Figure 4.

Suggested model of repeated hepatitis E epidemics in hyperendemic areas. IgG anti-Hepatitis E virus (anti-HEV) positivity in the general population is around 4%. Following the epidemic, around 20% are sero-positive. There is a general decline in sero-positivity of IgG anti-HEV and poor exposure to HEV infections during the inter-epidemic period. Repeat outbreaks occur when sero-positivity is around 4% and there is gross fecal contamination of drinking water sources (Adapted from Khuroo, et al. [4]).