Nikhil Prasad Fact checked by:Thailand Medical News Team Jul 06, 2026 1 hour, 8 minutes ago
Medical News: Large Review Finds Multiple Factors Behind Silent Hepatitis E Infections Across the Region
A major new study has revealed that pork meat alone cannot explain why hepatitis E virus (HEV) infections vary so dramatically across the Balkans. While eating contaminated pork has long been recognized as one of the main ways the virus spreads, researchers found that the bigger picture is far more complex, with environmental exposure, diagnostic methods and other animal sources also playing important roles.
A major Balkan study shows that while pork meat contributes to hepatitis E transmission, multiple environmental
and animal-related factors are also driving the virus's hidden spread
The research was conducted by scientists from the Department of Molecular Biology at the University of Plovdiv, the Center of Plant Systems Biology and Biotechnology, the Medical University of Plovdiv, Trakia University in Bulgaria, Brigham Young University–Hawaii in the United States, and the University of Manitoba in Canada. The team carried out the first comprehensive review and meta-analysis focused specifically on hepatitis E exposure among adults in the Balkan region.
More Than 13,000 People Included in the Analysis
The investigators combined data from 28 published studies involving 13,399 adults from Albania, Bulgaria, Croatia, Greece, Romania, Serbia and Turkey. They analyzed blood samples from both the general population and blood donors to determine how many people had antibodies against HEV, indicating previous infection.
The overall analysis showed that approximately 5.68 percent of adults had evidence of past hepatitis E infection. However, infection rates differed greatly between countries. Bulgaria recorded the highest pooled seroprevalence at 26.66 percent, followed by Serbia at 16.01 percent, Romania at 14.81 percent, Croatia at 9.41 percent, Turkey at 4.31 percent, and Greece at just 1.01 percent. These findings highlight that HEV is circulating throughout the Balkans but at highly uneven levels.
Pork Meat Is Only Part of the Story
Because hepatitis E genotype 3 is commonly transmitted through undercooked pork products, the researchers investigated whether countries with higher pork consumption also experienced higher infection rates.
Initial subgroup analyses appeared to support this idea. Countries with high pork consumption had an estimated HEV prevalence of nearly 14 percent, compared with about 4.7 percent in countries with very low or low pork consumption.
However, when the researchers used more rigorous statistical meta-regression analyses that accounted for multiple variables simultaneously, pork consumption was not found to be an independent predictor of hepatitis E exposure. The authors stressed that national pork consumption should be viewed only as an ecological indicator rather than proof of a direct relationship with infection.
This
Medical News report underscores one of the study's most important messages: hepatitis E transm
ission cannot be explained by pork meat alone. The findings suggest that multiple environmental, dietary and methodological factors combine to shape infection patterns across the Balkans.
Modern Testing Is Revealing More Hidden Infections
One of the strongest findings was that the type of laboratory test used had a major influence on reported infection rates. Some commercial antibody tests detected substantially more previous infections than others, producing large differences between studies.
The researchers also found that more recent studies consistently reported higher HEV prevalence than older investigations. Rather than indicating that hepatitis E is suddenly becoming more common, the authors believe improved diagnostic technology and greater awareness have allowed laboratories to detect infections that older tests frequently missed.
This means earlier surveys may have underestimated the true burden of hepatitis E across the region.
Other Sources of Infection May Be Important
The researchers highlighted growing evidence that HEV can spread through several additional routes. Besides pork, the virus has been detected in goats, sheep, wild boar, shellfish, contaminated irrigation water, fresh produce and even rodents. Rural living, backyard animal farming and environmental contamination may all contribute to human exposure.
The analysis also found no significant differences in infection rates between men and women or between blood donors and the general population, suggesting that silent exposure is widespread throughout Balkan communities.
Better Surveillance Is Needed
The authors noted that several Balkan countries still have little or no published information on hepatitis E, making it difficult to assess the virus across the entire region. They recommend standardized diagnostic testing and closer collaboration between medical, veterinary and environmental experts under a One Health framework to better understand how the virus spreads and to improve prevention strategies.
Conclusion
The findings demonstrate that hepatitis E remains an underrecognized public health issue across the Balkans. Although pork meat remains an important source of infection, it cannot fully explain the large differences seen between countries. Improved laboratory testing, expanded surveillance and greater attention to environmental and animal-related transmission pathways will be essential for accurately measuring the disease burden and reducing future infections.
The study findings were published in the peer reviewed journal: Viruses.
https://www.mdpi.com/1999-4915/18/7/736
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Medical News.
Read Also:
https://www.thailandmedical.news/news/new-hepatitis-e-virus-3i-subtype-detected-in-italy
https://www.thailandmedical.news/news/breaking-study-finds-that-hepatitis-e-virus-infects-and-replicates-in-men-s-testicles-and-sertoli-cells
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