The Epidemiology and Factors Associated with Human Viral Hepatitis Type E in Cambodia


Hepatitis E virus
Tropical diseases
Associated factors



Hepatitis E virus (HEV) is a global public health concern. HEV infection is a tropical disease that is often overlooked. It is most prevalent in countries with a low level of economic development, particularly in Southeast Asia, where the disease is endemic. The infection is responsible for more than 50% of acute viral hepatitis cases, with an overall prevalence ranging from approximately 10% to 40% in Asia. In Cambodia, the burden of HEV infection and its related risk factors are understudied. Therefore, we aimed to describe the epidemiology of HEV infection in a general population in Cambodia.


This study used existing data from a cross-sectional survey of the HEPAR (Hepatitis E virus and Arena virus in rodents and in human populations) project. We extracted related variables from the database project, which was implemented by the Cambodia Pasteur Institute in 2020. Three high population density locations in Cambodia were selected in 2020, including Phnom Penh, Kampong Cham, and Sihanouk Ville provinces, for a total sample of 788 people. Blood samples were drawn and screened for HEV antibodies. Multiple logistic regression analysis with a backward elimination approach was used.


The mean age of the participants was 35 years, ranging from 2 to 54 years. Close to 65% of the participants were women. Approximately 67% completed primary school or had no schooling. The overall HEV prevalence was 24.2% (95% CI: 21.3–27.4), and individuals who lived in Phnom Penh were more likely to be positive for HEV antibodies, with an AOR = 2.26 (95% CI: 1.0 – 5.2). In addition, the infection increased with ages: 21-35 years (AOR = 10.2, 95% CI: 2.8- 48.9), 36-50 years (AOR = 41.3, 95% CI: 13.2–184), > 50 years (AOR = 86.3, 95% CI: 28.0- 381), no education (AOR = 1.98, 95% CI: 1.1–3.7), and hospitalization (AOR = 1.63, 95% CI: 1.1–2.6).


The findings show that HEV infection has been circulating and remains high in the general population in Cambodia, especially in urban areas (Phnom Penh), among older age groups, lower education participants, and those admitted to hospitals. Therefore, interventions to prevent transmission should be more intensified in urban areas (i.e., Phnom Penh) and other urban cities with high population density and should focus on the above determinants. A surveillance program should be put in place to monitor the circulation of this neglected pathogen, specifically among vulnerable individuals.