We report the results of seroepidemiological study of hepatitis E virus (HEV) infection in 636 voluntary blood donors in four Provinces of Northern Thailand. The average seroprevalence of anti-HEV was 8.7%, which is lower than previous reports from HEV endemic areas and even in the central Thailand. No significant differences of the prevalence were found geographically and also by age and sex. Our findings suggest that Northern Thailand belongs to an intermediate prevalence group of HEV infection between non-endemic and endemic regions and the improvement of socioeconomic and hygienic status might control the spreading of HEV infection in this area

Hayashi Shigeki

Itakura Hideyo

Jiviriyawat Wanchai

Jiviriyawat Yupa

Jutavijittum Prapan

Toriyama Kan

Yousukh Amnat

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Trop. Med., 42 (2), 135-139, June, 2000 135S eroprevalence of Antibody to Hepatitis E Virus inVoluntary Blood Donors in Northern ThailandPrapan JUTAVIJITTUM1, Yupa JIVIRIYAWAT1, Wanchai JIVIRIYAWAT1,Amnat YOUSUKH1, Shigeki HAYASHI2, Hideyo ITAKURA3,and Kan TORIYAMA3D epartment of Pathology, Faculty of Medicine, Chiang Mai University, 110Intavaroros Rd., Chiang Mai 50200, Thailanddepartment of Gastroenterology, International Medical Center of Japan, 1-21-1Toyama, Shinjuku 162-8655, Tokyo, JapanDepartment of Pathology, Institute of Tropical Medicine, Nagasaki University,1-12-4 Sakamoto, Nagasaki 852-8523, JapanAbstract: We report the results of seroepidemiological study of hepatitis E virus (HEV)infection in 636 voluntary blood donors in four Provinces of Northern Thailand. The averageseroprevalence of anti-HEV was 8.7%, which is lower than previous reports from HEV en-demic areas and even in the central Thailand. No significant differences of the prevalencewere found geographically and also by age and sex. Our findings suggest that NorthernThailand belongs to an intermediate prevalence group of HEV infection between non-en-demic and endemic regions and the improvement of socioeconomic and hygienic statusmight control the spreading of HEV infection in this area.key words: Seroprevalence, hepatitis E virus, blood donors, Northern ThailandINTRODUCTIONHepatitis E virus (HEV) is the main causative agent of acute non-A, non-B, non-Chepatitis and transmitted via the fecal-oral route (Balayan et al, 1983; Reyes et al, 1990;Bradley, 1990). The disease manifests usually a self-limited course, except in pregnant wo-men,who suffer with a 15-25% fatally rate from fulminant hepatitis (Bradley, 1990; Tsega etal., 1992). Outbreaks of hepaptitis E have been reported over a wide geographic area in manydeveloping countries, especially in tropical and subtropical areas (Myint et al., 1985; Uchida,1992; Uchida et al., 1993; Mast and Krawczynski, 1996). Anti-HEV has been detected in<5% of children under 10 years of age, increasing to 10 - 40% among adults >25 years ofage in HEV endemic countries (Tsega et al., 1992; Mast and Krawczynski, 1996). Severalsporadic cases of HEV infection have also been reported in industrialized countries, wherealmost all are imported from endemic areas by immigrants, travelers or soldiers (DeCock etal., 1987; Skidmore et al., 1991; Hino et al, 1991; Jardi et al., 1993; Bryan et al., 1994).Received for publication, July 5, 2000Contribution No. 4022 from the Institute of Tropical Medicine, Nagasaki University136Seroprevalence studies among blood donors in some non-endemic countries have found ananti-HEV prevalence of 1 - 5% (Paul et al., 1994). The prevalence of anti-HEV in a previousreport were 15.7% in voluntary blood donors in Bangkok, 6.2% in children in NortheasternThailand and 2.3% in children in Southern Thailand, respectively (Poovorawan et al., 1996).Northern Thailand is contiguous to Myanmar, where is one of the highly endemic areas ofHEV infection (Myint et al., 1985; Uchida et al., 1993). The aim of present study was todetermine the prevalence of HEV infection in voluntary blood donors in Northern Thailand.MATERIALS AND METHODSDuring the period of July 1998 and July 1999, 636 serum samples were collectted fromvoluntary blood donors (446 males and 190 females, 17 to 60 years old) in Chiang Mai,Chiang Rai, Lampang and Lamphun Provinces in Northern Thailand (Fig. 1) and tested forthe presence of anti-HEV using HEV antibody ELISA kit (ANOGEN; Yes Biotech Laborato-ries Ltd., Ontario, Canda), which employed a qualitative sandwich immunoassay. Themicrotiter plates provided in the kit has been pre-coated with a mixture of synthetic HEVpolypeptides that correspond to highly antigenic segment of essential amino acid sequencesderived from ORF-2 and ORF-3 of Chinese HEV strain. The procedures of the examinationwere performed strictly with instruction manuals. The samples from positive result werepicked up for retest and only repeatedly reactive sera were considered positive. Thestatistical analysis of the results was performed using chi-square test.CHINALAO:f THAILANDVIETNAMCAMBODIAMYANMARMYANMARCHIANG MAILAMPHUNCHIANG RAIà"LAMPANGTHAILANDFigure 1 Map of Northern ThailandLAOS137RESULTSTable 1 shows prevalence of anti-HEV in voluntary blood donors in Northern Thailandby age and sex The average prevalence of anti-HEV in 636 voluntary blood donors inNorthern Thailand was 8.7%. The prevalence of anti-HEV in male (9.0%) was slightly higherthan in temale (7.9%). There were no significant differences of the prevalence by age andsex.Table 2 describes geographic prevalence of anti-HEV in Chiang Mai, Chiang Rai,Lampang and Lamphun Provinces in Northern Thailand. No remarkable differences of theprevalence of anti-HEV were found among these 4 Provinces.Table 1. Seropprevalence of anti-HEV in voluntary blood donors in Northern Thailand by age (years) and sex17-20 21-30 31-40 41-50 51-60 TotalMale 9/108 10/ 98 7/106 12/110 21 24 40/446(8.4%) (10.2%) (6.6%) (10.9%) (8.4%) (9.0%)Female II 38 51 60 6/ 56 3/ 32 O/ 4 15/190(2.7%) (8.4%) (10.8%) (9.4%) (0.0%) (7.9%)T otal 10/146 15/158 13/162 15/142 21 28 55/636(6.9%) (9.5%) (8.1%) (10.6%) (7.2%) (8.7%)Table 2. Seroprevalence of anti-HEV in 4 Provinces of Northtern ThailandChiang Mai Chiang Rai Lampang Lamphun TotalM ale H/148 13/135 5/ 67 III 96 40/446(7.5%) (9.7%) (7.5%) (ll.5%) (9.0%)F emale 71 62 3/ 38 21 47 3/ 43 15/190(ll.3%) (7.9%) (4.3%) (7.0%) (7.9%)Total 18/2 10 16/173 7/1 14 14/139 55/636(8.6%) (9.3%) (6.1%) (10.1%) (8.7%)DIS CUSSIONHEV infection is transmitted enterically and outbreaks are usually associated with fecalcontamination of the water supply (Balayan et al, 1983; Reyes et al., 1990; Bradley, 1990;Uchida et al., 1992). HEV is prevalent in South and Southeast Asia, Africa, Middle East!Central America and the former Soviet Union (Myint et al., 1985; Uchida, 1992; Arif et al.,1994; Mast and Krawczynski, 1996). Although several sporadic cases have been reportedfrom industrialized countries, almost all are imported from endemic countries by travelers,immigrants or soldiers (DeCock et al, 1987; Skidmore et al., 1991; Hino et al., 1991; Jardi et138al., 1993). The prevalence of anti-HEV is <5% in children under 10 years of age and in-creasing to 10 - 40% among adults >25 years of age in HEV endemic countries (Tsega etal., 1992; Mast and Krawczynski, 1996). Northern Thailand is contiguous to Myanmar, whereis a highly endemic area of HEV infection with the historical experiences of several outbreaksof the disease (Myint et al., 1985; Uchida, 1992; Uchida et al., 1993). In our study, averageseroprevalence of anti-HEV among 636 voluntary blood donors in Northern Thailand was8.7% and there were no significant differences in each Provinces and also by age and sex. Inthe recent study, seroprpevalence of anti-HEV in healthy blood donors was 15.7% in Bangkikand increased by age, up to 25% in the age group over 50 (Poovorawan et al, 1996). Com-paring with these reports, our findings indicate that prevalence of HEV infection in NorthernThailand is lower than in the HEV endemic countries and even in the central Thailand, andsuggest that Northern Thailand has not experienced hepatitis E epidemics and belongs to anintermediate prevalence region of HEV infection. Hepatitis A virus (HAV) is transmittted viathe fecal-oral route, similar manner to HEV and 90% of the general population developed theanti-HAV by the age of 10 years in 1982 in Bangkok (Viranuvati et al., 1982). However,epidemiological pattern of HAV infection in Chiang Mai area is changing after the improve-ment of socioeconomic status and the quality of hygiene and sanitation; only 8.7% was posi-tive for anti-HAV among children, 4 - 16 years of age, during 1998 and 1999 (Jutavijittumand Toriyama, in preparation for publication). Fortunately these environmental factors mightcontrol the spreading of heapatitis E in the same way of hepatitis A in Northern Thailand. Inaddition to the improvement of the quality of hygiene and sanitation, HEV vaccine, which isstill under development, should be the important method to prevent and eradicate HEV in-fection in endemic areas.ACKNOWLEDGMENTSWe are grateful to the relevant officers in the 10th Regional Blood Center, NationalBlood Center and Thai Red Cross Society for their cooperation. This work was supported bya Grant (Tokubetujigyou-hi) from the Ministry of Education, Science, Sports and Culture anda Grant for International Health Cooperation Research (9C-4) from the Ministry of Health andWelfare, Japan.RE FEREN CES1) Arif, M., Qattan, L, Al-Faleh, F. & Ramia S. (1994): Epidemiology of hepatitis E virus (HEV) in-fection in Saudi Arabia. Ann. Trop. Med. Parasitol., 90 (2), 189-1962) Balayan, M.S., Andjaparidze, A.G., Savinskaya, S.S., Ketiladze, E.S., Braginsky, D.M., Savino, A.P.& Poleschuk, V.F. (1983): Evidence for a Virus in Non-A, Non-B Hepatitis Transmitted via theFecal-Oral Route. 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Seroprevalence of Antibody to Hepatitis E Virus in Voluntary Blood Donors in Northern Thailand

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Seroprevalence of Antibody to Hepatitis E Virus in Voluntary Blood Donors in Northern Thailand

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