Epidemiologic estimates of hepatitis E virus infection in European countries.

OBJECTIVES: Reliable epidemiologic estimates of Hepatitis E Virus (HEV) infection and evidence on factors determining country-differences are sparse. We systematically assessed and extracted research data on three HEV infection markers and identified factors influencing HEV-positivity to generated adjusted EU/EEA country-specific estimates by a meta-analysis. METHODS: Reports on HEV published 2005-2015 for EU/EEA countries were obtained from PubMed, Embase, Scopus, and Cochrane databases. Utilizing data on anti-HEV IgG, IgM and HEV-RNA we estimated HEV sero-prevalence, recent and acute HEV infections. Respective magnitude of factors influencing HEV-positivity was characterized using deviance. Country-specific estimates were generated by multivariable logistic regression. RESULTS: Of 4980 records, 165 covering 18 EU/EEA countries met inclusion criteria. The majority of collected data were published for Germany, France, United Kingdom, The Netherlands, and Spain. Most influential factor for anti-HEV IgG was the assay used (42% of total deviance); IgM and HEV-RNA were predominately determined by studied population (34%, 74%). Adjusted country-specific estimates for anti-HEV IgG ranged from 1.82%-17.06%, IgM 0.14%-6.54%, and HEV-RNA 0.00%-0.10%. No general geographical pattern of HEV-positivity was visible. CONCLUSIONS: Our analysis revealed a high heterogeneity regarding data availability and HEV-seropositivity across EU/EEA countries. Determinants of HEV-estimates including assay are to be considered when interpreting HEV-epidemiology and its burden.

Perceptions of Zika virus risk in Germany in 2016.

Background: Risks associated with Zika virus (ZIKV) transmission in the Americas have been discussed widely in the media as several European athletes declined to participate in the 2016 Summer Olympic Games. Since risk perceptions of individuals in unaffected areas are unknown, we assessed the risk perceptions of ZIKV and related behaviour in Lower Saxony, Germany, with a specific focus on pregnant women and their partners. Methods: In May 2016, we surveyed 1,037 participants aged 15-69 years of an online panel (addressing hygiene and preventive behaviour regarding infections) in Lower Saxony with respect to their risk perceptions related to ZIKV. We additionally included 26 expectant parents who were recruited at antenatal preparation courses in Braunschweig and Hannover between May and July 2016. Results: Six hundred fifty-five (69.1%) of the panel participants had ever heard about ZIKV. About 8% of the study participants reported to be concerned about ZIKV. Pregnant women had the highest odds of reporting concern about ZIKV (OR: 6.24; 95% CI: 2.94-13.26, reference: non-pregnant women). The vast majority of participants (79%) would travel to the Olympics if they won a free trip; this proportion was lower in currently pregnant women (46%). Risk perceptions towards ZIKV were considerably lower than those towards Ebola during the 2014 epidemic. Conclusion: This study showed that fear of contracting ZIKV is not a major deterrent for travelling to high-risk areas. Pregnant women are appropriately concerned about the risk of ZIKV. Studies modelling the further spread of ZIKV need to account for these results.