title: Hepatitis E outbreak on cruise ship.
abstract: In 2008, acute hepatitis E infection was confirmed in 4 passengers returning to the United Kingdom after a world cruise. Epidemiologic investigation showed that of 789 persons who provided blood samples, 195 (25%) were seropositive, 33 (4%) had immunoglobulin [Ig] M levels consistent with recent acute infection (11 of these persons were symptomatic), and 162 (21%) had IgG only, consistent with past infection. Passenger mean age was 68 years. Most (426/789, 54%) passengers were female, yet most with acute infection (25/33, 76%) were male. Sequencing of RNA from 3 case-patients identified hepatitis E virus genotype 3, closely homologous to genotype 3 viruses from Europe. Significant association with acute infection was found for being male, drinking alcohol, and consuming shellfish while on board (odds ratio 4.27, 95% confidence interval 1.23-26.94, p = 0.019). This was probably a common-source foodborne outbreak.
authors.affiliation: Department of Gastrointestinal, Emerging and Zoonotic Infections, Health Protection Agency Centre for Infections, 61 Colindale Ave, London NW9 5EQ, UK. bengu.said@hpa.org.uk
authors.forename: Bengü
authors.initials: B
authors.lastname: Said
authors.forename: Samreen
authors.initials: S
authors.lastname: Ijaz
authors.forename: George
authors.initials: G
authors.lastname: Kafatos
authors.forename: Linda
authors.initials: L
authors.lastname: Booth
authors.forename: H Lucy
authors.initials: HL
authors.lastname: Thomas
authors.forename: Amanda
authors.initials: A
authors.lastname: Walsh
authors.forename: Mary
authors.initials: M
authors.lastname: Ramsay
authors.forename: Dilys
authors.initials: D
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D004196:Disease Outbreaks; D005260:Female; D005516:Food Microbiology; D005838:Genotype; D016751:Hepatitis E / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D011634:Public Health; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D012307:Risk Factors; D017747:Seafood / Q000009:adverse effects / Q000821:virology; D012758:Shellfish / Q000009:adverse effects / Q000821:virology; D012767:Ships; D014195:Travel; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral