Hep E not just an overseas risk

Tuesday, 19 Apr 2016

Clinicians should consider a diagnosis of hepatitis E in patients presenting with acute hepatitis, regardless of their travel history, infectious disease experts say.

The advice comes after reports of the first Australian outbreak involving 24 cases of serologically confirmed HEV in people who had not travelled overseas.

Reporting the cases in this week’s MJA Chaturangi Yapa from NSW Heath and colleagues said 17 of the cases were linked to a local restaurant.

All reported consuming pork liver pâte, with the remaining cases consuming a pork product during the incubation period.

The authors advised clinicians to request HEV testing in patients with acute hepatitis, irrespective of travel history, particularly where no aetiology has been determined.

Writing in an accompanying editorial Melbourne infectious disease experts Joseph Doyle and Alex Thompson said locally acquired HEV infection had been considered to be very rare in Australia.

However, they noted that a number of sporadic cases had been reported in Western countries that were also not associated with a history of travel to disease-endemic areas.

The current cases indicated the need to consider locally acquired HEV as a cause of acute hepatitis in Australian patients.

“We suggest HEV serological testing should be requested in cases of acute hepatitis where the initial diagnostic panel is negative, including for people who have not travelled abroad” they wrote.

“Reference laboratories can perform HEV nucleic acid testing, but HEV RNA is generally only detectable in blood during the first week of infection, and in stool for 2 weeks after symptom onset; faecal shedding generally corresponds with infectiousness,” they added.

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