The Association Between Hepatitis E Virus Infection and Age, Gender, and Diet in Ecuador

Date of Award

December 2018

Degree Type


Degree Name

Master of Science (MS)


Nutrition Science and Dietetics


Brittany L. Kmush

Subject Categories

Medicine and Health Sciences


The hepatitis E virus (HEV) is a major cause of viral hepatitis throughout the world, but is more common in developing areas, causing liver disease in infected people. Currently, there are gaps in the research about the epidemiology of hepatitis E virus in South America in general, but specifically Ecuador. The purpose of this study is to address these gaps and describe the epidemiology and risk factors for HEV infection. Participants from Machala, a tropical, coastal city, in the El Oro Province were enrolled from January 2014 until December 2015. The study population included 219 index febrile illness patients and 257 associates who lived in close proximity (200 meters) to these patients who agreed to participate in the study. The overall prevalence of HEV in the study was 3.36% (95% CI: 1.95-5.44%). The prevalence of HEV in the associates was 5.06% (95% CI: 2.98-8.46%) and the prevalence in index patients was 1.37% (95% CI: 0.47-3.95%). The associates are more representative of the general population as febrile index patients tend to be younger. The average age of the positive HEV individuals was 49.2 (95% CI: 40.7-57.5) years. The average age of the individuals that were negative for HEV was 32.4 (95% CI: 31.7-45.4) years (t-test p-value: 0.0005). Gender was not associated with seropositivity (t-test p-value: 0.581). Out of the 16 HEV positive cases, 12 (75%) recalled eating meat during one of their meals in the previous 24 hours. Out of the 460 HEV negative cases, 302 (66.37%) recalled eating meat during one of their daily meals. The odds ratio is 1.52 (95% CI:0.48- 4.79, p-value=0.475). BMI was not associated with seropositivity (chi-square p-value: 0.729). Out of the positive HEV cases, 6.25% were classified as underweight, 31.25% were classified as average weight and 62.5% were considered overweight. For the negative HEV cases, 5.5% were classified as underweight, 41.2% were classified as average weight and 53.3% were classified as overweight. The odds ratio is 1.496 for the underweight individuals (CI: 0.168-13.33, p-value=0.718) and the odds ratio is 1.545 for the overweight individuals (CI:0.519-4.598, p-value=0.434), both compared to average weight. The seroprevalence found in this study is similar to that found in other South American countries. Additionally, the increasing seroprevalence with age is commonly observed in HEV endemic areas. Based on the age distribution, it is possible that genotypes 1 or 2 are circulating in this population.


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