Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021.
<h4>Background</h4>Hepatitis E virus (HEV) causes acute jaundice and poses an important public health problem in low- and middle-income countries. Limited surveillance capacity and suboptimal access to diagnostics leads to under-reporting of HEV infections in affected countries, includin...
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Public Library of Science (PLoS)
2024-12-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0012746 |
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| author | Chulwoo Rhee Amy Dighe Nishan Katuwal Haeun Cho Ramzi Mraidi Dipesh Tamrakar Jacqueline KyungAh Lim Nimesh Poudyal Il-Yeon Park Deok Ryun Kim Ritu Amatya Rajeev Shrestha Andrew S Azman Julia Lynch |
| author_facet | Chulwoo Rhee Amy Dighe Nishan Katuwal Haeun Cho Ramzi Mraidi Dipesh Tamrakar Jacqueline KyungAh Lim Nimesh Poudyal Il-Yeon Park Deok Ryun Kim Ritu Amatya Rajeev Shrestha Andrew S Azman Julia Lynch |
| author_sort | Chulwoo Rhee |
| collection | DOAJ |
| description | <h4>Background</h4>Hepatitis E virus (HEV) causes acute jaundice and poses an important public health problem in low- and middle-income countries. Limited surveillance capacity and suboptimal access to diagnostics leads to under-reporting of HEV infections in affected countries, including Nepal. Serum antibodies against HEV are indicative of past infection. We analyzed existing samples from a nationally representative serosurvey to describe the geospatial distribution and factors associated with HEV seroprevalence in Nepal, as a proxy for infection.<h4>Methodology/principle findings</h4>A nationally representative cross-sectional serosurvey of 3,922 individuals ≥2 years old from 975 households spread across 65 wards throughout Nepal was conducted between November 2021 and January 2022. Bio-banked samples were tested for anti-HEV IgG. Seroprevalence and its 95% confidence interval were estimated by age, sex, ecological region, municipality type, and other waterborne-disease related risk factors. Bayesian geostatistical models were fitted to observed seroprevalence data and used to generate high-resolution maps of seroprevalence across Nepal. Available samples from 3,707 participants were tested for anti-HEV IgG, and 3,703 were used for final analysis. We found 20.8% (95% CI: 19.5-22.2) of participants had evidence of prior HEV infection. HEV seroprevalence increased with age, and was higher in males (23.5%, 95% CI: 21.5-25.5) than in females (18.6%, 95% CI: 16.9-20.3). Seroprevalence in hilly (28.9%, 95% CI: 26.6-31.2) and mountain (24.6%, 95% CI: 18.8-30.5) regions were significantly higher than in terai (14.2%, 95% CI: 12.7-15.8). While there was no significant difference between urban and rural populations, the predicted seroprevalence was highest in Kathmandu, the capital of Nepal, reaching seroprevalence of 50% in some selected area. No statistically significant differences were found for wealth quintile, water source, and toilet facility.<h4>Conclusions</h4>This study provides population-based serologic evidence that HEV is endemic in Nepal, with the greatest risk of infection in Kathmandu. |
| format | Article |
| id | doaj-art-9fb263f1d9b54c858f8f4ab904cc39dc |
| institution | Kabale University |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-9fb263f1d9b54c858f8f4ab904cc39dc2025-01-17T05:32:31ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352024-12-011812e001274610.1371/journal.pntd.0012746Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021.Chulwoo RheeAmy DigheNishan KatuwalHaeun ChoRamzi MraidiDipesh TamrakarJacqueline KyungAh LimNimesh PoudyalIl-Yeon ParkDeok Ryun KimRitu AmatyaRajeev ShresthaAndrew S AzmanJulia Lynch<h4>Background</h4>Hepatitis E virus (HEV) causes acute jaundice and poses an important public health problem in low- and middle-income countries. Limited surveillance capacity and suboptimal access to diagnostics leads to under-reporting of HEV infections in affected countries, including Nepal. Serum antibodies against HEV are indicative of past infection. We analyzed existing samples from a nationally representative serosurvey to describe the geospatial distribution and factors associated with HEV seroprevalence in Nepal, as a proxy for infection.<h4>Methodology/principle findings</h4>A nationally representative cross-sectional serosurvey of 3,922 individuals ≥2 years old from 975 households spread across 65 wards throughout Nepal was conducted between November 2021 and January 2022. Bio-banked samples were tested for anti-HEV IgG. Seroprevalence and its 95% confidence interval were estimated by age, sex, ecological region, municipality type, and other waterborne-disease related risk factors. Bayesian geostatistical models were fitted to observed seroprevalence data and used to generate high-resolution maps of seroprevalence across Nepal. Available samples from 3,707 participants were tested for anti-HEV IgG, and 3,703 were used for final analysis. We found 20.8% (95% CI: 19.5-22.2) of participants had evidence of prior HEV infection. HEV seroprevalence increased with age, and was higher in males (23.5%, 95% CI: 21.5-25.5) than in females (18.6%, 95% CI: 16.9-20.3). Seroprevalence in hilly (28.9%, 95% CI: 26.6-31.2) and mountain (24.6%, 95% CI: 18.8-30.5) regions were significantly higher than in terai (14.2%, 95% CI: 12.7-15.8). While there was no significant difference between urban and rural populations, the predicted seroprevalence was highest in Kathmandu, the capital of Nepal, reaching seroprevalence of 50% in some selected area. No statistically significant differences were found for wealth quintile, water source, and toilet facility.<h4>Conclusions</h4>This study provides population-based serologic evidence that HEV is endemic in Nepal, with the greatest risk of infection in Kathmandu.https://doi.org/10.1371/journal.pntd.0012746 |
| spellingShingle | Chulwoo Rhee Amy Dighe Nishan Katuwal Haeun Cho Ramzi Mraidi Dipesh Tamrakar Jacqueline KyungAh Lim Nimesh Poudyal Il-Yeon Park Deok Ryun Kim Ritu Amatya Rajeev Shrestha Andrew S Azman Julia Lynch Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021. PLoS Neglected Tropical Diseases |
| title | Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021. |
| title_full | Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021. |
| title_fullStr | Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021. |
| title_full_unstemmed | Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021. |
| title_short | Geospatial distribution of Hepatitis E seroprevalence in Nepal, 2021. |
| title_sort | geospatial distribution of hepatitis e seroprevalence in nepal 2021 |
| url | https://doi.org/10.1371/journal.pntd.0012746 |
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