title: Frequent hepatitis E in the Netherlands without traveling or immunosuppression.
abstract: OBJECTIVE
  In several Western countries, silent endemic hepatitis E virus (HEV) infection is common among blood donors. Immunocompromised persons may develop chronic hepatitis E, but the relevance of endemic HEV for immunocompetent persons remains largely unknown. We investigated the immune status and travel history in cases of hepatitis E in the Netherlands.
  
  
  METHODS
  Between January 2009 and May 2014, physicians throughout the Netherlands submitted samples from 4067 hepatitis patients to Sanquin Diagnostic Services for HEV antibody testing. For the 144 patients testing positive for HEV IgM and HEV RNA, travel behavior and immune status were assessed. Complete information was obtained for 81 patients.
  
  
  RESULTS
  Surprisingly, the majority of patients (52/81, 64%) were immunocompetent and did not travel outside Europe. HEV genotyping was obtained for 47 non-traveling patients, all concerned HEV genotype 3.
  
  
  CONCLUSIONS
  Our findings suggest that currently in Western countries the impact of hepatitis E for non-traveling, immunocompetent persons is underestimated. Historically cases of hepatitis A, B and C, but not cases of hepatitis E, are notifiable and warrant preventive measures. However, in parts of Western Europe HEV may have become the most important source of viral hepatitis, in immunocompetent and in immunosuppressed persons. Pending measures against the ongoing transmission of HEV genotype 3 in parts of Europe, physicians should consider hepatitis E in dealing with new hepatitis patients.
authors.affiliation: Department of Blood-Borne Infections, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Koot
authors.affiliation: Department of Blood-Borne Infections, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands; Department of Virus Diagnostic Services, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.
authors.forename: B M
authors.initials: BM
authors.lastname: Hogema
authors.affiliation: Department of Virus Diagnostic Services, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Koot
authors.affiliation: Department of Blood-Borne Infections, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Molier
authors.affiliation: Department of Blood-Borne Infections, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands; Medical Microbiology (CINIMA), Academic Medical Center, Amsterdam, The Netherlands. Electronic address: h.l.zaaijer@amc.uva.nl.
authors.forename: H L
authors.initials: HL
authors.lastname: Zaaijer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D016751:Hepatitis E / Q000453:epidemiology* / Q000209:etiology*; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010802:Phylogeny; D012367:RNA, Viral; D014195:Travel; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: HEV genotype 3; Hepatitis E; Immunocompetent; Immunosuppressed; Zoonotic