Trends in hepatitis E virus incidence and seroprevalence in the Netherlands, 1988 to 2025

BACKGROUNDHepatitis E virus (HEV) can cause serious liver disease, especially in immunosuppressed patients. In 2013, the Netherlands started HEV-RNA screening of donations for production of solvent detergent (S/D)-treated plasma. Since 2017, all Dutch blood donations are screened.AIMTo study trends in HEV infection, we analysed the prevalence of HEV antibodies in Dutch donors since 1988, and HEV-RNA screening results since 2013.METHODSPrevalence of anti-HEV IgG antibodies was determined in donor samples from 2023, and compared to our previous serosurveillance studies, performed on donor samples collected in 1988, 2000 and 2011. We collected HEV-RNA screening results of S/D plasma donations since 2013, and of all blood donations since 2017.RESULTSIn 2023, 24.3% of donors tested positive for anti-HEV antibodies. Seroprevalence increased with age. An age-cohort effect contributed to an overall decline in seroprevalence compared with 1988, reflecting historically higher infection pressure. Among donors born after 1950, seroprevalence rose in samples collected after 2000. HEV-RNA screening results initially revealed a high incidence that declined sharply after 2015, followed by an upward trend beginning in 2020. HEV-RNA positivity was more common in male and older donors.CONCLUSIONThe data indicate substantial historical fluctuations of HEV infection pressure. High seroprevalence in the late 20th century suggests widespread past exposure, followed by a prolonged period of reduced infection rates. Around 2000, HEV appears to have re-emerged, with increasing seroprevalence among younger donors. Screening has revealed marked year-to-year variability in incidence, underscoring dynamic patterns of HEV circulation.