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Autochthonous hepatitis E in Southwest England: a comparison with hepatitis A

European Journal of Clinical Microbiology & Infectious Diseases volume 27, pages 579–585 (2008)Cite this article

Abstract

The incidence of hepatitis A is falling. In contrast, autochthonous hepatitis E is an emerging infection in developed countries. The objective of this study was to compare both laboratory-confirmed cases of hepatitis A and autochthonous hepatitis E over a 2-year period in Cornwall and Devon and anti-hepatitis A virus (HAV) IgG and anti-hepatitis E virus (HEV) IgG seroprevalence in blood donors. The databases of microbiology laboratories in Cornwall and Devon were searched for the number of diagnostic HEV and HAV assays performed during 2005–2006 and the number of confirmed cases of acute hepatitis A and hepatitis E detected. Patients were followed up until recovery or death. Sera from 500 blood donors from the regional centre were tested for HEV and HAV IgG. In total, 28 cases of autochthonous hepatitis E were identified from 838 assays, and 20 cases of hepatitis A were identified from 4503 assays. Compared to hepatitis A cases, patients with hepatitis E were older (mean age 61 vs. 45 years, P = 0.003), less likely to present in winter (P = 0.028) and had more complications (five vs. one). The IgG seroprevalence rates in blood donors were 45% for HAV and 16% for HEV. There was no relationship between HAV and HEV IgG seropositivity. Autochthonous hepatitis E may be more common than hepatitis A, affects older patients, is less likely to occur in winter and may be associated with more complications. Patients with acute hepatitis, whatever their age or travel history, should be tested for HEV.

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Acknowledgements

We would also like to acknowledge the contribution of colleagues in Cornwall who helped in data acquisition, including Dr. Hyder Hussaini, Dr. David Levine, Dr. Iain Murray, Dr. Lucina Jackson, Dr. Nick Michell, Dr. Peter Thatcher, Dr. Nikki Hare, Dr. Jennie Stephens and the nursing staff in outpatients, Short Stay Unit, Carnkie and Tincroft wards at the Royal Cornwall Hospital, Truro, UK. Colleagues in Devon who helped include Dr. Matthew Cramp (Derriford Hospital Plymouth), Dr. John Lowes and Dr. Keith George (Torbay Hospital), Dr. John Christie (Royal Devon and Exeter Hospital, Exeter) and Dr. Andrew Davies (North Devon District hospital, Barnstaple).

Funding

HRD is in receipt of a grant from the Duchy Health Charity, which supports the HEV research work in Cornwall UK.

Conflict of interest statement

There are no conflicts of interest.

Authorship

HRD instigated the study, wrote the paper and is the guarantor. WS recruited patients for the serosurvey, identified the cases and reviewed the drafts. PT identified the cases of hepatitis E in Plymouth, provided follow-up data and reviewed the drafts. SH identified the cases of hepatitis A and E in Exeter, provided follow-up data and reviewed the drafts. RR identified the cases of hepatitis A and E in Torbay, provided follow-up data and reviewed the drafts. UW identified the cases of hepatitis A and E in Plymouth, provided follow-up data and reviewed the drafts. VE performed the IgG studies and reviewed the drafts. SI performed the HEV serology, HEV RT-PCR and molecular characterisation and reviewed the drafts. RB co-instigated the study, performed the IgG studies and reviewed the drafts of the paper.

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Affiliations

  1. Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, Truro, Cornwall, UK, TR1 3LJ

    H. R. Dalton & W. Stableforth

  2. Peninsula College of Medicine and Dentistry, Truro, UK

    H. R. Dalton

  3. Department of Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK

    S. Hazeldine

  4. Department of Gastroenterology, Derriford Hospital, Plymouth, UK

    P. Thurairajah & U. Warshow

  5. Department of Gastroenterology, Torbay Hospital, Torbay, UK

    R. Ramnarace

  6. Virus Reference Department, Centre for Infections, Health Protection Agency, London, UK

    S. Ijaz

  7. Clinical Microbiology, Royal Cornwall Hospital Trust, Truro, UK

    V. Ellis & R. Bendall

Authors
  1. H. R. Dalton
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  2. W. Stableforth
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  3. S. Hazeldine
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  4. P. Thurairajah
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  5. R. Ramnarace
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  6. U. Warshow
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  7. S. Ijaz
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  8. V. Ellis
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  9. R. Bendall
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Corresponding author

Correspondence to H. R. Dalton.

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Dalton, H.R., Stableforth, W., Hazeldine, S. et al. Autochthonous hepatitis E in Southwest England: a comparison with hepatitis A. Eur J Clin Microbiol Infect Dis 27, 579–585 (2008). https://doi.org/10.1007/s10096-008-0480-z

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  • DOI: https://doi.org/10.1007/s10096-008-0480-z

Keywords

  • Autochthonous
  • Hepatitis A
  • Hepatitis E
  • Zoonosis