Prevalence of hepatitis E virus in China from 1997 to 2022: a systematic review and meta-analysis

INTRODUCTION: Several studies have reported on hepatitis E virus (HEV) prevalence in various regions of China, but the results vary widely. Herein, we conducted a systematic review and meta-analysis to assess the seroprevalence, RNA-positive rate, genotype distribution of HEV in China, and its risk factors. METHODS: We included 208 related studies involving 1,785,569 participants published between 1997 and 2022. Random-effects models were used to pool prevalence, and subgroup analyses were conducted by population, gender, age, study period, regions, and rural–urban distribution. The meta regression models and pooled odds ratios (OR) were performed to identify risk factors for HEV infections. RESULTS: The pooled anti-HEV IgG, IgM, and Ag seroprevalence, and RNA detection rates in China from 1997 to 2022 were 23.17% [95% confidence interval (CI): 20.23–26.25], 0.73% (95% CI: 0.55–0.93), 0.12% (95% CI: 0.01–0.32), and 6.55% (95% CI: 3.46–12.05), respectively. The anti-HEV IgG seropositivity was higher in the occupational population (48.41%; 95% CI: 40.02–56.85) and older adult aged 50–59 years (40.87%; 95% CI: 31.95–50.11). The dominant genotype (GT) of hepatitis E in China was GT4. Notably, drinking non-tap water (OR = 1.82; 95% CI: 1.50–2.20), consumption of raw or undercooked meat (OR = 1.47; 95% CI: 1.17–1.84), and ethnic minorities (OR = 1.50; 95% CI: 1.29–1.73) were risk factors of anti-HEV IgG seroprevalence. DISCUSSIONS: Overall, the prevalence of hepatitis E was relatively high in China, especially among older adults, ethnic minorities, and humans with occupational exposure to pigs. Thus, there is a need for preventive measures, including HEV infection screening and surveillance, health education, and hepatitis E vaccine intervention in high-risk areas and populations. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42023397036.