Multi-dimensional surveillance of hepatitis E: a 20-year observational analysis in Shanghai, China.
5 affiliations
- 1Department of Viral Hepatitis Control and Prevention, Institute of Tuberculosis and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 201107, China.
- 2Virus Testing Laboratory, Pathogen Detection Institute, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 201107, China.
- 3Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China.
- 4Department of Viral Hepatitis Control and Prevention, Institute of Tuberculosis and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 201107, China. [email protected].
- 5Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, 200032, China. [email protected].
Abstract
Background
Hepatitis 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.Methods
Hepatitis 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.Results
A 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.Conclusions
HEV 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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BibTeX
@article{chen2026multidimensional,
title = {{Multi-dimensional surveillance of hepatitis E: a 20-year observational analysis in Shanghai, China.}},
author = {Kaiyun Chen and Wei Wang and Xin Shen and Di Xu and Yanting Lee and Zheng Teng and Jiming Zhang and Hong Ren and Yihan Lu},
journal = {BMC infectious diseases},
year = {2026},
month = jul,
doi = {10.1186/s12879-026-14060-5},
url = {https://europepmc.org/article/MED/42894128},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Multi-dimensional surveillance of hepatitis E: a 20-year observational analysis in Shanghai, China.
AU - Kaiyun Chen
AU - Wei Wang
AU - Xin Shen
AU - Di Xu
AU - Yanting Lee
AU - Zheng Teng
AU - Jiming Zhang
AU - Hong Ren
AU - Yihan Lu
PY - 2026
DA - 2026/07/01
JO - BMC infectious diseases
DO - 10.1186/s12879-026-14060-5
UR - https://europepmc.org/article/MED/42894128
AB - Background Hepatitis 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.Methods Hepatitis 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.Results A 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.Conclusions HEV 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.
SN - 1471-2334
ER -