title: Hepatitis E is a cause of unexplained hepatitis in The Netherlands.
abstract: BACKGROUND
  Hepatitis E virus (HEV) is the major etiologic agent of enterically transmitted viral hepatitis in much of the developing world. Evidence provided in recent years shows that HEV is also prevalent in very low numbers in non-endemic countries. Recently, a cluster of three patients with acute hepatitis E but no history of travel to endemic countries was discovered in the geographical area provided with service by the Public Health Laboratory Groningen and Drenthe, The Netherlands.
  
  
  OBJECTIVE
  This lead to the question whether hepatitis E is a cause of unexplained hepatitis in this district.
  
  
  METHODS
  The prevalence of anti-HEV IgG and IgM among 209 patients with clinical signs of hepatitis, negative test for hepatitis A-C, no history of foreign travel and no other cause of hepatocellular damage was compared with a matched control group of 209 individuals.
  
  
  RESULTS
  We found a significant difference in seroprevalence between the two groups for IgG anti-HEV as determined with the Abbot HEV EIA (6.2% versus 0.5%); however this difference could not be confirmed with the Genelabs Diagnostics HEV IgG ELISA (6.7% versus 3.8%). For confirmed cases of IgM anti-HEV we also detected a significant difference between the two groups (3.3% versus 0.5%). Remarkably, the combination of IgG and IgM anti-HEV was only found among hepatitis patients.
  
  
  CONCLUSIONS
  This study provides evidence of locally acquired hepatitis E in The Netherlands. Therefore, in cases of unexplained acute hepatitis, the diagnosis of hepatitis E should be considered even in the absence of foreign travel.
authors.affiliation: Department of Medical Microbiology, University Hospital Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. k.waar@med.rug.nl
authors.forename: K
authors.initials: K
authors.lastname: Waar
authors.forename: M M P T
authors.initials: MM
authors.lastname: Herremans
authors.forename: H
authors.initials: H
authors.lastname: Vennema
authors.forename: M P G
authors.initials: MP
authors.lastname: Koopmans
authors.forename: C A
authors.initials: CA
authors.lastname: Benne
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D016751:Hepatitis E / Q000175:diagnosis / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000276:immunology*; D006801:Humans; D007124:Immunoenzyme Techniques; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M