title: The added value of hepatitis E diagnostics in determining causes of hepatitis in routine diagnostic settings in the Netherlands.
abstract: OBJECTIVE
  Hepatitis E virus (HEV) genotype 3 is endemic in Europe and an underdiagnosed and emerging (public) health issue. In recent years commercial enzyme immunoassays (EIAs) that detect antibodies to HEV more adequately, became available. We investigated the added value of this HEV serology in the diagnostic work flow to detect viral causes of recent hepatitis.
  
  
  METHODS
  During a 2-year period (May 2013 to May 2015), HEV serology was added to the hepatitis work flow, consisting of serological detection of hepatitis viruses A, B and C (HAV, HBV, HCV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Samples positive for HEV IgM were also analysed using PCR to detect HEV RNA. If positive, HEV sequencing was performed for genotyping purposes.
  
  
  RESULTS
  In 235 out of 2521 patients (9.3%), a viral cause for hepatitis was found. Recent HAV, HBV, HCV, EBV or CMV infections were serologically diagnosed in 3, 34, 10, 69 and 42 patients, respectively. Seventy-eight patients (3.1%) had a recent HEV infection. In 49 of them, sufficient HEV RNA was present for genotyping. All patients were infected with HEV genotype 3.
  
  
  CONCLUSIONS
  In our region, an HEV infection is the most frequently diagnosed viral cause for recent hepatitis. These results indicate that, in a country where HEV is endemic, serological HEV diagnostics should be added to the standard work-up for viral hepatitis.
authors.affiliation: The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands. Electronic address: m.h.e.doting@umcg.nl.
authors.forename: M H E
authors.initials: MHE
authors.lastname: Doting
authors.affiliation: Izore Centre for Infectious Diseases Friesland, Medical Microbiology, Leeuwarden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Weel
authors.affiliation: The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands.
authors.forename: H G M
authors.initials: HGM
authors.lastname: Niesters
authors.affiliation: The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Riezebos-Brilman
authors.affiliation: Izore Centre for Infectious Diseases Friesland, Medical Microbiology, Leeuwarden, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Brandenburg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D016751:Hepatitis E / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods / Q000706:statistics & numerical data; D058889:Molecular Typing / Q000379:methods / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D016036:Seroepidemiologic Studies; D055815:Young Adult
keywords: Diagnostics; General practitioner; Genotyping; Hepatitis E virus; Recent hepatitis; Serology; The Netherlands; Viral