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

Hepatitis E indigenous to developed countries (hepatitis E IDC ) 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 E IDC , 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. J. Med. Virol. 80:283–288, 2008. © 2007 Wiley‐Liss, Inc.