Seroprevalence of hepatitis E antibodies in a population of recyclable waste pickers in Brazil

doi:10.1016/j.jcv.2014.01.002

Journal of Clinical Virology

Volume 59, Issue 3, March 2014, Pages 188-191

https://doi.org/10.1016/j.jcv.2014.01.002 Get rights and content

Abstract

Background

Hepatitis E virus (HEV) infection represents an important cause of acute viral hepatitis. Selective waste collection is a widespread activity carried out by the urban poor, and recyclable waste pickers have a lifestyle that makes this group highly vulnerable to unfavorable socio-economic and environmental factors. To date, the epidemiology of HEV infection in this population remains unknown.

Objectives

To assess the seroprevalence of hepatitis E-specific antibodies in a population of recyclable waste pickers in Brazil.

Study design

Between April 2010 and May 2011, a cross-sectional study was conducted among recyclable waste pickers from all 15 recycling cooperatives in Goiânia City, Central Brazil. The participants were tested for serological markers indicative of HEV infection.

Results

Of 432 individuals asked to participate in the survey, 431 (99.8%) agreed to participate. Twenty-four of 431 participants were anti-HEV IgG positive by ELISA. Of these, 22 were confirmed positive by immunoblot, resulting in an anti-HEV IgG prevalence of 5.1% (95% CI: 3.4–7.6). In addition, four individuals were anti-HEV IgM positive by ELISA. Of these, three (0.7%; 95% CI: 0.4–2.4) were confirmed anti-HEV IgM positive by immunoblot, but were HEV RNA negative. One was concurrently positive for anti-HEV IgG. Only age > 40 years was independently associated with the presence of anti-HEV.

Conclusions

These findings demonstrated that the prevalence of HEV antibodies among recyclable waste pickers in Central Brazil is relatively low and increased with age.

Section snippets

Background

Hepatitis E virus (HEV) is globally distributed, and its infection is one of the leading causes of acute viral hepatitis in endemic countries. This virus is mainly transmitted via fecal–oral routes following ingestion of contaminated water or food. Prevalence rates of this infection vary according to studied age groups, urbanization conditions, and socio-economic levels. Thus, different epidemiological patterns have been observed in developing and developed countries. In developing countries,

Objectives

This study aimed to assess the seroprevalence of hepatitis E-specific antibodies in a population of recyclable waste pickers in Brazil.

Study design

This is a seroprevalence survey of recyclable waste pickers for HEV antibodies in Goiânia City (estimated population of 1,300,000), the capital of the Goiás State in Central Brazil. Since 2008, Goiânia has been engaged in the implementation of a recycling program administered by the municipal government to provide collection of recyclables for every household free of charge. The rise in household recyclable collection rates has led to the creation of 15 cooperatives.

Between April 2010 and May

Results

Of 432 recyclable waste pickers who were invited to take part in the study, 431 (99.8%) agreed to participate. Sociodemographic characteristics of the study population are shown in Table 1. The mean age was 36.9 years (standard deviation = 13.6). Most recyclable waste pickers (62.4%) were females, 48.7% were married, and 79.4% were non-Caucasian. Nearly 80.0% of the participants had received 9 years or less of formal education, and 52.7% reported a monthly income of US$ 300 or less.

Twenty-four of

Discussion

This study represents the first investigation designed to estimate the prevalence of HEV among recyclable waste pickers. The prevalence of anti-HEV IgG found among recyclable waste pickers was slightly higher than that reported in a Brazilian blood donors population (2.3%; 95% CI: 1.5–3.5) [10]; but it was, however, in accordance with other rates demonstrated for healthy persons in Brazil (range from 0% to 7.5%) [11]. Nevertheless, these studies are difficult to compare due to the different

Funding

This study was supported by Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado de Goiás (FAPEG).

Competing interests

The authors declare no conflicts of interest.

Ethical approval

The study was approved by the by the Ethics Committee of the Federal University of Goiás. All participant subjects gave informed consent to the study.

Acknowledgements

The authors thank Thaís Marinho, Tamíris Marinho, Marcos Matos, Nativa Del-Rios, Lyriane Apolinário, Tássia Marinho and Andreia Andrade for their collaboration during the data and blood collection, and Ágabo Costa e Silva for technical assistance. The authors also thank Fernando Bartholo (Incubadora Social da UFG), the recycling cooperatives and the recyclable waste pickers in Goiânia City.

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Exclusion criteria included formal waste pickers, as well as other similar terms (e.g., collector, scavenger, recycler), non-scholarly articles and publications, and non-English language articles. There were 23 articles that were excluded because the articles were written in Portuguese or Spanish; these included: Alencar et al. (2009), Almeida et al. (2009), Braga et al. (2015), Castilhos Junior et al. (2013), Dias (2011), Dias et al. (2014), Dias (2016), Ferreira (2012), Hoefel et al. (2013), Jesus (2012), Lermen and Fisher (2010), Lima et al. (2016), Maciel et al. (2011), Martins et al. (2014), Ramos et al. (2013), Santos and Silva (2009), Santos and Silva (2011), Sicoli (2014), Soares (2014), Souza (2014), Teixeira et al. (2015), Virgem et al. (2014), and Zacarias and Bavaresco (2009). The process of data analysis began with the selected research and literature being reviewed, analyzed, and interpreted.
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However, the strength of the evidence varies significantly among different risk factors. Despite pork consumption being widely reported as a risk factor for HEV among immunocompetent population, only one study found a statistical association between HEV infection and the consumption of undercooked pork in HIV+ individuals [32–36]. Interestingly, this study found no association between sexual orientation or CD4 counts and HEV infection but found a trend to higher prevalence in non-white individuals [32].
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In the present study we found a prevalence of 18.8% of anti-HEV IgG among a sample of schistosomiasis patients. Such prevalence is higher than that observed in immunocompetent populations in the country.18–23 There is only one study from Brazil that included, among other groups, patients with SM.
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Short CommunicationSeroprevalence of hepatitis E antibodies in a population of recyclable waste pickers in Brazil

Abstract

Background

Objectives

Study design

Results

Conclusions

Section snippets

Background

Objectives

Study design

Results

Discussion

Funding

Competing interests

Ethical approval

Acknowledgements

Lancet

Virus Res

J Clin Virol

Res Vet Sci

J Clin Virol

Hepatitis E: current status

Rev Med Virol

Lixo, trabalho e saúde: um estudo de caso com catadores em um aterro metropolitano no Rio de Janeiro, Brasil

Cad Saude Publica

World at work: Brazilian ragpickers

Occup Environ Med

Informal recycling and occupational health in Santo André, Brazil

Int J Environ Health Res

HIV infection and related risk behaviors in a community of recyclable waste collectors of Santos, Brazil

Rev Saude Publica

Short Communication
Seroprevalence of hepatitis E antibodies in a population of recyclable waste pickers in Brazil