The reported incidence of clinical hepatitis E cases is rising in some non-endemic countries, with concurrent concerns regarding potential hepatitis E virus (HEV) contamination of the blood supply. Therefore, the characterization of major potential sources of human HEV exposure is important to inform risk assessment and public health policy. A systematic review was conducted, including a comprehensive search in six electronic bibliographic databases, verified by hand-searching reference lists of HEV reviews, and a grey literature search, of the broad research question 'what is the evidence of the association between predictors of human HEV exposure, and HEV IgG seropositivity, in non-endemic countries?' Using forms designed a priori, captured studies were appraised at first-level screening, second-level characterization, and third-level data extraction and risk of bias assessment. Meta-analysis yielded summary estimates of association between potential predictors and odds of HEV seropositivity. Meta-analysis and meta-regression of the odds of HEV seroprevalence in specific groups characterized potential sources of HEV exposure. From 4,163 captured citations, 245 relevant studies underwent data extraction, investigating HEV seroprevalence or predictors in both healthy subjects and targeted patient groups. Across these groups, increasing age was a predictor of HEV IgG seropositivity. Both human immunodeficiency virus patients and haemodialysis patients had significantly increased odds of HEV seropositivity relative to the general population. Working with pigs, in forestry, or in hospitals, was significantly associated with increased odds of HEV seropositivity, as were consumption of meat, pork or game meat, or hunting. Chronological time was not associated with HEV seropositivity within our data sets. Further study of the distribution of potential dietary or behavioural predictors between high and lower prevalence areas within non-endemic countries could improve our understanding of the relative importance of specific HEV transmission pathways.

中文翻译：

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对非流行国家中人类戊型肝炎病毒暴露预测因素的系统回顾和荟萃分析。

在一些非流行国家中，报告的临床戊型肝炎病例的发病率正在上升，与此同时，人们还担心潜在的戊型肝炎病毒（HEV）会污染血液供应。因此，表征人类戊型肝炎病毒暴露的主要潜在来源对于指导风险评估和公共卫生政策很重要。进行了系统的审查，包括在六个电子书目数据库中进行全面搜索，并通过手工搜索HEV审查的参考清单进行验证，并通过灰色文献检索对广泛的研究问题“人类的预测因子之间存在关联的证据进行了验证”。非流行国家的HEV暴露和HEV IgG血清阳性？使用先验设计的表格，对捕获的研究进行一级筛选，二级表征，第三级数据提取和偏见风险评估。荟萃分析得出了潜在的预测因素与HEV血清阳性几率之间关联的汇总估计。特定人群中戊型肝炎血清阳性率的荟萃分析和荟萃回归特征表明了戊型肝炎病毒暴露的潜在来源。从4,163项被捕获的引文中，有245项相关研究进行了数据提取，以调查健康受试者和目标患者组中的HEV血清阳性率或预测因子。在这些人群中，年龄增长是HEV IgG血清阳性的预测指标。相对于一般人群，人类免疫缺陷病毒患者和血液透析患者均具有明显增加的HEV血清阳性率。在森林或医院与猪一起工作与戊型肝炎病毒血清阳性几率的增加显着相关，例如食用肉，猪肉或野味或狩猎。在我们的数据集中，时间顺序与戊型肝炎病毒血清阳性无关。进一步研究非流行国家高流行区和低流行区之间潜在的饮食或行为预测因素的分布，可以增进我们对特定混合动力车传播途径相对重要性的理解。