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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 slight decrease in 2006 and a significant decrease in 2007. However, since 2008 numbers of cases began to increase again, showing marked increases in 2010/11 (Table). There continues to be a high proportion (more than 20% each year) of cases in older individuals, particularly males, which may be indigenously acquired.

Year

 

 2003

2004

2005

2006

2007

2008

2009

 2010 *2011

Number of confirmed cases

 

 125

150

329

292

162

178

175

 276 450

                                                                                                       *provisional data only 

A structured questionnaire (surveillance form) 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. Surveillance Form: HEV infection (PDF, 130 KB) 

All completed surveillance forms should be faxed to the EIZ team at HPA Colindale (secure fax: 0208905 9929).

A case-control study is currently being undertaken to investigate routes of acquisition in cases of possible indigenous origin following a marked increase in the number of hepatitis E cases seen in England and Wales in 2010/11. Please note the investigation does not replace the current operational guidelines which should still be followed.

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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