis; it is most
commonly transmitted via the oral-faecal route, but can also be transmitted by blood or blood products,
vertically from an infected mother to the foetus or by transplanted organs. The aim of the study was to
present the current seroprevalence of HEV among soldiers from the Polish Special Forces deployed on
military operations carried out in harsh environmental conditions.
Materials and methods: The research conducted between October and November 2016 involved 253 active
duty soldiers, 237 men and 16 women, aged 26–57, without clinical symptoms of infection, participants in
military operations in Asia and Africa. Accurate HEV diagnosis required the implementation of a two-phase
diagnostic protocol. During the first phase, immunoenzymatic ELISA method was used to detect specific
anti-HEV antibodies (IgM and IgG) in blood serum samples indicating contact with an infectious agent in
the past. During the second phase, serum samples obtained from subjects with positive or inconclusive
test results were tested again using confirmatory recomLine HEV IgM/IgG immunoassay.
Results: Immunoenzymatic assay found anti-HEV antibodies (IgM and/or IgG) in blood serum samples
obtained from 18 soldiers. Confirmatory tests were carried out among soldiers tested positive with ELISA
or those with inconclusive test results; the confirmatory tests showed anti-HEV antibodies (IgM and/or IgG)
in 16 of the studied soldiers, i.e. 6.3% of the study group.
Conclusions: The occurrence of HEV infections in Polish soldiers justifies the need for the introduction of
screening tests for HEV in the military environment, especially among blood donors and in cases of whole
blood or blood products transfusion.
Keywords: hepatitis E virus (HEV)seroprevalencePolish soldiers
References
- Korzeniewski K. Health hazards in areas of military operations conducted in different climatic and sanitary conditions. Int Marit Health. 2011; 62(1): 41–62.
- Dziennik Ustaw 2016, poz. 946. Rozporządzenie Ministra Obrony Narodowej z dnia 13.06.2016 r. w sprawie urlopu aklimatyzacyjnego i turnusów leczniczo-profilaktycznych [in Polish].
- Buisson Y, Coursaget P, Bercion R, et al. Hepatitis E virus infection in soldiers sent to endemic regions. Lancet. 1994; 344(8930): 1165–1166.
- Coursaget P, Buisson Y, Enogat N, et al. Outbreak of enterically-transmitted hepatitis due to hepatitis A and hepatitis E viruses. J Hepatol. 1998; 28(5): 745–750.
- Global Infectious Diseases and Epidemiology Network. Hepatitis E, Worldwide. Available at. https://web.gideonline.com/web/epidemiology (Access: 29 Apr 2018).
- Aspinall EJ, Couturier E, Faber M, et al. Country experts. Hepatitis E virus infection in Europe: surveillance and descriptive epidemiology of confirmed cases, 2005 to 2015. Euro Surveill. 2017; 22(26).
- Lapa D, Capobianchi MR, Garbuglia AR. Epidemiology of Hepatitis E Virus in European Countries. Int J Mol Sci. 2015; 16(10): 25711–25743.
- Dalton HR, Bendall R, Ijaz S, et al. Hepatitis E: an emerging infection in developed countries. Lancet Infect Dis. 2008; 8(11): 698–709.
- Riveiro-Barciela M, Rodríguez-Frías F, Buti M. Hepatitis E virus: new faces of an old infection. Ann Hepatol. 2013; 12(6): 861–870.
- Pischke S, Behrendt P, Manns MP, et al. HEV-associated cryoglobulinaemia and extrahepatic manifestations of hepatitis E. Lancet Infect Dis. 2014; 14(8): 678–679.
- Deroux A, Brion JP, Hyerle L, et al. Association between hepatitis E and neurological disorders: two case studies and literature review. J Clin Virol. 2014; 60(1): 60–62.
- Łapiński TW, Jaroszewicz J. Hepatitis E virus infection: a new threat for Europe. Przegl Epidemiol. 2016; 70(1): 11–4, 103.
- Adlhoch C, Avellon A, Baylis SA, et al. Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15. J Clin Virol. 2016; 82: 9–16.
- Pischke S, Behrendt P, Bock CT, et al. Hepatitis E in Germany: an under-reported infectious disease. Dtsch Arztebl Int. 2014; 111(35-36): 577–583.
- Buti M, Domínguez A, Plans P, et al. Community-based seroepidemiological survey of hepatitis E virus infection in Catalonia, Spain. Clin Vaccine Immunol. 2006; 13(12): 1328–1332.
- Olsen B, Axelsson-Olsson D, Thelin A, et al. Unexpected high prevalence of IgG-antibodies to hepatitis E virus in Swedish pig farmers and controls. Scand J Infect Dis. 2006; 38(1): 55–58.
- Faber MS, Wenzel JJ, Jilg W, et al. Hepatitis E virus seroprevalence among adults, Germany. Emerg Infect Dis. 2012; 18(10): 1654–1657.
- Mansuy JM, Legrand-Abravanel F, Calot JP, et al. High prevalence of anti-hepatitis E virus antibodies in blood donors from South West France. J Med Virol. 2008; 80(2): 289–293.
- Hogema BM, Molier M, Slot Ed, et al. Past and present of hepatitis E in the Netherlands. Transfusion. 2014; 54(12): 3092–3096.
- Grabarczyk P, Sulkowska E, Gdowska J, et al. Molecular and serological infection marker screening in blood donors indicates high endemicity of hepatitis E virus in Poland. Transfusion. 2018; 58(5): 1245–1253.
- Larska M, Krzysiak MK, Jabłoński A, et al. Hepatitis E virus antibody prevalence in wildlife in Poland. Zoonoses Public Health. 2015; 62(2): 105–110.
- Jaroszewicz J, Flisiak R, Kalinowska A, et al. Acute hepatitis E complicated by acute pancreatitis: a case report and literature review. Pancreas. 2005; 30(4): 382–384.
- Bura M, Michalak M, Chojnicki M, et al. Seroprevalence of anti-HEV IgG in 182 Polish patients. Postepy Hig Med Dosw (Online). 2015; 69: 320–326.
- Sadkowska-Todys M, Baumann-Popczyk A, Wnukowska N, et al. Occurrence and prevalence of selected zoonotic agents: Echinococcus multilocularis, Trichinella spiralis and hepatitis E virus (HEV) in the population of Polish hunters--results of the study conducted in 2010-2012. Przegl Epidemiol. 2015; 69(4): 673–8, 823.
- Bura M, Łagiedo M, Michalak M, et al. Hepatitis E virus IgG seroprevalence in HIV patients and blood donors, west-central Poland. Int J Infect Dis. 2017; 61: 20–22.
