Recent reports from Cornwall remind us that autothonous cases of Hepatitis E are increasingly reported in Europe. In fact, reported rates in England and Wales are somewhat higher than those of other regional countries.

The following background data on Hepatitis E in the United Kingdom are abstracted from the Gideon e-book series. [1,2] Primary references are availale on request.

Only one autochthonous case (in 1999) of Hepatitis E was reported during 1994 to 2000 – all others were either imported or source unknown.
– 10 autochthonous cases had been reported as of 2006.
– 186 cases were reported during 1996 to 2003 – including 17 autochthonous cases.
– 100 confirmed and presumed indigenous infections were reported in 2005 (30.4% of total cases, 70% above age 55 years).
– 181 cases were confirmed during January to June, including 25 autochthonous cases.

21 autochthonous cases were documented in southwestern England during a 7-year period (2007 publication). 5 ; 28 in Cornwall and Devon during 2005 to 2006.
- A series of 24 cases of non-travel associated Hepatitis E infection was treated at a hospital in south Wales during a 25-month period (2010 publication)
- 13 cases were confirmed in South Hampshire during a 13-month period (2005 to 2006)

Prevalence surveys:
5% to 35% of pigs on farms in the Yorkshire Humberside area (2008 publication)

Seroprevalence surveys:
16% of blood donors, 13% of patients with chronic liver disease and 25% in individuals over 60 years (southwestern England, 2008 publication)
13% of persons in England (1991 to 2004)
3.9% (native-born) to 8.8% (foreign-born) of persons in inner city London (1996 publication)
2.4% of farming industry workers (2009 publication) 13

Human infection by a porcine strain of Hepatitis E virus has been documented.

Notable outbreaks:
2008 – An outbreak (33 cases) was reported among passengers on a British round-the-world cruise ship.

References:
1. Berger SA. Infectious Diseases of the United Kingdom, 956 pp, 2010. Gideon e-book series. http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-kingdom/
2. Berger SA. Hepatitis D, E and G: Global Status, 89 pp, 2010. http://www.gideononline.com/ebooks/disease/hepatitis-d-e-and-g-global-status/

Update: Posted in ProMED

Although less-recognized that other forms of viral hepatitis, several studies have suggested that Hepatitis E infection is common in the United States. [1,2]

Seroprevalence surveys:
21.0% of non-institutionalized Americans – with highest rates among US-born individuals, males, non-Hispanic whites, and individuals residing in the Midwest and/or in metropolitan areas (1988 to 1994)
13.6% of destitute and 15% of homeless persons in Los Angeles (2000)
2.1% of blood donors (1992 publication)
29.3% of patients with chronic liver disease (Cincinnati, Ohio, 1995 to 2006)
23% to 26% of veterinarians treating swine, compared to 18% of a control group of blood donors (1999)
10.9% of swine workers in North Carolina (2002 publication)
77% of wild rats in Maryland (1997)
73.5% of Norway rats in Baltimore (2005 to 2006)
90% of Norway rats in Hawaii (1986)
44% of Norway rats in Louisiana (1995)

References:
1. Berger SA. Infectious Diseases of the United States, 996 pp. 2010, Gideon e-books http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Berger SA. Hepatitis D, E and G: Global Status, 92 pp. 2010, Gideon e-books http://www.gideononline.com/ebooks/disease/hepatitis-d-e-and-g-global-status/

Update: Posted in ProMED

As reported in ProMED:
Notwithstanding the recent episode in Uganda [see: ProMED-mail post Hepatitis E virus - Uganda 20080304.0894], outbreaks of hepatitis E in Sub-Saharan Africa are rarely reported. The following summary was abstracted from GIDEON.

Botswana
1985 – An outbreak (245 cases) in Maun was ascribed to possible water contamination.

Central African Republic
2002 – An outbreak (48 confirmed cases) in Bangui may have been caused by contaminated drinking water.
2004 – An outbreak (10 cases) in Bangui was caused by contaminated water sold by a street vendor.

Chad
2004 – An outbreak (1442 cases, 46 fatal) was reported in Goz Amer and Goz Beida – Sudanese refugee camps.
2005 – An outbreak (50 or more fatal cases) was reported in the area of Goz Beida (eastern Chad).
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