title: Coastal clustering of HEV; Cornwall, UK.
abstract: OBJECTIVE
  Autochthonous hepatitis E virus (HEV) infection is a porcine zoonosis and increasingly recognized in developed countries. In most cases the route of infection is uncertain. A previous study showed that HEV was associated geographically with pig farms and coastal areas.
  
  
  OBJECTIVE
  The aim of the present research was to study the geographical, environmental and social factors in autochthonous HEV infection.
  
  
  METHODS
  Cases of HEV genotype 3 infection and controls were identified from 2047 consecutive patients attending a rapid-access hepatology clinic. For each case/control the following were recorded: distance from home to nearest pig farm, distance from home to coast, rainfall levels during the 8 weeks before presentation, and socioeconomic status.
  
  
  RESULTS
  A total of 36 acute hepatitis E cases, 170 age/sex-matched controls and 53 hepatitis controls were identified. The geographical spread of hepatitis E cases was not even when compared with both control groups. Cases were more likely to live within 2000 m of the coast (odds ratio=2.32, 95% confidence interval=1.08-5.19, P=0.03). There was no regional difference in the incidence of cases and controls between west and central Cornwall. There was no difference between cases and controls in terms of distance from the nearest pig farm, socioeconomic status or rainfall during the 8 weeks before disease presentation.
  
  
  CONCLUSIONS
  Cases of HEV infection in Cornwall are associated with coastal residence. The reason for this observation is uncertain, but might be related to recreational exposure to beach areas exposed to HEV-contaminated 'run-off' from pig farms. This hypothesis merits further study.
authors.affiliation: aEuropean Centre for Environment & Human Health, University of Exeter Medical SchoolbUniversity of Exeter Medical SchoolcCornwall Gastrointestinal UnitdDepartment of Clinical Microbiology, Royal Cornwall Hospital, TruroePublic Health England, St Austell, Cornwall, UK.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Hunter
authors.forename: Richie G
authors.initials: RG
authors.lastname: Madden
authors.forename: Ashleigh M
authors.initials: AM
authors.lastname: Stone
authors.forename: Nick
authors.initials: N
authors.lastname: Osborne
authors.forename: Ben
authors.initials: B
authors.lastname: Wheeler
authors.forename: Louisa
authors.initials: L
authors.lastname: Vine
authors.forename: Amanda
authors.initials: A
authors.lastname: Dickson
authors.forename: Maggie
authors.initials: M
authors.lastname: Barlow
authors.forename: James
authors.initials: J
authors.lastname: Lewis
authors.forename: Richard P
authors.initials: RP
authors.lastname: Bendall
authors.forename: Nan X
authors.initials: NX
authors.lastname: Lin
authors.forename: William E
authors.initials: WE
authors.lastname: Henley
authors.forename: William H
authors.initials: WH
authors.lastname: Gaze
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
mesh_terms: D000822:Animal Husbandry; D000818:Animals; D016022:Case-Control Studies; D016000:Cluster Analysis; D004739:England / Q000453:epidemiology; D004781:Environmental Exposure; D016751:Hepatitis E / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016017:Odds Ratio; D011891:Rain; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013552:Swine; D013997:Time Factors