Volume 9, Number 4—April 2003 Hepatitis E Virus Epidemiology in
Industrialized Countries To determine the prevalence of
Hepatitis E virus (HEV) in industrialized nations, we analyzed
the excretion of HEV strains by the populations of Spain,
France, Greece, Sweden, and the United States. Twenty of 46
(43.5%) urban sewage samples collected in Barcelona from 1994 to
2002 tested positive for HEV. We identified 15 HEV strains,
which were similar to two HEV isolates previously described in
Barcelona in clinical samples and to strains from diverse
geographic HEV-nonendemic areas. We also identified two HEV
strains in sewage samples from Washington, D.C., and Nancy,
France; these samples were also positive for Hepatitis A virus.
In addition, we studied the role of pigs as a reservoir for HEV
and identified one new swine HEV strain. Our results suggest
that HEV may be more prevalent than previously considered in
industrialized countries and that variants of the virus
circulate simultaneously in one region. Hepatitis E