Unexpectedly high incidence of indigenous acute hepatitis E within South Hampshire: time for routine testing?

De Silva, Aminda N., Muddu, Ajay K., Iredale, John P., Sheron, Nick, Khakoo, Salim I. and Pelosii, Emanuela (2007) Unexpectedly high incidence of indigenous acute hepatitis E within South Hampshire: time for routine testing? Journal of Medical Virology, 80 (2), 283-288. (doi:10.1002/jmv.21062).

Abstract

Hepatitis E indigenous to developed countries (hepatitis EIDC) is a form of hepatitis E in persons with no travel history to highly endemic areas. It has been recognized recently as an emerging clinical entity in a significant number of economically developed countries including UK. However, it is still perceived as a rare disease and routine laboratory testing for hepatitis E is not performed. A series of 13 cases of hepatitis EIDC, diagnosed in a 13-month period from June 2005 within a single center in South Hampshire, UK, is presented. These patients were identified after implementing a novel-screening algorithm that introduced routine hepatitis E serological investigations. Patients were middle aged or elderly and males were affected more commonly. Four patients (31%) required hospital admission. All reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed cases carried hepatitis E virus (HEV) genotype-3, which bore close sequence homology to HEV circulating in UK pigs. None of these patients recalled eating undercooked pork products or close contact with pigs during the 2 months preceding the onset of acute hepatitis. In comparison, during the same period, only two cases of hepatitis A and five cases of acute hepatitis B were diagnosed. These data illustrate the importance of introducing routine hepatitis E testing in all patients with unexplained acute liver disease and absence of relevant travel history. Routine testing can clarify hepatitis E epidemiology whilst improving the clinical management of patients with acute liver disease.

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Contributors

Author: Nick Sheron

Author: Salim I. Khakoo

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