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In 2005, 329 cases of hepatitis E virus infection were confi rmed in England and Wales; 33 were confi rmed indigenous infections, and a further 67 were estimated to be indigenous infections. Hepatitis E should be considered in the investigation of patients with hepatitis even if they have no history of travel.A cute hepatitis caused by hepatitis E virus (HEV) has historically been considered an imported disease associated with travel to a disease-endemic area. However, an increasing number of sporadic hepatitis E cases not associated with travel have been reported from industrialized countries, including England and Wales (1).Four HEV genotypes have been identifi ed that correlate with the geographic origin of the virus (2). Genotype 1 is regularly identifi ed with disease-hyperendemic areas such as Africa and southern Asia; genotype 2, with Mexico and West Africa; genotype 3, with industrialized countries such as North America, Europe, and Japan; and genotype 4, with eastern Asia and India.The epidemiology of non-travel-associated hepatitis E is largely unknown. Although the main route of transmission in disease-hyperendemic areas is the consumption of fecally contaminated water, risk factors for HEV infection in nondisease-hyperendemic countries have included occupational exposure to pigs (3) and consumption of raw or undercooked pork products (4), shellfi sh (5), and venison (6).HEV is endemic in pig populations worldwide (7), including England and Wales, where HEV genotype 3 is widespread in pigs, and subgenomic sequencing studies have shown a close relationship between pig and human HEV strains (8). Although zoonotic transmission from swine to humans appears plausible, the possibility of a reservoir common to both swine and humans cannot be excluded. The StudyThe reference laboratory for hepatitis E at the Health Protection Agency's Centre for Infections reported 17 cases of non-travel-associated hepatitis E in England and Wales from 1996 through 2003 (5). During 2004, that laboratory and the other hepatitis E reference laboratory in Birmingham received an increased number of samples for HEV testing with a corresponding increase in numbers of hepatitis E cases diagnosed by testing for HEV immunoglobulin (Ig) M and IgG by using ELISAs (Genelabs Technologies Inc, Redwood City, CA, USA). These observations led to this study, the aims of which were to describe the epidemiology of hepatitis E in England and Wales, estimate the number of non-travel-associated cases, and identify risk factors for HEV infection in indigenous cases.During 2005 The number of indigenous HEV infections was estimated for those with an unknown travel history by fi tting a logistical regression model that used Caucasian name and age as predictor variables. An estimated 67 (95% confidence interval 58-75) of the 176 patients (when the date of birth was known) in this group acquired their infection in England and Wales.Twenty-eight indigenous case-patients were available for telephone interview in which a detailed structured questionnaire w...

Emerging infections pose a constant threat to society and can require a substantial response, thus systems to assess the threat level and inform prioritization of resources are essential. A systematic approach to assessing the risk from emerging infections to public health in the UK has been developed. This qualitative assessment of risk is performed using algorithms to consider the probability of an infection entering the UK population, and its potential impact, and to identify knowledge gaps. The risk assessments are carried out by a multidisciplinary, cross-governmental group of experts working in human and animal health. This approach has been piloted on a range of infectious threats identified by horizon scanning activities. A formal risk assessment of this nature should be considered for any new or emerging infection in humans or animals, unless there is good evidence that the infection is neither a recognized human disease nor a potential zoonosis.

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