Table of Contents

Locator Record

Title: Hepatitis E (HEPE_F )
Contact Number: 1-866-441-NCHS
Years of Content: 2009 - 2010
First Published: January, 2012
Revised: NA
Access Constraints: None
Use Constraints: None
Geographic Coverage: National
Subject:Hepatitis E
Record Source: NHANES 2009 - 2010
Survey Methodology: NHANES 2009 - 2010 is a stratified multistage probability sample of the civilian non-institutionalized population of the U.S.
Medium: NHANES Web site; SAS transport files

Component Description

Hepatitis viruses constitute a major public health problem because of the morbidity and mortality associated with the acute and chronic consequences of these infections. New immunization strategies have been developed to eliminate the spread of hepatitis B virus (HBV) and hepatitis A virus (HAV) in the United States. Recommendations have also been developed for the prevention and control of hepatitis C virus (HCV) infection. Infection with hepatitis E virus (HEV) has been responsible for large water-borne epidemics of acute disease in developing countries and for acute sporadic disease in industrialized developed countries. In immunocompromised individuals, infection with HEV may also cause chronic infection, which may progress to fibrosis and cirrhosis. Because of the high rate of asymptomatic infection with these viruses, information about the prevalence of these diseases is needed to monitor prevention efforts. By testing a nationally representative sample of the U.S. population, NHANES will provide the most reliable estimates of age-specific prevalence needed to evaluate the effectiveness of the strategies to prevent these infections. In addition, NHANES provides the means to better define the epidemiology of other hepatitis viruses. NHANES testing for markers of infection with hepatitis viruses will be used to determine secular trends in infection rates across most age and racial/ethnic groups, and will provide a national picture of the epidemiologic determinants of these infections.

Eligible Sample

Survey participants aged 6 years or older are eligible to be tested.

Description of Laboratory Methodology

Blood specimens are processed, stored, and shipped to the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Detailed instructions on specimen collection and processing can be found in the NHANES Laboratory/Medical Technologists Procedures Manual (LPM).


Hepatitis E (IgG)

DS-EIA-ANTI-HEV-G is an enzyme immunoassay kit intended for the detection of IgG antibodies to hepatitis E virus in human serum or plasma. During an initial incubation, HEV antibody in the sample binds with HEV antigen coated onto wells of a polystyrene stripped plate. Unbound sample is removed by washing. During a second incubation, horseradish peroxidase-labeled antibody conjugate (monoclonal mouse antibodies against human IgG) binds to any human IgG from the sample that was captured on the well. Unbound conjugate is removed by washing and a substrate solution containing tetramethylbenzidine is added to produce color. The reaction is stopped by adding a sulphuric acid solution and the OD of each well is read. The presence or absence of IgG antibodies to hepatitis E virus is determined by the ratio of the OD of each sample to the calculated cut-off value. A sample is considered negative if the sample OD value is < cut-off and is considered positive if the sample OD value is > cut-off.


Hepatitis E (IgM)

DS-EIA-ANTI-HEV-M is an enzyme immunoassay kit intended for the detection of IgM antibodies to hepatitis E virus in human serum or plasma. During an initial incubation, HEV antibody in the sample binds with HEV antigen coated onto wells of a polystyrene stripped plate. Unbound sample is removed by washing. During a second incubation, horseradish peroxidase-labeled antibody conjugate (monoclonal mouse antibodies against human IgM) binds to any human IgM from the sample that was captured on the well. Unbound conjugate is removed by washing and a substrate solution containing tetramethylbenzidine is added to produce color. The reaction is stopped by adding a sulphuric acid solution and the OD of each well is read.The presence or absence of IgM antibodies to hepatitis E virus is determined by the ratio of the OD of each sample to the calculated cut-off value. A sample is considered negative if the sample OD value is < cut-off and is considered positive if the sample OD value is > cut-off.

Data Processing and Editing

Read the General Documentation on Laboratory Data file for detailed data processing and editing protocols. The analytical methods are described in the Description of Laboratory Methodology section above.

Detailed instructions on specimen collection and processing can be found in the NHANES Laboratory/Medical Technologists Procedures Manual (LPM).

 

Laboratory Quality Assurance and Monitoring

The NHANES quality assurance and quality control (QA/QC) protocols meet the 1988 Clinical Laboratory Improvement Act mandates. Detailed QA/QC instructions are discussed in the NHANES Laboratory/Medical Technologists Procedures Manual (LPM) . Read the LABDOC file for detailed QA/QC protocols.

A detailed description of the quality assurance and quality control procedures can be found on the NHANES website.

Analytic Notes

The analysis of NHANES laboratory data must be conducted with the key survey design and basic demographic variables. The NHANES Household Questionnaire Data Files contain demographic data, health indicators, and other related information collected during household interviews. They also contain all survey design variables and sample weights for these age groups. The phlebotomy file includes auxiliary information such as the conditions precluding venipuncture. The household questionnaire and phlebotomy files may be linked to the laboratory data file using the unique survey participant identifier SEQN. 

The age ranges and constraints for hepatitis E testing are as follows: The IgM and IgG hepatitis E antibody tests are performed on all participants 6 years or older.

Exam sample weights should be used for analyses. Please refer to the NHANES Analytic Guidelines  and the on-line NHANES  Tutorial  for further details on the use of sample weights and other analytic issues.

References

Codebook and Frequencies

SEQN - Respondent sequence number

Variable Name:
SEQN
SAS Label:
Respondent sequence number
English Text:
Respondent sequence number.
Target:
Both males and females 6 YEARS - 150 YEARS

LBDHEG - Hepatitis E IgG (anti-HEV)

Variable Name:
LBDHEG
SAS Label:
Hepatitis E IgG (anti-HEV)
English Text:
Hepatitis E IgG (anti-HEV)
Target:
Both males and females 6 YEARS - 150 YEARS
Hard Edits:
to

LBDHEM - Hepatitis E IgM (Anti-HEV)

Variable Name:
LBDHEM
SAS Label:
Hepatitis E IgM (Anti-HEV)
English Text:
Hepatitis E IgM (Anti-HEV)
Target:
Both males and females 6 YEARS - 150 YEARS
Hard Edits:
to