Autochthonous hepatitis E in southwest England

Area of Science:

• Hepatology
• Virology
• Epidemiology

Background:

• Autochthonous hepatitis E (HEV) is recognized in developed nations, but its prevalence and characteristics in the UK remain largely unknown.
• Understanding local HEV epidemiology is crucial for public health.
• Previous studies have not fully elucidated the extent of indigenous HEV infections in the UK.

Purpose of the Study:

• To investigate the natural history, identify lifestyle risk factors, and determine the molecular epidemiology of autochthonous hepatitis E in southwest England.
• To assess the frequency of indigenous HEV infections in patients with unexplained hepatitis.
• To characterize the HEV genotype involved in UK cases.

Main Methods:

• Retrospective analysis of 333 patients with unexplained hepatitis over seven years.
• Testing for hepatitis E virus (HEV) infection markers.
• Amplification and molecular characterization of isolated HEV RNA using polymerase-chain-reaction (PCR).

Main Results:

• Twenty-one (6.3%) patients were diagnosed with autochthonous hepatitis E, with no travel history to endemic areas.
• Affected individuals were predominantly middle-aged or elderly males; most infections occurred in spring, summer, and autumn.
• All PCR-confirmed cases harbored HEV genotype 3, closely related to strains found in UK pigs. Most patients recovered within six weeks.

Conclusions:

• Autochthonous hepatitis E is likely underdiagnosed in the United Kingdom.
• Pigs may serve as a reservoir for HEV genotype 3, suggesting a potential zoonotic transmission route.
• Hepatitis E represents a significant public health concern in the UK requiring further investigation and awareness.