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LETTERS: Hannah Lewis, Dilys Morgan, Samreen Ijaz, and Elizabeth Boxall Indigenous hepatitis E virus infection in England and Wales BMJ 2006; 332: 1509-b-1510-b [Full text]

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Indigenously acquired Hepatitis E: the most common acute viral hepatitis detected in a single centre

Emanuela Pelosi, Peter Hawtin, Aminda De Silva, Nick Sheron, Salim Khakoo   (12 August 2006)

Indigenously acquired Hepatitis E: the most common acute viral hepatitis detected in a single centre 12 August 2006
Emanuela Pelosi, Consultant Virologist Health Protection Agency South East , Southampton General Hospital SO16 6Yd, Peter Hawtin, Aminda De Silva, Nick Sheron, Salim Khakoo Send response to journal: Re: Indigenously acquired Hepatitis E: the most common acute viral hepatitis detected in a single centre	The recent letter by Lewis(1) addresses autochthonous hepatitis E virus (HEV) infection in the UK and suggests that cases may remain unrecognised without routine testing for acute hepatitis E. In Southampton, between May 2005 and June 2006, we have detected 15 cases of acute hepatitis E. Thirteen patients, 9 males and 4 females, were Caucasian and without travel to endemic areas. The average age was 70 years (range 47-85 years), substantially higher than that reported by Lewis(1). Seven of these patients required hospital admission. Two patients were of Asian origin with recent travel to endemic areas. In contrast, during the same period, only two cases of acute hepatitis A and four cases of acute hepatitis B were detected. We systematically test all samples with an ALT >300 IU/l (normal range: 5-42) for hepatitis E IgM and IgG if negative for acute hepatitis A, B, C, CMV and EBV. HEV RNA was detected by PCR in 8/13 hepatitis E antibody positive cases without travel history to endemic regions. In all eight cases the virus was genotype 3, the most common genotype in the UK(2). The high frequency of Hepatitis E detection in this hospital may be a direct result of this recently implemented testing algorithm. Currently available commercial kits for antibody testing were designed to detect infection in endemic countries where different genotypes predominate. Consequently, they may not be fully suitable to detect specific antibodies to genotype strains affecting patients from non-endemic areas(3). Two of our patients had atypical serological profiles, but with detectable HEV RNA. Autochthonous hepatitis E is the most frequently detected acute viral hepatitis in Southampton and we stress the importance of defining appropriate algorithms to identify cases for HEV testing. Dr Emanuela Pelosi, Consultant Virologist Emanuela.Pelosi@suht.swest.nhs.uk Health Protection Agency South East, Southampton General Hospital Dr Peter Hawtin, Regional Microbiologist, Health Protection Agency South East, Southampton General Hospital Dr Aminda De Silva, SpR in Medicine, Southampton University Hospitals Dr Nick Sheron, Senior Lecturer and Consultant Hepatologist, Southampton University Hospitals Dr Salim Khakoo, Wellcome Trust Senior Fellow in Clinical Science and Honorary Consultant Hepatologist, Southampton University Hospitals 1. Lewis H, Morgan D, Boxall E. Indigenous hepatitis E virus infection in England and Wales. BMJ 2006;332:1509-1510. 2. Banks M, Bendall R, Grierson S, Heath G, Mitchell J. and Dalton H. Human and Porcine Hepatitis E Virus strains, United Kingdom. Emerg. Infec. Dis. 2004;10:953-955 3. Lin CC, Wu JC, Chang TT, Chang WY, Yu ML, Tam AW, et al. Diagnostic value of Immunoglobulin G (IgG) and IgM Anti-Hepatitis E Virus (HEV) Tests Based on HEV RNA in an Area Where Hepatitis E Is Not Endemic. J. Clin. Microbiol. 2000;38:3915-3918 Competing interests: None declared