Epidemiology

Hepatitis E may be an emerging concern in UK

Last Updated: 2006-04-13 18:20:32 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A team of UK researchers report eight cases of locally acquired hepatitis E seen over a 5-month period in 2005.

Hepatitis E (HEV) is uncommon in the UK, Dr. Robert P. Walt and colleagues at the Birmingham Heartlands Hospital note, adding that cases are usually related to travel to endemic areas. Only five cases of non-travel related HEV in the UK have been reported in the literature, they point out in the Journal of Medical Virology for April.

In the present series, all patients presented with clinical and biochemical characteristics of acute hepatitis, which could not be attributed to medication, and no patients reported having traveled abroad.

Ultrasound examination revealed no focal hepatic abnormality or dilatation of the biliary tract, and serology for HAV, HBV, HVC and autoimmune (ANA, SMA, and LKM antibodies) hepatitis was negative in all patients.

HEV IgM testing confirmed recent infection in six of the patients. In the other two cases, IgM was equivocal or negative, but HEV IgG was positive after clinical recovery.

Usually, the main route of HEV infection in the developing world is contaminated water, the authors note. That is unlikely in the UK and they suggest an alternative source -- cross-species infection.

None of the patients admitted to any contacts with pigs, or to eating undercooked meat, but the frequent consumption of pork pies or shellfish in two cases were potential sources for infection.

A third patient had recently been in contact with a jaundiced patient, they report.

The team concludes that "HEV should be sought in all cases of acute hepatitis in the UK, regardless of travel history, once more common causes have been excluded."

Journal of Medical Virology;78:473-475.