Hepatitis E is more common than hepatitis A among returning travellers presenting to tertiary care

Catherine Cosgrove, Margaret Armstrong, Mike Kidd, Michael Brown, Tom Doherty

Hospital for Tropical Diseases, London, UK.
The Department of Virology, University College Hospitals London, London, UK.

DOI: 10.4236/wjcd.2013.38082                

Abstract

Introduction: Acute viral hepatitis is a relatively common infection resulting in hospital attendance after foreign travel. Travellers and doctors are generally aware of hepatitis A and the fact that safe and effective immunisation is available. In contrast, there is no widely available vaccine for hepatitis E and most physicians’ experience with this condition is limited. Over the last few years, the number of cases of hepatitis E has increased. Methods: We examined the prevalence of hepatitis A and E among patients presenting to the Hospital for Tropical Diseases between 2000 and 2009. Travel history, demographics and laboratory parameters of these patients were compared. Results: The annual incidence of hepatitis A remained static, while that of hepatitis E increased from 1 to 4. Hepatitis E was associated with older age, travel to the Indian sub-continent (ISC), and visiting friends and relatives (VFR). Peak ALT was similar between patients with hepatitis A or E, but as many as a third of those with hepatitis E developed a prolonged INR, compared to 11% of those with hepatitis A. In addition, patients with hepatitis E had a longer hospital admission by a median of 3 days. Conclusion: Hepatitis E is now the commonest cause of faeco-oral viral hepatitis at this centre, and is associated with laboratory features suggestive of more severe liver damage and longer hospital stay.

 

Keywords

Hepatitis; Returning Traveller

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Public Health England, “Hepatitis A Laboratory Reports and Statutory Notifications, England and Wales,” 2010. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HepatitisA/EpidemiologicalData/
[2]	Behrens, R.H., Collins, M., Botto, B. and Heptonstall, J. (1995) Risk for British travellers of acquiring hepatitis A. British Medical Journal, 311, 193. http://dx.doi.org/10.1136/bmj.311.6998.193a
[3]	Public Health England, 2010. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HepatitisA/Guidelines/
[4]	Li, L., Zhu, Y., Fu, H., Wei, X., Wang, L., Liang, J., Ji, Y., Tang, R. and Zhuang, H. (2009) Full-genome nucleotide sequence and analysis of a Chinese swine hepatitis E virus isolate of genotype 4 identified in the Guangxi Zhuang autonomous region: Evidence of zoonotic risk from swine to human in South China. Liver International, 29, 1230-1240. http://dx.doi.org/10.1111/j.1478-3231.2009.02012.x
[5]	Public Health England, 2010. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HepatitisE/Surveillance/
[6]	Shrestha, M.P., Scott, R.M., Joshi, D.M., Mammen, P.M., Thapa, G.B., Thapa, N., et al. (2007) Safety and efficacy of a recombinant hepatitis E vaccine. The New England Journal of Medicine, 356, 895-903. http://dx.doi.org/10.1056/NEJMoa061847
[7]	Zhu, F.C., Zhang, J., Zhang, X.F., Zhou, C., Wang, Z.Z., Huang, S.J., Wang, H., et al. (2010) Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: A large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet, 376, 895-902. http://dx.doi.org/10.1016/S0140-6736(10)61030-6
[8]	Mushahwar, I.K. (2008) Hepatitis E virus: molecular virology, clinical features, diagnosis, transmission, epidemiology, and prevention. Journal of Medical Virology, 80, 646-658. http://dx.doi.org/10.1002/jmv.21116
[9]	Krawczynski, K. (2007) Hepatitis E vaccine—Ready for prime time? The New England Journal of Medicine, 356, 949-951. http://dx.doi.org/10.1056/NEJMe068311
[10]	Ijaz, S., Arnold, E., Banks, M., Hewitt, K., Ngui, S.L., Boxall, E., et al. (2005) Non-travel-associated hepatitis E in England and Wales: Demographic, clinical, and molecular epidemiological characteristics. The Journal of Infectious Diseases, 192, 1166-1172. http://dx.doi.org/10.1086/444396
[11]	Dalton, H.R., Thurairajah, P.H., Fellows, H.J., Hussaini, H.S., Mitchell, J., Bendall, R., et al. (2007) Autochthonous hepatitis E in southwest England. Journal of Viral Hepatitis, 14, 304-309. http://dx.doi.org/10.1111/j.1365-2893.2006.00800.x
[12]	De Silva, A.N., Muddu, A.K., Iredale, J.P., Sheron, N., Khakoo, S.I. and Pelosi, E. (2008) Unexpectedly high incidence of indigenous acute hepatitis E within South Hampshire: Time for routine testing? Journal of Medical Virology, 80, 283-288. http://dx.doi.org/10.1002/jmv.21062
[13]	Bhatia, V., Singhal, A., Panda, S.K. and Acharya, S.K. (2008) A 20-year single-center experience with acute liver failure during pregnancy: Is the prognosis really worse? Hepatology, 48, 1577-1585. http://dx.doi.org/10.1002/hep.22493
[14]	Dalton, H.R., Bendall, R.P., Keane, F.E., Tedder, R.S. and Ijaz, S. (2009) Persistent carriage of hepatitis E virus in patients with HIV infection. The New England Journal of Medicine, 361, 1025-1027. http://dx.doi.org/10.1056/NEJMc0903778
[15]	Haagsma, E.B., Niesters, H.G., van den Berg, A.P., Riezebos-Brilman, A., Porte, R.J., Vennema, H., et al. (2009) Prevalence of hepatitis E virus infection in liver transplant recipients. Liver Transplantation, 15, 1225-1258.
[16]	Haagsma, E.B., van den Berg, A.P., Porte, R.J., Benne, C.A., Vennema, H., Reimerink, J.H., et al. (2008) Chronic hepatitis E virus infection in liver transplant recipients. Liver Transplantation, 14, 547-553. http://dx.doi.org/10.1002/lt.21480
[17]	Li, R.C., Ge, S.X., Li, Y.P., Zheng, Y.J., Nong, Y., Guo, Q.S., et al. (2006) Seroprevalence of hepatitis E virus infection, rural southern People’s Republic of China. Emerging Infectious Diseases Journal, 12, 1682-1688. http://dx.doi.org/10.3201/eid1211.060332
[18]	Mohanavalli, B., Dhevahi, E., Menon, T., Malathi, S. and Thyagarajan, S.P. (2003) Prevalence of antibodies to hepatitis A and hepatitis E virus in urban school children in Chennai 1. Indian Pediatrics, 40, 328-331.
[19]	Lewis, H.C., Boisson, S., Ijaz, S., Hewitt, K., Ngui, S.L., Boxall, E., et al. (2008) Hepatitis E in England and Wales. Emerging Infectious Diseases Journal, 14, 165-167. http://dx.doi.org/10.3201/eid1401.070307