title: Autochthonous hepatitis E in Scotland.
abstract: BACKGROUND
  Hepatitis E virus is well recognized cause of acute hepatitis. Traditionally hepatitis E virus (HEV) infections were generally associated with travel to Asia and Africa. Autochthonous hepatitis E is recognized as a major cause acute hepatitis in England and Wales. However, autochthonous hepatitis E has never been documented in Scotland.
  
  
  OBJECTIVE
  We attempted to determine if autochthonous HEV occurred in Scotland.
  
  
  METHODS
  Samples from 377 individuals in the South-East of Scotland presenting with acute hepatitis were tested over six years. Acute hepatitis E was confirmed by detecting viraemia or documenting seroconversion and ORF-2 region sequenced. Structured interviews were carried out to identify risk factors for infection.
  
  
  RESULTS
  Sixteen individuals (4.2%) had evidence of past HEV infection. Twelve (3.2%) had acute HEV infection, 10 of whom had viraemia (genotype 1=3; genotype 3=7). Of these seven with genotype 3 infection, three had not travelled outside Scotland within the incubation period, while four had travelled to Spain (n=3) or Turkey (n=1). All three individuals with genotype 1 infection had travelled to the Indian subcontinent.
  
  
  CONCLUSIONS
  A significant proportion of HEV genotype 3 infections was autochthonous (43%). HEV screening should hence be an integral part of acute hepatitis screening in Scotland, irrespective of the travel history.
authors.affiliation: Department of Laboratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom. Electronic address: sandeep.ramalingam@nhslothian.scot.nhs.uk.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Ramalingam
authors.forename: Donald
authors.initials: D
authors.lastname: Smith
authors.forename: Louise
authors.initials: L
authors.lastname: Wellington
authors.forename: Jeff
authors.initials: J
authors.lastname: Vanek
authors.forename: Peter
authors.initials: P
authors.lastname: Simmonds
authors.forename: Alastair
authors.initials: A
authors.lastname: MacGilchrist
authors.forename: Andrew
authors.initials: A
authors.lastname: Bathgate
authors.forename: Kenneth
authors.initials: K
authors.lastname: Simpson
authors.forename: Ingolfur
authors.initials: I
authors.lastname: Johannessen
mesh_terms: D000328:Adult; D000368:Aged; D019353:Endemic Diseases; D005260:Female; D016751:Hepatitis E / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology
keywords: Autochthonous; HAV; HEV; Hepatitis E virus; RIE; Royal Infirmary of Edinburgh; Scotland; Viral hepatitis; hepatitis A virus; hepatitis E virus