Observational studyBMC infectious diseases2026
Multi-dimensional surveillance of hepatitis E: a 20-year observational analysis in Shanghai, China.
Observational study in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHepatitis E virus (HEV) remains a major public health concern in China, with a significant increase in notified incidence over the last two decades. We aimed to examine trends and potential contributing factors associated with hepatitis E incidence and infection in Shanghai, a highly developed metropolis.
methodsHepatitis E notified incidence data were retrieved from the National Notifiable Infectious Disease Reporting System (2004-2024). Six cross-sectional community-based serological surveys were conducted between 2001 and 2024, involving a total of 6,305 participants. Pathogen surveillance was annually conducted in confirmed cases, swine bile, and shellfish between 2018 and 2024. HEV was genotyped via amplification of a 150-nt fragment within ORF2 and phylogenetically analyzed.
resultsA total of 14,071 hepatitis E cases were notified in Shanghai during 2004-2024, with a Joinpoint detected in 2012 and an increasing trend thereafter (annual percentage change 5.03%, p = 0.044). In serological surveys, the age-standardized anti-HEV IgG positivity rate ranged between 18.56% and 34.43% among 6,305 participants. The exploratory ratio of notified clinical cases to estimated asymptomatic infections (clinical-to-asymptomatic ratio, C/A ratio) increased most markedly in the 1961-1970 birth cohort between 2010 and 2020. Moreover, 548 of 1,367 cases and 126 of 3,900 swine bile samples tested positive for HEV RNA; none of 724 shellfish samples were positive. HEV genotype 4 accounted for 97.35% of cases, and eight genotype 3 sequences were isolated.
conclusionsHEV infection remained common in both humans and swine in Shanghai. A comprehensive control strategy may be essential for achieving hepatitis E elimination, especially by identifying high-risk populations to reduce the burden of clinically apparent hepatitis E, in addition to routine HEV surveillance.
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