Considering the large proportion of donors who consume meat on a daily basis it is not surprising that the low percentage (3.3%) of vegetarian donors is not sufficient to affect the overall seroprevalence. difference in prevalence was apparent for all those age groups. Conclusions Compared with meat-eating donors, the incidence of HEV contamination is usually significantly lower among donors not eating meat, indicating that meat consumption is a major risk factor for HEV contamination. Introduction Hepatitis E computer virus (HEV) is an enterically transmitted non-enveloped virus, classified into at least 4 genotypes [1]. Recently it became obvious that locally acquired HEV genotype 3 (gt3) infections occur frequently in high-income countries [1]. For example, in Southeast England, one in 2848 donations were found HEV RNA positive, and in the Netherlands one in 760 donations was HEV-RNA positive [2,3]. HEV gt3 contamination usually goes unnoticed, but it can progress to severe and fatal disease; immunocompromised patients are at risk of developing chronic contamination and cirrhosis [4]. Source(s) and transmission routes of HEV gt3 to humans are still enigmatic. Pigs form by far the largest known reservoir and are a likely source, as most swine farms throughout Europe are infected, HEV has been detected in retail meat and HEV isolates from pigs are genetically highly much like HEV found in patients and blood donors [1,5]. However, the majority of sequences from HEV isolates from pigs in the United Kingdom differ from the dominant type seen in British patients, suggesting that HEV in the UK may be imported via meat from other countries, or additional sources and transmission routes may exist [6]. An increased seroprevalence among people with occupational contact with pigs (veterinarians and farmers) was reported in several but not all studies [7,8,9,10]. Case control studies have shown significantly more pork, wild boar and offal meat consumption among hepatitis E patients as compared to control groups [11,12], but part of the difference may be caused by recollection bias. Furthermore, these studies focused on patients displaying clinical symptoms, representing a minority of individuals infected with HEV gt3. Two local HEV outbreaks were analyzed in which asymptomatically infected persons were traced; consumption of pork liver pat and shellfish were the most likely source of contamination in a restaurant in Australia and on a cruise ship, respectively [13,14]. While consumption of undercooked meat is generally assumed to be a major source of HEV contamination, most evidence is usually indirect or based on case reports. It is not well known to what extent HEV-contaminated fruit, vegetables and water contribute to transmission of HEV [15,16]. To further clarify the relation between meat consumption and HEV contamination, we compared the anti-HEV IgG seroprevalence among blood donors who do not eat meat with those (Rac)-PT2399 who eat meat on a daily basis. Materials and methods Donors who consume meat on a daily (Rac)-PT2399 basis and donors who declared to consume no meat at all were recognized using data from Donor InSight, a questionnaire applied to a random sample of approximately 10% of the Dutch blood donor populace in 2007C2009 [17]. As part of this questionnaire, donors were asked how often they consumed Cd99 meat per week. Five answers were possible, ranging from never to (almost) every day. 647 of 19,867 donors (3.3%) who answered the question about meat consumption declared to never consume meat and 18722 (94%) declared to consume meat (almost) every day. Repository samples from 403 donors who do now consume meat, collected between October 2011 and (Rac)-PT2399 May 2012 were available. A control group with comparable age and sex distribution was selected among donors who reported to consume meat on an (almost) daily basis (94.2% of the DIS participants) and made a donation between November 2012 and January 2013. Samples were tested for HEV antibodies using the Wantai HEV-IgG assay (Wantai Biological Pharmacy Enterprise Co., Beijing, China) following the manufacturers instructions. Possible differences in sensitivity of different kit lots were assessed by screening a panel of samples representing the entire range of HEV-IgG antibody reactivity using the test (Rac)-PT2399 kit lots applied. A comparison with the sensitivity of the kit lot used in our previous study [18] was made accordingly, using samples from the previous study (Rac)-PT2399 and one of the kit.