Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease

TLDR

The study aims to describe the natural history of locally acquired hepatitis E and the seroprevalence of HEV IgG in Southwest England. Patients with unexplained hepatitis were tested for HEV and monitored until recovery or death, while 500 blood donors, 336 individuals over 60, and 126 chronic liver disease patients were screened for HEV IgG. Forty autochthonous genotype 3 hepatitis E cases were identified, most were self‑limiting and anicteric, yet 15 % had serious complications and 3 died, with a seasonal peak in spring/summer; HEV IgG seroprevalence rose with age (16 % in donors, 13 % in chronic liver disease patients, 25 % in those >60) and the disease is more common and carries significant morbidity, especially in chronic liver disease.

Abstract

Aims To report the natural history of autochthonous hepatitis E and hepatitis E virus (HEV) IgG seroprevalence in Southwest England. Methods Patients with unexplained hepatitis were tested for hepatitis E and cases followed until recovery or death. Five hundred blood donors, 336 individuals over the age of 60 years and 126 patients with chronic liver disease were tested for HEV IgG. Results Forty cases of autochthonous hepatitis E (genotype 3) were identified. Hepatitis E was anicteric in 25% of cases and usually caused a self-limiting hepatitis predominantly in elderly Caucasian males. Six of 40 had a significant complication and three patients died, two of who had previously undiagnosed cirrhosis. Hepatitis E shows a seasonal variation with peaks in the spring and summer and no cases in November and December. HEV IgG prevalence increases with age, is more common in men and is 16% in blood donors, 13% in patients with chronic liver disease and 25% in individuals over 60 years. Conclusion Autochthonous hepatitis E is more common than previously recognized, and should be considered in the differential diagnosis in patients with hepatitis, whatever their age or travel history. It carries a significant morbidity and when seen in the context of chronic liver disease carries an adverse prognosis.