Indigenous hepatitis E virus infection in England and WalesBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7556.1509-b (Published 22 June 2006) Cite this as: BMJ 2006;332:1509
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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
Health Protection Agency South East, Southampton General
Dr Peter Hawtin, Regional Microbiologist, Health Protection
Agency South East, Southampton General Hospital
Dr Aminda De Silva, SpR in Medicine, Southampton University
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
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: No competing interests