Is the increase in hepatitis E in Scotland true or a reflection of testing patterns?

Claire L. Crossan, S Nair, Rory Gunson, J. P. Burns, A. Smith-Palmer, I. Johannessen, S. Ramalingam, Linda Scobie

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Background: Autochthonous hepatitis E (HEV) is now recognised as the major cause of acute viral hepatitis in Scotland and transfusion associated HEV is increasingly recognised to be a major problem. The incidence of HEV infection in Scotland has also increased dramatically in recent years. Since 2011 there has been a substantial increase in laboratory reports of HEV; from 13 in 2011, to 78 in 2012, 95 in 2013 and 161 in 2014, more than ten-fold the number four years earlier. However, it has been difficult to determine whether the increase in incidence is real or reflected increased testing in Scotland.
Methods: An archive of samples (n = 316) from patients investigated for hepatitis or screened for blood borne hepatitis viruses between 2008 and 2009 in the West of Scotland was identified. All samples had tested negative for hepatitis B and C. Samples were screened for anti-HEV IgM and IgG antibodies using two commercial ELISA kits (Mikrogen Diagnostik, Germany and Wantai, Beijing, China). All HEV IgM and IgG antibody positive samples were tested for the presence of HEV RNA by RT-PCR. Acute HEV was defined as a sample reactive for HEV IgM and either HEV RNA or HEV IgG.
Results: The patient demographic ranged from 1 to 75 years (Mean: 45.3 years, SD:14.8) with a female to male ratio of 1:1.18. HEV IgM was detected in 0.37% and 2.7% of samples by Mikrogen and Wantai respectively. HEV IgG, was detected in 5.4% and 9.0% of samples by Mikrogen and Wantai respectively. Two acute cases were identified, one sample was reactive for both HEV IgM and HEV IgG but was not found to be viraemic; the second sample was IgM reactive and HEV RNA positive. Three IgG positive samples were also found to be viraemic with genotype 3 by RT-PCR.
Conclusions: As per our definition, there were two cases of acute hepatitis E in our archived panel 2008–2009, one of which was not viraemic. The sero- prevalence of HEV IgG ranged from 5.4 to 9.0% with the two assays. Differences in the HEV IgG results between assays are known to occur and molecular testing has been recommended for patients who may be immune-suppressed. These results would also suggest that molecular testing may preferential. We hence conclude that the increase in the incidence of acute hepatitis E seen over the past few years in Scotland is real and not an artifact of improved diagnostics.
Original languageEnglish
Title of host publicationJournal of Clinical Virology
Subtitle of host publicationAbstracts of the 18th Annual Meeting of European Society for Clinical Virology, 9th–12th September 2015, Edinburgh
PublisherElsevier B.V.
PagesS96-97
Number of pages2
Volume70
DOIs
Publication statusPublished - Sep 2015

Publication series

NameJournal of Clinical Virology
NumberSupplement 1
Volume70
ISSN (Print)1386-6532

Fingerprint

Hepatitis E
Scotland
Immunoglobulin G
Immunoglobulin M
RNA
Hepatitis
Incidence
Polymerase Chain Reaction
Hepatitis Viruses
Antibodies
Hepatitis C
Hepatitis B
Artifacts
Germany
China
Enzyme-Linked Immunosorbent Assay
Genotype
Demography
Infection

Keywords

  • hepatitis E
  • acute viral hepatitis
  • testing patterns
  • screening

Cite this

Crossan, C. L., Nair, S., Gunson, R., Burns, J. P., Smith-Palmer, A., Johannessen, I., ... Scobie, L. (2015). Is the increase in hepatitis E in Scotland true or a reflection of testing patterns? In Journal of Clinical Virology: Abstracts of the 18th Annual Meeting of European Society for Clinical Virology, 9th–12th September 2015, Edinburgh (Vol. 70, pp. S96-97). (Journal of Clinical Virology; Vol. 70, No. Supplement 1). Elsevier B.V.. https://doi.org/10.1016/j.jcv.2015.07.224
Crossan, Claire L. ; Nair, S ; Gunson, Rory ; Burns, J. P. ; Smith-Palmer, A. ; Johannessen, I. ; Ramalingam, S. ; Scobie, Linda. / Is the increase in hepatitis E in Scotland true or a reflection of testing patterns?. Journal of Clinical Virology: Abstracts of the 18th Annual Meeting of European Society for Clinical Virology, 9th–12th September 2015, Edinburgh. Vol. 70 Elsevier B.V., 2015. pp. S96-97 (Journal of Clinical Virology; Supplement 1).
@inproceedings{a8814eb4e8964ba08f6be6df3f4485c7,
title = "Is the increase in hepatitis E in Scotland true or a reflection of testing patterns?",
abstract = "Background: Autochthonous hepatitis E (HEV) is now recognised as the major cause of acute viral hepatitis in Scotland and transfusion associated HEV is increasingly recognised to be a major problem. The incidence of HEV infection in Scotland has also increased dramatically in recent years. Since 2011 there has been a substantial increase in laboratory reports of HEV; from 13 in 2011, to 78 in 2012, 95 in 2013 and 161 in 2014, more than ten-fold the number four years earlier. However, it has been difficult to determine whether the increase in incidence is real or reflected increased testing in Scotland.Methods: An archive of samples (n = 316) from patients investigated for hepatitis or screened for blood borne hepatitis viruses between 2008 and 2009 in the West of Scotland was identified. All samples had tested negative for hepatitis B and C. Samples were screened for anti-HEV IgM and IgG antibodies using two commercial ELISA kits (Mikrogen Diagnostik, Germany and Wantai, Beijing, China). All HEV IgM and IgG antibody positive samples were tested for the presence of HEV RNA by RT-PCR. Acute HEV was defined as a sample reactive for HEV IgM and either HEV RNA or HEV IgG.Results: The patient demographic ranged from 1 to 75 years (Mean: 45.3 years, SD:14.8) with a female to male ratio of 1:1.18. HEV IgM was detected in 0.37{\%} and 2.7{\%} of samples by Mikrogen and Wantai respectively. HEV IgG, was detected in 5.4{\%} and 9.0{\%} of samples by Mikrogen and Wantai respectively. Two acute cases were identified, one sample was reactive for both HEV IgM and HEV IgG but was not found to be viraemic; the second sample was IgM reactive and HEV RNA positive. Three IgG positive samples were also found to be viraemic with genotype 3 by RT-PCR.Conclusions: As per our definition, there were two cases of acute hepatitis E in our archived panel 2008–2009, one of which was not viraemic. The sero- prevalence of HEV IgG ranged from 5.4 to 9.0{\%} with the two assays. Differences in the HEV IgG results between assays are known to occur and molecular testing has been recommended for patients who may be immune-suppressed. These results would also suggest that molecular testing may preferential. We hence conclude that the increase in the incidence of acute hepatitis E seen over the past few years in Scotland is real and not an artifact of improved diagnostics.",
keywords = "hepatitis E, acute viral hepatitis, testing patterns, screening",
author = "Crossan, {Claire L.} and S Nair and Rory Gunson and Burns, {J. P.} and A. Smith-Palmer and I. Johannessen and S. Ramalingam and Linda Scobie",
year = "2015",
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language = "English",
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series = "Journal of Clinical Virology",
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}

Crossan, CL, Nair, S, Gunson, R, Burns, JP, Smith-Palmer, A, Johannessen, I, Ramalingam, S & Scobie, L 2015, Is the increase in hepatitis E in Scotland true or a reflection of testing patterns? in Journal of Clinical Virology: Abstracts of the 18th Annual Meeting of European Society for Clinical Virology, 9th–12th September 2015, Edinburgh. vol. 70, Journal of Clinical Virology, no. Supplement 1, vol. 70, Elsevier B.V., pp. S96-97. https://doi.org/10.1016/j.jcv.2015.07.224

Is the increase in hepatitis E in Scotland true or a reflection of testing patterns? / Crossan, Claire L.; Nair, S; Gunson, Rory ; Burns, J. P.; Smith-Palmer, A.; Johannessen, I.; Ramalingam, S.; Scobie, Linda.

Journal of Clinical Virology: Abstracts of the 18th Annual Meeting of European Society for Clinical Virology, 9th–12th September 2015, Edinburgh. Vol. 70 Elsevier B.V., 2015. p. S96-97 (Journal of Clinical Virology; Vol. 70, No. Supplement 1).

Research output: Chapter in Book/Report/Conference proceedingConference contribution

TY - GEN

T1 - Is the increase in hepatitis E in Scotland true or a reflection of testing patterns?

AU - Crossan, Claire L.

AU - Nair, S

AU - Gunson, Rory

AU - Burns, J. P.

AU - Smith-Palmer, A.

AU - Johannessen, I.

AU - Ramalingam, S.

AU - Scobie, Linda

PY - 2015/9

Y1 - 2015/9

N2 - Background: Autochthonous hepatitis E (HEV) is now recognised as the major cause of acute viral hepatitis in Scotland and transfusion associated HEV is increasingly recognised to be a major problem. The incidence of HEV infection in Scotland has also increased dramatically in recent years. Since 2011 there has been a substantial increase in laboratory reports of HEV; from 13 in 2011, to 78 in 2012, 95 in 2013 and 161 in 2014, more than ten-fold the number four years earlier. However, it has been difficult to determine whether the increase in incidence is real or reflected increased testing in Scotland.Methods: An archive of samples (n = 316) from patients investigated for hepatitis or screened for blood borne hepatitis viruses between 2008 and 2009 in the West of Scotland was identified. All samples had tested negative for hepatitis B and C. Samples were screened for anti-HEV IgM and IgG antibodies using two commercial ELISA kits (Mikrogen Diagnostik, Germany and Wantai, Beijing, China). All HEV IgM and IgG antibody positive samples were tested for the presence of HEV RNA by RT-PCR. Acute HEV was defined as a sample reactive for HEV IgM and either HEV RNA or HEV IgG.Results: The patient demographic ranged from 1 to 75 years (Mean: 45.3 years, SD:14.8) with a female to male ratio of 1:1.18. HEV IgM was detected in 0.37% and 2.7% of samples by Mikrogen and Wantai respectively. HEV IgG, was detected in 5.4% and 9.0% of samples by Mikrogen and Wantai respectively. Two acute cases were identified, one sample was reactive for both HEV IgM and HEV IgG but was not found to be viraemic; the second sample was IgM reactive and HEV RNA positive. Three IgG positive samples were also found to be viraemic with genotype 3 by RT-PCR.Conclusions: As per our definition, there were two cases of acute hepatitis E in our archived panel 2008–2009, one of which was not viraemic. The sero- prevalence of HEV IgG ranged from 5.4 to 9.0% with the two assays. Differences in the HEV IgG results between assays are known to occur and molecular testing has been recommended for patients who may be immune-suppressed. These results would also suggest that molecular testing may preferential. We hence conclude that the increase in the incidence of acute hepatitis E seen over the past few years in Scotland is real and not an artifact of improved diagnostics.

AB - Background: Autochthonous hepatitis E (HEV) is now recognised as the major cause of acute viral hepatitis in Scotland and transfusion associated HEV is increasingly recognised to be a major problem. The incidence of HEV infection in Scotland has also increased dramatically in recent years. Since 2011 there has been a substantial increase in laboratory reports of HEV; from 13 in 2011, to 78 in 2012, 95 in 2013 and 161 in 2014, more than ten-fold the number four years earlier. However, it has been difficult to determine whether the increase in incidence is real or reflected increased testing in Scotland.Methods: An archive of samples (n = 316) from patients investigated for hepatitis or screened for blood borne hepatitis viruses between 2008 and 2009 in the West of Scotland was identified. All samples had tested negative for hepatitis B and C. Samples were screened for anti-HEV IgM and IgG antibodies using two commercial ELISA kits (Mikrogen Diagnostik, Germany and Wantai, Beijing, China). All HEV IgM and IgG antibody positive samples were tested for the presence of HEV RNA by RT-PCR. Acute HEV was defined as a sample reactive for HEV IgM and either HEV RNA or HEV IgG.Results: The patient demographic ranged from 1 to 75 years (Mean: 45.3 years, SD:14.8) with a female to male ratio of 1:1.18. HEV IgM was detected in 0.37% and 2.7% of samples by Mikrogen and Wantai respectively. HEV IgG, was detected in 5.4% and 9.0% of samples by Mikrogen and Wantai respectively. Two acute cases were identified, one sample was reactive for both HEV IgM and HEV IgG but was not found to be viraemic; the second sample was IgM reactive and HEV RNA positive. Three IgG positive samples were also found to be viraemic with genotype 3 by RT-PCR.Conclusions: As per our definition, there were two cases of acute hepatitis E in our archived panel 2008–2009, one of which was not viraemic. The sero- prevalence of HEV IgG ranged from 5.4 to 9.0% with the two assays. Differences in the HEV IgG results between assays are known to occur and molecular testing has been recommended for patients who may be immune-suppressed. These results would also suggest that molecular testing may preferential. We hence conclude that the increase in the incidence of acute hepatitis E seen over the past few years in Scotland is real and not an artifact of improved diagnostics.

KW - hepatitis E

KW - acute viral hepatitis

KW - testing patterns

KW - screening

U2 - 10.1016/j.jcv.2015.07.224

DO - 10.1016/j.jcv.2015.07.224

M3 - Conference contribution

VL - 70

T3 - Journal of Clinical Virology

SP - S96-97

BT - Journal of Clinical Virology

PB - Elsevier B.V.

ER -

Crossan CL, Nair S, Gunson R, Burns JP, Smith-Palmer A, Johannessen I et al. Is the increase in hepatitis E in Scotland true or a reflection of testing patterns? In Journal of Clinical Virology: Abstracts of the 18th Annual Meeting of European Society for Clinical Virology, 9th–12th September 2015, Edinburgh. Vol. 70. Elsevier B.V. 2015. p. S96-97. (Journal of Clinical Virology; Supplement 1). https://doi.org/10.1016/j.jcv.2015.07.224