title: Hepatitis E virus is the leading cause of acute viral hepatitis in Lothian, Scotland.
abstract: Acute viral hepatitis affects all ages worldwide. Hepatitis E virus (HEV) is increasingly recognized as a major cause of acute hepatitis in Europe. Because knowledge of its characteristics is limited, we conducted a retrospective study to outline demographic and clinical features of acute HEV in comparison to hepatitis A, B and C in Lothian over 28 months (January 2012 to April 2014). A total of 3204 blood samples from patients with suspected acute hepatitis were screened for hepatitis A, B and C virus; 913 of these samples were also screened for HEV. Demographic and clinical information on patients with positive samples was gathered from electronic patient records. Confirmed HEV samples were genotyped. Of 82 patients with confirmed viral hepatitis, 48 (59%) had acute HEV. These patients were older than those infected by hepatitis A, B or C viruses, were more often male and typically presented with jaundice, nausea, vomiting and/or malaise. Most HEV cases (70%) had eaten pork or game meat in the few months before infection, and 14 HEV patients (29%) had a recent history of foreign travel. The majority of samples were HEV genotype 3 (27/30, 90%); three were genotype 1. Acute HEV infection is currently the predominant cause of acute viral hepatitis in Lothian and presents clinically in older men. Most of these infections are autochthonous, and further studies confirming the sources of infection (i.e. food or blood transfusion) are required.
authors.affiliation: Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: I
authors.initials: I
authors.lastname: Kokki
authors.affiliation: CIIE, University of Edinburgh, King's Buildings, Edinburgh, UK.
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.affiliation: Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, UK.
authors.forename: P
authors.initials: P
authors.lastname: Simmonds
authors.affiliation: Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ramalingam
authors.affiliation: Public Health and Health Policy and NHS Lothian, Edinburgh, UK.
authors.forename: L
authors.initials: L
authors.lastname: Wellington
authors.affiliation: Public Health and Health Policy and NHS Lothian, Edinburgh, UK.
authors.forename: L
authors.initials: L
authors.lastname: Willocks
authors.affiliation: Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: I
authors.initials: I
authors.lastname: Johannessen
authors.affiliation: Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK; Public Health Agency of Sweden, Solna, Sweden; European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Harvala
keywords: Clinical virology; Edinburgh; RNA virus; public health; virus diagnostic