The results of our study highlight different geographical areas of high general and environmental suitability for the occurrence of waterborne outbreaks of hepatitis E virus. Specifically, our predictions indicate that, at a global scale, the most ecologically suitable hotspots for the virus are the Ganges Valley and Pakistan, the west coast of Saudi Arabia and subequatorial African countries. In addition, we have determined the most important factors and conditions for the spatial occurrence of HEV outbreaks at global scale, and for the seasonal occurrence of outbreaks at regional scale using the Ganges watershed as a case study(population density and water balance).
Our results have also shown that local particularities may also influence the onset of an outbreak, and thus further studies are necessary to better understand the role of other factors such as rainfall, soil properties, land use or river network ephemerality acting at regional scale. In addition, the dataset of HEV outbreaks used here is relatively small (59 entries) and thus more data on the concentration of HEV in surface water, and the occurrence of HEV waterborne cases should be obtained.
Due to the lack of appropriate data, in our models we have not included other environmental factors that may also be important for the occurrence of HEV outbreaks (e.g. sanitation). Nevertheless, the present study represents a step forward for anticipating and preventing the occurrence of hepatitis E epidemics due to the contamination of drinking and recreational water.
For more information, please contact us or take a look at our publication "Population density and water balance influence the global occurrence of hepatitis E epidemics". We sincerely hope that our results will be useful for you!