Epidemiology of Hepatitis E Virus in Croatia: a Narrative Mini-Review

Hepatitis E virus (HEV) infection is an emerging public health problem worldwide, mainly presenting as acute self-limiting hepatitis, but extra-hepatic manifestations, as well as chronic hepatitis in immunocompromised populations, have been more commonly recognized. The seroprevalence ranges from 0.6% to 52.5% in Europe, depending on the geographical region and population group tested. This narrative review focuses on HEV epidemiology in Croatia. The seroprevalence studies show that HEV is widespread in Croatia, with significant differences among population groups; healthcare professionals (2.7%), pregnant women (2.9%), general population (3.4%), injecting drug users (6.1%), animal-related professions (4.0-8.1%), alcohol abusers (8.9%), war-related PTSD patients (8.6%), patients with chronic liver diseases (15.1%), blood donors (21.5%), patients after liver transplantation (24.4%) and patients on hemodialysis (5.2-43.4%). The data show that HEV IgG positivity increases with age and is higher in continental than coastal parts of Croatia and in suburban and rural areas. Phylogenetic analysis show that all detected HEV strains in Croatia were identified as genotype 3. Since the emerging trends of HEV spreading are likely to continue, continuous surveillance is important, especially in immunocompromised persons at risk of chronic hepatitis E