Is the increase in Hepatitis E incidence 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


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.
Number of pages2
Publication statusPublished - Sept 2015

Publication series

NameJournal of Clinical Virology
ISSN (Print)1386-6532


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


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