Hepatitis E Outbreak on Cruise Ship

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Abstract

The outbreak was probably foodborne.

Abstract

In 2008, acute hepatitis E infection was confirmed in 4 passengers returning to the United Kingdom after a world cruise. Epidemiologic investigation showed that of 789 persons who provided blood samples, 195 (25%) were seropositive, 33 (4%) had immunoglobulin [Ig] M levels consistent with recent acute infection (11 of these persons were symptomatic), and 162 (21%) had IgG only, consistent with past infection. Passenger mean age was 68 years. Most (426/789, 54%) passengers were female, yet most with acute infection (25/33, 76%) were male. Sequencing of RNA from 3 case-patients identified hepatitis E virus genotype 3, closely homologous to genotype 3 viruses from Europe. Significant association with acute infection was found for being male, drinking alcohol, and consuming shellfish while on board (odds ratio 4.27, 95% confidence interval 1.23–26.94, p = 0.019). This was probably a common-source foodborne outbreak.

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Most cited references 17

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Complete or near-complete nucleotide sequences of hepatitis E virus genome recovered from a wild boar, a deer, and four patients who ate the deer.

N Kitajima, Kazuaki Takahashi, Natsumi Abe … (2004)

Zoonosis has been implicated in hepatitis E virus (HEV) transmission. We examined wild boar living in a forest of Hyogo prefecture, Japan, and found HEV RNA in three of seven boars. A full-genome HEV isolate from one of them was revealed to be 99.7% identical to a previous isolate from a wild deer hunted in the same forest and to those from four patients who contracted hepatitis E after eating raw meat of the deer. These findings suggest an interspecies HEV transmission between boar and deer in their wild life, and that both animals might serve as an infection source for human beings as suggested previously.

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Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type.

M S Khuroo (1980)

A common source waterborne epidemic of viral hepatitis was studied in Kashmir valley over the six month period from November 1978 to April 1979. Highly sensitive serologic tests for hepatitis B and hepatitis A failed to reveal either one as an etiologic agent of hepatitis. Of 16620 inhabitants of the area screened four times in these six months, viral hepatitis developed in 1.65 per cent. In addition, 27.3 per cent of 128 persons who had contacts with patients who had viral hepatitis had biochemical features of anicteric hepatitis. The mode of spread of the epidemic, length of incubation, clinical features and biochemical test results of the patients studied resembled that of hepatitis A. These findings were in contrast to that of non-A, non-B hepatitis following transfusion, which closely resembles hepatitis B. The data strongly suggest the possibility of another human hepatitis virus and established the fecal oral route of its spread.

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Hepatitis E virus.

Subrat Kumar Panda, Deepshi Thakral, Shagufta Rehman (2015)

Hepatitis E virus (HEV) is the aetiological agent of non-HAV enterically transmitted hepatitis. It is the major cause of sporadic as well as epidemic hepatitis, which is no longer confined to Asia and developing countries but has also become a concern of the developed nations. In the Indian subcontinent, it accounts for 30-60% of sporadic hepatitis. It is generally accepted that hepatitis E is mostly self-limited and never progresses to chronicity. It has a higher mortality in pregnant women where the disease condition is accentuated with the development of fulminant liver disease. Currently, no antiviral drug or vaccine is licensed for HEV, although a vaccine candidate is in clinical trials. HEV genome is 7.2kb in size with three open reading frames (ORFs) and 5' and 3' cis acting elements, which have important roles to play in HEV replication and transcription. ORF1 codes for methyl transferase, protease, helicase and replicase; ORF2 codes for the capsid protein and ORF3 for a protein of undefined function. HEV has recently been classified in the genus Hepevirus of the family Hepeviridae. There are four major recognised genotypes with a single known serotype. The absence of a reliable in vitro propagation system is an obstacle to deciphering HEV biology. The genome of HEV has been cloned, sequenced and the infectious nature of these replicons has been established. However, questions related to replication, transcription, virus-host interactions and pathogenesis remain to be answered. This comprehensive review summarises the progress made so far in HEV research, and addresses some of the unanswered questions.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Infect Dis

Journal ID (publisher-id): EID

Title: Emerging Infectious Diseases

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 1080-6040

ISSN (Electronic): 1080-6059

Publication date (Print): November 2009

Volume: 15

Issue: 11

Pages: 1738-1744

Affiliations

[1]Health Protection Agency Centre for Infections, London, UK (B. Said, S. Ijaz, G. Kafatos, A. Walsh, M. Ramsay, D. Morgan)

[2]Hampshire and Isle of Wight Health Protection Unit, Whitely, UK (L. Booth)

[3]North West London Health Protection Unit, London (H.L. Thomas)

[1 ]Other team members are listed at the end of this article.

Author notes

Address for correspondence: Bengü Said, Department of Gastrointestinal, Emerging and Zoonotic Infections, Health Protection Agency Centre for Infections, 61 Colindale Ave, London NW9 5EQ, UK; email: bengu.said@ 123456hpa.org.uk

Article

Publisher ID: 09-1094

DOI: 10.3201/eid1511.091094

PMC ID: 2857258

PubMed ID: 19891860

SO-VID: e6cc362e-328f-491d-b5d0-63204e1b6c53

Hepatitis E Outbreak on Cruise Ship

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Zoonoses

Most cited references 17

Complete or near-complete nucleotide sequences of hepatitis E virus genome recovered from a wild boar, a deer, and four patients who ate the deer.

Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type.

Hepatitis E virus.

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