Hepatitis E in high-income countries.
OBJECTIVE
To discuss recent advances in characterising viral Hepatitis E (HEV) in nonendemic regions, with a special focus on epidemiology in high-income countries, different clinical aspects of the disease, possible zoonotic origin of these cases and the improvement of Hepatitis E diagnosis.


RESULTS
In high-income countries, most cases of Hepatitis E are acquired locally and not imported from endemic regions. Different genotypes are involved in indigenous cases than those in endemic regions. Particular population groups, such as transplant recipients, can be persistently infected by hepatitis E and develop chronic diseases. Viral hepatitis E is frequently observed in people in animal care occupations. Indeed, HEV has a large animal reservoir and this emerging disease in developed countries has probably a zoonotic origin.


CONCLUSIONS
Recent studies on viral Hepatitis E have shown that the epidemiology of the disease differs between endemic and nonendemic regions. Several lines of evidence suggest that Hepatitis E is more frequent than was suspected and that it has a possible animal origin. Particular attention must be paid to the possible chronic evolution of various forms of the disease. Surveillance of human cases and animal reservoirs must be developed further.
Pavio
Nicole
N
UMR 1161 Virology, AFSSA LERPAZ, ENVA, INRA. 23 Avenue du General de Gaulle, 94706 Maisons-Alfort cedex, France. npavio@vet-alfort.fr
Mansuy
Jean-Michel
JM
D000818:Animals; D019049:Developed Countries; D016751:Hepatitis E / Q000453:epidemiology*; D006801:Humans; D016273:Occupational Exposure; D016377:Organ Transplantation / Q000009:adverse effects; D015047:Zoonoses / Q000635:transmission