Journal of Medical Virology Prevalence of Antibodies to Hepatitis E Virus in Immigrants: A Seroepidemiological Survey in the District of Foggia (Apulia-Southern Italy) Gaetano Scotto, 1 * Domenico Martinelli, 2 Adele Giammario, 1 Rosa Prato, 2 and Vincenzina Fazio 3 1 Clinic of Infectious Diseases, University of Foggia, Foggia, Italy 2 Section of Hygiene, Department of Medical and Occupational, University of Foggia, Foggia, Italy 3 Clinical Chemistry Laboratory, Hospital of Foggia, Foggia, Italy Hepatitis E virus (HEV) is the etiologic agent of endemically transmitted viral hepatitis. HEV is endemic in developing countries where it occurs in sporadic and endemic forms, but au- tochthonous sporadic cases of hepatitis E have been reported in North America and in Europe, including Italy. The aim of the present study was to assess the seroprevalence of antibodies to HEV in immigrants from developing coun- tries to the province of Foggia. The seropreva- lence of HEV was determined in a cohort of 412 immigrants (mostly from countries in sub- Saharan Africa) who had arrived recently in Italy. Serum samples were tested for anti-HEV by a commercial enzyme immunoassay (EIA) based on recombinant proteins; positive results were confirmed by a Western blot assay (Recomblot HEV). A total of 88 (21.3%) of the 412 serum samples examined were reactive to IgG anti-HEV. Eighty-one of these samples (19.7%) were confirmed by Western blot. Anti-HEV IgM was found in 34/81 subjects (41.9%) of the anti-HEV IgG positive serum samples. Almost all anti-HEV positive subjects were asymptomatic clinically, but alanine aminotransferase serum values were elevated in 28/34 (82.3%) patients with IgM anti-HEV- positive. The results of this study indicate high circulation of HEV in the immigrant population. The high prevalence of acute hepatitis involved mainly subjects who arrived in Italy during the same period from the same countries (Eritrea, Ethiopia, and Somalia). J. Med. Virol. ß 2012 Wiley Periodicals, Inc. KEY WORDS: hepatitis E; immigrants; seroe- pidemiological survey INTRODUCTION Hepatitis E virus (HEV) represents the major etio- logical agent of enteric non-A hepatitis. Once thought to be an infection confined to developing countries, it is now recognized as a disease of widespread geo- graphic distribution. It is associated with large epi- demic outbreaks, particularly in developing countries (South-East Asia, the Middle East, and North Africa) where the disease is endemic [Purcell and Emerson, 2008]; antibodies to HEV, which are indicative of past infection, have been detected in 5–30% of the general population of these countries [Aggarwal and Naik, 2009]. Sporadic acute cases of HEV hepatitis were de- scribed in Western countries [Psichogiou et al., 1995; Schwartz et al., 1999; Dalton et al., 2008]. Previous seroprevalence studies in industrialized countries reported variable but consistent rates of anti-HEV antibodies in healthy populations: 2.5% in the USA, [Tsang et al., 2000] and 0.4–3% in Western Europe [Mansuy et al., 2004; Ijaz et al., 2005]. In Mediterra- nean European countries (Italy, Spain, and Greece) sporadic HEV infections have been reported, indicat- ing that the virus is somehow present in those popula- tions [Gessoni and Manoni, 1996]. In a recent Italian long-term prospective study, the prevalence of acute hepatitis E was 20.6% in a cohort of 651 patients with acute viral non-A–C hepatitis. Most of these hepatitis cases were travel-related [Romano ` et al., 2011]. In the last 20 years a migratory flow has been going on from developing countries to USA and Western Europe; as *Correspondence to: Gaetano Scotto, Clinic of Infectious Dis- eases, University of Foggia, viale Luigi Pinto 1, 71100 Foggia (FG), Italy. E-mail: g.scotto@medicina.unifg.it Accepted 10 July 2012 DOI 10.1002/jmv.23400 Published online in Wiley Online Library (wileyonlinelibrary.com). ß 2012 WILEY PERIODICALS, INC.