title: Non-travel-associated hepatitis E in England and Wales: demographic, clinical, and molecular epidemiological characteristics.
abstract: Between 1996 and 2003, 186 cases of hepatitis E were serologically diagnosed. Of these, 17 (9%) were not associated with recent travel abroad. Patients were >55 years old (range, 56-82 years old) and tended to be male (76%). Two patients presented with fulminant hepatitis. A total of 129 (69%) cases were associated with recent travel to countries where hepatitis E virus (HEV) is hyperendemic. Compared with patients with travel-associated disease, patients with non-travel-associated disease were more likely to be older, living in coastal or estuarine areas, not of South Asian ethnicity, and infected by genotype 3 strains of HEV. The genotype 3 subgenomic nucleotide sequences were unique and closely related to those from British pigs. Patients infected by HEV indigenous to England and Wales tended to belong to a distinct demographic group, there were multiple sources of infection, and pigs might have been a viral reservoir.
authors.affiliation: Virus Reference Division, Centre for Infections, Health Protection Agency, University College London, London, United Kingdom.
authors.forename: Samreen
authors.initials: S
authors.lastname: Ijaz
authors.forename: Eve
authors.initials: E
authors.lastname: Arnold
authors.forename: Malcolm
authors.initials: M
authors.lastname: Banks
authors.forename: Richard P
authors.initials: RP
authors.lastname: Bendall
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Cramp
authors.forename: Richard
authors.initials: R
authors.lastname: Cunningham
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Harrison
authors.forename: Simon F
authors.initials: SF
authors.lastname: Hill
authors.forename: Lorna
authors.initials: L
authors.lastname: Macfarlane
authors.forename: Rolf E
authors.initials: RE
authors.lastname: Meigh
authors.forename: Shuja
authors.initials: S
authors.lastname: Shafi
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Sheppard
authors.forename: Jacquie
authors.initials: J
authors.lastname: Smithson
authors.forename: Melanie P
authors.initials: MP
authors.lastname: Wilson
authors.forename: Chong-Gee
authors.initials: CG
authors.lastname: Teo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D004739:England / Q000453:epidemiology; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000453:epidemiology* / Q000503:physiopathology* / Q000821:virology; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D014195:Travel; D014852:Wales / Q000453:epidemiology
chemical_list: D006508:Hepatitis Antibodies