# Elevated risk of hepatitis E virus infection among sheep smallholders in Xinjiang, China

## TL;DR

Sheep smallholders in Xinjiang, China, face a significantly higher risk of hepatitis E virus infection compared to the general population.

## Contribution

This study identifies smallholder sheep farmers as a high-risk group for HEV infection, highlighting the need for targeted public health interventions.

## Key findings

- Sheep industry workers had a 53.0% HEV seropositivity rate, much higher than the general population's 13.3%.
- Smallholder farmers had a 10.1-fold increased risk of HEV infection compared to other groups.
- No significant HEV risk was found among slaughterhouse or retail market workers.

## Abstract

Hepatitis E virus (HEV) is an emerging zoonotic pathogen that infects both humans and domestic animals. Although HEV has been detected in sheep, the risks of transmission along the food chain via the mutton industry chain remain poorly characterized. This study aimed to assess the occupational risk of HEV infection among sheep industry workers. A cross-sectional survey was conducted among sheep workers in various settings, including smallholder farms, slaughterhouses, and retail markets. Serum samples from these workers, as well as from individuals in the general population, were collected and tested for anti-HEV IgM and IgG antibodies using commercial ELISA kits. Risk factors for HEV seropositivity across different occupational environments were analyzed using logistic regression. The seropositivity rate among sheep industry workers was 53.0% (132/249), significantly higher than that in the general population (13.3%, 33/249). Multi-variable analysis revealed a markedly increased risk of HEV infection among smallholder sheep farmers (adjusted OR = 10.1, 95% CI: 6.3–16.3). In contrast, there was no significantly elevated risk among people working in retail markets or slaughterhouses. The results indicate that occupational exposure to sheep is associated with a heightened risk of HEV infection, particularly in smallholder farm settings. Strengthening HEV control measures for HEV in high-risk occupational environments is essential for long-term public health prevention and elimination efforts.