title: 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.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, Truro, Cornwall, UK. harry.dalton@rcht.cornwall.nhs.uk
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
authors.forename: William
authors.initials: W
authors.lastname: Stableforth
authors.forename: Prem
authors.initials: P
authors.lastname: Thurairajah
authors.forename: Simon
authors.initials: S
authors.lastname: Hazeldine
authors.forename: Rene
authors.initials: R
authors.lastname: Remnarace
authors.forename: Warshow
authors.initials: W
authors.lastname: Usama
authors.forename: Liz
authors.initials: L
authors.lastname: Farrington
authors.forename: Noor
authors.initials: N
authors.lastname: Hamad
authors.forename: Cyril
authors.initials: C
authors.lastname: Sieberhagen
authors.forename: Vic
authors.initials: V
authors.lastname: Ellis
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mitchell
authors.forename: S Hyder
authors.initials: SH
authors.lastname: Hussaini
authors.forename: Malcolm
authors.initials: M
authors.lastname: Banks
authors.forename: Samreen
authors.initials: S
authors.lastname: Ijaz
authors.forename: Richard P
authors.initials: RP
authors.lastname: Bendall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001782:Blood Donors / Q000706:statistics & numerical data*; D002908:Chronic Disease; D004739:England / Q000453:epidemiology; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D016752:Hepatitis E virus / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012621:Seasons; D016036:Seroepidemiologic Studies
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G