Hepatitis E virus (HEV) in Scotland: evidence of recent increase in viral circulation in humans

Katrina Thom, Pamela Gilhooly, Karen McGowan, Kristen Malloy, Lisa M. Jarvis, Claire Crossan, Linda Scobie, Oliver Blatchford, Alison Smith-Palmer, Mhairi C. Donnelly, Janice S. Davidson, Ingolfur Johannessen, Kenneth J. Simpson, Harry R. Dalton, Juraj Petrik*

*Corresponding author for this work

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Hepatitis E virus (HEV) is now increasingly recognised in industrialised countries, where it causes acute infection, and chronic infection in immunosuppressed individuals, including transplant recipients [1,2]. In Europe, locally acquired hepatitis E is predominantly a porcine zoonosis associated with HEV genotypes (gt) 3 and 4. Around 70% of individuals exposed to HEV gt3 are asymptomatic [3]. In many industrialised countries infection with HEV is more common than previously thought. For instance, based on blood donor data from South East England, there are an estimated 100,000 human infections each year in England [4]. Because HEV infection is common and commonly asymptomatic, HEV has found its way into the blood supply, with frequency of viraemic donations between 1:600 to 1:14520 [5-7] and recently some countries (France, Germany, Ireland, the Netherlands) have started or are considering the implementation of HEV RNA donation screening [8,9]. This includes the United Kingdom (UK), which introduced screening of donations destined for ‘high-risk’ recipients (solid organ and haematological stem cell transplant recipients, neonates) [10] in February 2016 and universal screening in March 2017.

Anti-HEV IgG seroprevalence and incidence of hepatitis E varies both between and within countries, and over time. For example, in south-west (SW) France, one study has found a seroprevalence of 52% and incidence of hepatitis E of 3% [11]. Although HEV appears to be hyperendemic in SW France, seroprevalence varies considerably between French departments (range: 8–86%) [12]. The reason for this observation is unknown, but could be related to geographical differences in dietary habits. In contrast, seroprevalence in Scotland, first assessed for the period 2004–08, was found to be 4.7% [5]. In recent years the number of cases of hepatitis E documented in many European countries, including Scotland, has increased, mostly due to improved testing and case ascertainment. However, there is evidence that points to a recent genuine increase in incidence in some European countries [6,12-16].

Compared with many European countries, previously reported Scottish seroprevalence data and rates of viraemia in blood donors were low [5]. In an earlier study, donors were sampled during 2004–08 and were mainly from the Edinburgh area. However, figures for the rest of Scotland and recent changes in seroprevalence and numbers of viraemic blood donors are unknown. The aims of this study were to determine the recent seroprevalence in differing geographical areas of Scotland and if there has been a change in recent years and to cross reference this with the current numbers of viraemic donors and laboratory-confirmed cases, including those in the Scottish liver transplant population.
Original languageEnglish
Number of pages10
Issue number12
Publication statusPublished - 22 Mar 2018


  • hepatitis E
  • virology
  • Scotland
  • epidemiology

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