Hepatitis E virus infection in swine workers: a meta-analysis.
Hepatitis E virus (HEV) infects both humans and animals. Swine has been confirmed to be the principal natural reservoir, which raises a concern that HEV infection would be substantially increasing among swine workers. The present study calculated the pooled prevalence of IgG antibodies against HEV among swine workers and the general population in previous cross-sectional studies. We conducted a meta-analysis comparing the prevalence of HEV infection between swine workers and the general population, including local residents, blood donors and non-swine workers. Through searches in three databases (PubMed and OVID in English, and CNKI in Chinese) and after study selection, a total of 32 studies from 16 countries (from 1999 through 2018) were included in the meta-analysis. A random-effect model was employed in the study; an I2 statistic assessed heterogeneity, and the Egger's test detected publication bias. The comparative prevalence of anti-HEV IgG was pooled from the studies. Compared to the general population, the prevalence ratio (PR) for swine workers was estimated to be 1.52 (95% CI 1.38-1.76) with the I2 being 71%. No publication bias was detected (p=0.40). A subgroup analysis further indicated increased prevalence of anti-HEV IgG in the swine workers in Asia (PR=1.49, 95% CI: 1.35-1.64), in Europe (PR=1.93, 95% CI: 1.49-2.50) and in all five swine-related occupations, including swine farmers, butchers, meat processors, pork retailers and veterinarians (PR ranged between 1.19 and 1.75). In summary, swine workers have a relatively higher prevalence of past HEV infection, and this finding is true across swine-related occupations, which confirms zoonotic transmission between swine and swine workers.