Seroprevalence of swine hepatitis E virus and the farmers' potential risk of infection in the Province of Bali, Indonesia.

Background and aims: Hepatitis E virus (HEV) infection formerly and predominantly occurred in rural areas. However, it has recently been spread to urban and peri-urban areas. This study aimed to estimate the seroprevalence of HEV in pigs collected from urban and rural areas in Bali. The potential of the pig farmers' risk level for being exposed to HEV and the virus transmitted to them in association with their pig-rearing practices was also assessed.

Materials and methods: A total of 183 pigs from 68 herds were sampled in this study, with 91 pigs collected from Denpasar as the representative samples of urban areas and 92 pigs from Karangasem Regency as the representative samples from rural areas. Sera from the sampled pigs were collected and immunoglobulin G antibodies against HEV were detected using a commercial enzyme-linked immunosorbent assay. A questionnaire was prepared for interviewing the farmers. Bivariable and multivariable logistic regression analyses were performed to identify the putative factors associated with seropositivity. Meanwhile, the potential risk-incurring practices of the farmers for HEV being transmitted to them from their pig-rearing practices were assessed by scoring their responses from the interview.

Results: Overall, 23.5% (43/183) (95% confidence interval [CI]: 17.6-30.3) pig sera tested were detected to have the antibodies against HEV. Among 68 pig herds, 36.8% (25) (95% CI: 25.4-49.3) of them had antibodies in at least one pig sampled from each herd. Pigs sampled from Karangasem were 5 times (Odds ratio [OR] 5.34, 95% CI: 2.27-13.54, p < 0.001) more likely to be seropositive than pigs collected from Denpasar. However, no difference was found in the seropositivity to HEV in pig herds between Denpasar and Karangasem (p = 0.05). In assessing the pig rearing management factors, pig farmers from Denpasar were 3 times (OR 3.0, 95% CI: 1.07-8.52, p = 0.05) more likely to rear pigs for economic investment compared to the farmers from Karangasem. Regarding anticipating pig diseases that can be transmitted to humans, farmers from Denpasar were 6 times (OR 5.72, 95% CI: 1.48-26.7, p = 0.0074) more likely to anticipate zoonotic diseases compared to the farmers from Karangasem. Similarly, pig farmers from Denpasar were 3 times (OR 3.29, 95% CI: 1.08-10.23, p = 0.035) more likely to anticipate pig diseases that could be transmitted to humans than the farmers from Karangasem. Pig farmers from Denpasar had 4 times the odds (OR 4.49, 95% CI: 1.11-18.19, p = 0.03) of washing their hands after going to the pigpens compared to the farmers from Karangasem. All the participants were categorized as being at high risk of HEV exposure and transmission.

Conclusion: IgG antibodies against HEV were detected among pigs reared in rural areas of Karangasem and those reared in urban areas of Denpasar. This suggests that the risk of HEV exposure and transmission in these areas is not negligible. To minimize the risk, public education on zoonotic diseases, including HEV infection, transmission, and prevention, needs to be implemented and particularly targeted to local pig farmers.