Hepatitis E Virus Infection in Brazil: A Scoping Review of Epidemiological Features.

Introduction: Although Brazil includes industrialized regions, such as the Southeast, it also has underdeveloped areas with poor sanitation, such as the North and Northeast, resembling regions in Africa and Asia where HEV is endemic. In Brazil, HEV is suspected to occur mainly as a zoonosis. Given the wide variation in HEV prevalence across the five regions, a scoping review was conducted to systematically evaluate its prevalence and circulating genotypes.

Aim: To investigate the epidemiological characteristics of HEV in Brazil, including modes of transmission, by reviewing genotyping studies in humans and swine.

Methods: This scoping review followed the methodological framework of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. Gray literature was retrieved from Google Scholar, the Brazilian Digital Library of Theses and Dissertations, and the Thesis and Dissertation Catalog of the Coordination for the Improvement of Higher Education Personnel. Searches were performed in June and July 2025 in MEDLINE and LILACS. The evidence on HEV epidemiology in Brazil was mapped using the Population, Concept, and Context strategy.

Results: Among 57 studies on HEV prevalence in Brazil, 45 (78.9%) involved humans and 12 (21.1%) involved swine. IgG prevalence ranged from 0.5% in the North to 59.4% in the South. IgM prevalence was lowest in the Northeast (0.1%) and highest in the North (16.3%). In swine, HEV was detected in all regions, with variation in sample types, husbandry practices, and prevalence. Genotyping revealed exclusively HEV-3 in all regions where analysis was performed.

Conclusions: HEV infection is present throughout Brazil, with higher prevalence in the South and Southeast. The circulating genotype is HEV-3, and transmission is likely linked to swine breeding and consumption.