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Surveillance

Hepatitis E virus (HEV) is an enteric virus which was, until recently, only considered an imported infection. The perception that HEV is still only travel-associated may lead to under-ascertainment of this disease. Any unexplained hepatitis, regardless of travel history should be tested for HEV.

HEV surveillance covers all patients tested for HEV and cases confirmed as HEV positive by the two reference laboratories (Birmingham and Colindale).The objective is to ascertain and investigate non-travel associated cases of HEV in the UK and to identify potential risk factors.

In the UK, between 1996 and 2003, 17 (9%) of 186 serologically confirmed cases of Hepatitis E were indigenously acquired. These non-travel associated cases were likely to be older, male and infected with the genotype 3 strain (related to the pig strain). In addition, 85% of British pigs were found to be anti-HEV antibody positive. However, no direct evidence of transmission from pig to human has been demonstrated. See Related Publications

The number of cases of HEV infection diagnosed by the reference laboratories increased significantly between 2003 and 2005. This was followed by a marked decrease between 2007 and 2009. However, since 2010 numbers of cases have increased substantially (Table). Non-travel cases now account for the majority (64%) of cases in 2011/12 compared to an average of 43% of cases in previous years. Over 60% of the non-travel cases are male and over 50 years of age. Following the increase in the number of hepatitis E cases seen in England and Wales a case-control study was  undertaken to investigate routes of acquisition in cases of possible indigenous origin.

Year

 

 2003

2004

2005

2006

2007

2008

2009

 2010 2011 *2012

Number of confirmed cases

 124 149 329 289 162 176 175 274 456

566 

                                                                                    *provisional data 

Click here for the current operational guidelines  for Health Protection Units to respond appropriately to laboratory reports and/or clinical notifications of hepatitis E virus (HEV) infection.

A structured questionnaire (see surveillance form below) has been developed as part of HEV surveillance. If an outbreak, cluster or interesting case is identified this can be used to gather further information. All completed surveillance forms should be faxed to the EIZ team at HPA Colindale (secure fax: 0208905 9929).

For further information on surveillance for human Hepatitis E in the UK please contact us.


 
  • Surveillance Form: HEV infection (PDF, 130 KB)
    Structured HEV surveillance questionnaire for the collection of detailed information in an outbreak, cluster or for an unusual/ interesting case of HEV
    Added/updated: 7 September 2011

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