Research article Open Access
Like 0



Previous studies showed low levels of circulating hepatitis E virus (HEV) in Scotland. We aimed to reassess current Scottish HEV epidemiology. Blood donor samples from five Scottish blood centres, the minipools for routine HEV screening and liver transplant recipients were tested for HEV antibodies and RNA to determine seroprevalence and viraemia. Blood donor data were compared with results from previous studies covering 2004–08. Notified laboratory-confirmed hepatitis E cases (2009-16) were extracted from national surveillance data. Viraemic samples from blood donors (2016) and chronic hepatitis E transplant patients (2014–16) were sequenced. Anti-HEV IgG seroprevalence varied geographically and was highest in Edinburgh where it increased from 4.5% in 2004–08) to 9.3% in 2014–15 (p = 0.001). It was most marked in donors < 35 years. HEV RNA was found in 1:2,481 donors, compared with 1:14,520 in 2011. Notified laboratory-confirmed cases increased by a factor of 15 between 2011 and 2016, from 13 to 206. In 2011–13, 1 of 329 transplant recipients tested positive for acute HEV, compared with six cases of chronic infection during 2014–16. Of 10 sequenced viraemic donors eight and all six patients were infected with genotype 3 clade 1 virus, common in European pigs. The seroprevalence, number of viraemic donors and numbers of notified laboratory-confirmed cases of HEV in Scotland have all recently increased. The causes of this change are unknown, but need further investigation. Clinicians in Scotland, particularly those caring for immunocompromised patients, should have a low threshold for testing for HEV.


Article metrics loading...

Loading full text...

Full text loading...



  1. Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J, et al. Hepatitis E. Lancet. 2012;379(9835):2477-88.  https://doi.org/10.1016/S0140-6736(11)61849-7  PMID: 22549046 
  2. Dalton HR, Bendall R, Ijaz S, Banks M. Hepatitis E: an emerging infection in developed countries. Lancet Infect Dis. 2008;8(11):698-709.  https://doi.org/10.1016/S1473-3099(08)70255-X  PMID: 18992406 
  3. Guillois Y, Abravanel F, Miura T, Pavio N, Vaillant V, Lhomme S, et al. High proportion of asymptomatic infections in an outbreak of hepatitis E associated with a spit-roasted piglet, France, 2013. Clin Infect Dis. 2016;62(3):351-7.  https://doi.org/10.1093/cid/civ862  PMID: 26429341 
  4. Hewitt PE, Ijaz S, Brailsford SR, Brett R, Dicks S, Haywood B, et al. Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. Lancet. 2014;384(9956):1766-73.  https://doi.org/10.1016/S0140-6736(14)61034-5  PMID: 25078306 
  5. Cleland A, Smith L, Crossan C, Blatchford O, Dalton HR, Scobie L, et al. Hepatitis E virus in Scottish blood donors. Vox Sang. 2013;105(4):283-9.  https://doi.org/10.1111/vox.12056  PMID: 23763589 
  6. Zaaijer HL. No artifact, hepatitis E is emerging. Hepatology. 2015;62(2):654.  https://doi.org/10.1002/hep.27611  PMID: 25418372 
  7. Donnelly MC, Scobie L, Crossan CL, Dalton H, Hayes PC, Simpson KJ. Review article: hepatitis E-a concise review of virology, epidemiology, clinical presentation and therapy. Aliment Pharmacol Ther. 2017;46(2):126-41.  https://doi.org/10.1111/apt.14109  PMID: 28449246 
  8. Domanović D, Tedder R, Blümel J, Zaaijer H, Gallian P, Niederhauser C, et al. Hepatitis E and blood donation safety in selected European countries: a shift to screening? Euro Surveill. 2017;22(16):30514.  https://doi.org/10.2807/1560-7917.ES.2017.22.16.30514  PMID: 28449730 
  9. O’Riordan J, Boland F, Williams P, Donnellan J, Hogema BM, Ijaz S, et al. Hepatitis E virus infection in the Irish blood donor population. Transfusion. 2016;56(11):2868-76.  https://doi.org/10.1111/trf.13757  PMID: 27522065 
  10. Advisory Committee on the Safety of Blood. Tissues and Organs. SaBTO/BSBMT Recommendations on the use of HEV-screened blood components. [Accessed 8 Jun 2016]. Available from: http://hospital.blood.co.uk/media/28241/hev-sabto-recommendations-march-2016.pdf
  11. Mansuy JM, Bendall R, Legrand-Abravanel F, Sauné K, Miédouge M, Ellis V, et al. Hepatitis E virus antibodies in blood donors, France. Emerg Infect Dis. 2011;17(12):2309-12.  https://doi.org/10.3201/eid1712.110371  PMID: 22172156 
  12. Mansuy JM, Gallian P, Dimeglio C, Saune K, Arnaud C, Pelletier B, et al. A nationwide survey of hepatitis E viral infection in French blood donors. Hepatology. 2016;63(4):1145-54.  https://doi.org/10.1002/hep.28436  PMID: 27008201 
  13. Petrik J, Lozano M, Seed CR, Faddy HM, Keller AJ, Prado Scuracchio PS, et al. Hepatitis E. Vox Sang. 2016;110(1):93-130.  https://doi.org/10.1111/vox.12285  PMID: 26198159 
  14. Hogema BM, Molier M, Slot E, Zaaijer HL. Past and present of hepatitis E in the Netherlands. Transfusion. 2014;54(12):3092-6.  https://doi.org/10.1111/trf.12733  PMID: 24889277 
  15. Ijaz S, Said B, Boxall E, Smit E, Morgan D, Tedder RS. Indigenous hepatitis E in England and wales from 2003 to 2012: evidence of an emerging novel phylotype of viruses. J Infect Dis. 2014;209(8):1212-8.  https://doi.org/10.1093/infdis/jit652  PMID: 24273173 
  16. Adlhoch C, Avellon A, Baylis SA, Ciccaglione AR, Couturier E, de Sousa R, et al. Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15. J Clin Virol. 2016;82:9-16.  https://doi.org/10.1016/j.jcv.2016.06.010  PMID: 27393938 
  17. Health Protection Scotland (HPS). Gastrointestinal & Zoonoses. Glasgow: HPS. [Accessed Jun 2016]. Available from: http://www.hps.scot.nhs.uk/giz/index.aspx
  18. Health Protection Scotland (HPS). HPS Weekly Report. 2016;50(13). Glasgow: HPS; 29 Mar 2016. Available from: http://www.hps.scot.nhs.uk/documents/ewr/pdf2016/1613.pdf
  19. Gyarmati P, Mohammed N, Norder H, Blomberg J, Belák S, Widén F. Universal detection of hepatitis E virus by two real-time PCR assays: TaqMan and Primer-Probe Energy Transfer. J Virol Methods. 2007;146(1-2):226-35.  https://doi.org/10.1016/j.jviromet.2007.07.014  PMID: 17825434 
  20. Tamura K, Nei M. Estimation of the number of nucleotide substitutions in the control region of mitochondrial DNA in humans and chimpanzees. Mol Biol Evol. 1993;10(3):512-26. PMID: 8336541 
  21. Kumar S, Stecher G, Tamura K. MEGA7: Molecular Evolutionary Genetics Analysis version 7.0 for bigger datasets. Mol Biol Evol. 2016;33(7):1870-4.  https://doi.org/10.1093/molbev/msw054  PMID: 27004904 
  22. Bouquet J, Cherel P, Pavio N. Genetic characterization and codon usage bias of full-length Hepatitis E virus sequences shed new lights on genotypic distribution, host restriction and genome evolution. Infect Genet Evol. 2012;12(8):1842-53.  https://doi.org/10.1016/j.meegid.2012.07.021  PMID: 22951575 
  23. Slot E, Hogema BM, Riezebos-Brilman A, Kok TM, Molier M, Zaaijer HL. Silent hepatitis E virus infection in Dutch blood donors, 2011 to 2012. Euro Surveill. 2013;18(31):20550.  https://doi.org/10.2807/1560-7917.ES2013.18.31.20550  PMID: 23929229 
  24. Smith DB, Ijaz S, Tedder RS, Hogema B, Zaaijer HL, Izopet J, et al. Variability and pathogenicity of hepatitis E virus genotype 3 variants. J Gen Virol. 2015;96(11):3255-64.  https://doi.org/10.1099/jgv.0.000264  PMID: 26282123 
  25. Doceul V, Bagdassarian E, Demange A, Pavio N. Zoonotic hepatitis E virus: classification, animal reservoirs and transmission routes. Viruses. 2016;8(10):E270.  https://doi.org/10.3390/v8100270  PMID: 27706110 
  26. Said B, Usdin M, Warburton F, Ijaz S, Tedder RS, Morgan D. Pork products associated with human infection caused by an emerging phylotype of hepatitis E virus in England and Wales. Epidemiol Infect. 2017;145(12):2417-23.  https://doi.org/10.1017/S0950268817001388  PMID: 28756783 
  27. Scottish Government. Farm livestock – Pigs. Edinburgh: Scottish Government. [Accessed Jun 2016]. Available from: http://www.gov.scot/Topics/Statistics/Browse/Agriculture-Fisheries/agritopics/Pigs
  28. Colson P, Borentain P, Queyriaux B, Kaba M, Moal V, Gallian P, et al. Pig liver sausage as a source of hepatitis E virus transmission to humans. J Infect Dis. 2010;202(6):825-34.  https://doi.org/10.1086/655898  PMID: 20695796 
  29. Crossan C, Grierson S, Thomson J, Ward A, Nunez-Garcia J, Banks M, et al. Prevalence of hepatitis E virus in slaughter-age pigs in Scotland. Epidemiol Infect. 2015;143(10):2237-40.  https://doi.org/10.1017/S0950268814003100  PMID: 25410494 
  30. O’Hara Z, Crossan C, Craft J, Scobie L. First report of the presence of hepatitis E virus in Scottish-harvested shellfish purchased at retail level. Food Environ Virol. 2018.  PMID: 29442296 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error