All travelers 18 years and older were eligible
if planning to travel for 1–13 weeks to one or more (sub)tropical countries. All Selleckchem Cabozantinib participants consulted a nurse or medical doctor specialized in travel medicine. Aside from the recommended vaccinations and prescription for antimalaria chemoprophylaxis, according to the Dutch National Guidelines on Traveler’s Health Advice, oral and written information was given about how to avoid acquiring travel-related diseases. This survey formed part of a larger study of travel-related infectious disease. Before departure and 2–6 weeks after return participants donated venous blood samples for serologic testing for anti-HEV antibodies. Participants kept a structured diary from the day they arrived at the (sub)tropical destination and until 2 weeks after
return. Before departure, data were collected for each participant using a standard questionnaire for data collection on health, vaccination status, and travel history. The study protocol was approved by the Medical Ethics Committee of the Academic Medical Centre Amsterdam. Blood samples were immediately stored at 6°C and centrifuged and frozen at−80°C. Serum samples were tested for immunoglobulin Ixazomib purchase G (IgG) antibodies to HEV (anti-HEV IgG) by means of an enzyme-linked immunosorbent assay (MP diagnostics HEV ELISA) according to the manufacturer’s instructions. This test uses antigens from ORF2 and ORF3 of Mexico and Burma strains which can detect especially HEV genotypes 1 and 2, and has lower sensitivity for detection of infection with genotype 3. The presence of IgG antibodies specific for HEV is determined by relating the absorbance of the specimens to the cut-off value of the plate. A sample was Casein kinase 1 considered to be positive if the value was greater than or equal to
the cut-off value. Only when a participants’ post-travel sample tested positive, the pre-travel sample was tested as well. When pre- and post-travel samples tested positive, a previous infection was assumed. Seroconversion was assumed if the pre-travel sample tested negative and the post-travel sample tested positive. To avoid erroneous seroconversion results, a positive test value within the range of 15% above the cut-off value was considered “gray zone” and not indicative for seroconversion. Risk factors for previous HEV infection were calculated using SPSS for Windows version 19.0 to obtain prevalence rates (PRs), univariable (and multivariable) prevalence rate ratios (PRRs), and 95% confidence intervals, by means of logistic regression modeling. The study started with 1276 subjects who intended to travel to (sub)tropical countries for a period of time between 1 and 13 weeks. Of these 1276 participants, 70 were excluded (5.