Globally, liver disease caused by hepatitis A, B, C, D and E viruses is estimated by the World Health Organisation (WHO) to cause the death of around 1.4 million individuals annually. On World Hepatitis Day, 28 July 2014, the WHO underlines the recent resolution of its World Health Assembly directing its 194 Member States to ensure they have national policies in place to address the challenge of viral hepatitis in a manner that builds on local, national and international expertise and experience with a view to combat the hepatitis viruses successfully.
Worldwide, hepatitis E virus (HEV) is an emerging infection with a current estimate of around 20 million infections occurring annually – with >3 million acute cases and around 57,000 deaths (WHO data). The virus is transmitted primarily through the faecal-oral route causing mostly asymptomatic infection but HEV acquisition may also develop into overt hepatitis and fulminant hepatic failure. Although HEV prevalence is highest in East and South Asia, it is now clear that the infection is a global challenge that does not require travel to such high prevalence areas. Instead, autochthonous (locally acquired) hepatitis E is now a recognised component of UK HEV epidemiology with an increase in HEV cases having been observed in the British nations. In particular, recent collaborative research between NHS Lothian and the University of Edinburgh has highlighted the situation within the Lothian health board. Equally, Health Protection Scotland (HPS) has observed a substantial national increase in laboratory reports of HEV infection rising from 15 cases in 2011 to 95 reports in 2013. Although no HEV outbreaks have been reported in Scotland, greater awareness of autochthonous HEV has led to a general increase in HEV testing with identification of cases.
As a result of the above, NHS Scotland is collaborating closely with the University of Edinburgh and other Scottish research institutions with a view to forge a national approach to the prompt identification and management of HEV infection as well as delineating some of the research required to further our understanding of the virus and its pathogenesis thereby supporting the WHO in its efforts to combat viral (HEV) hepatitis.
Ingólfur Johannessen, Specialist Virology Centre, Department of Laboratory Medicine, the Royal Infirmary of Edinburgh (University of Edinburgh)