Hepatitis E in Ireland –

current situation and

future plans

Dr Lelia Thornton

HSE Health Protection Surveillance Centre, Ireland

ECDC Hepatitis E Meeting, Stockholm, December 2015

HEV in foods

Foods are not currently tested for HEV in Ireland

Planned collaboration between a number of labs – human, veterinary, food and marine – to develop capacity for foodborne virus testing

HEV in animals

No routine testing by veterinary laboratories in Ireland

In 2011, a limited serological survey of pigs in 9 counties – IgG commercial assay

• Sera from 330 pigs

– 89 (27%) positive

• 16 herds

– 13 (81%) positive

O’Connor M et al. Irish Vet J 2015;68:8

Blood Donor Data

• Irish Blood Transfusion Service

(IBTS) carried out 3 studies

on blood donors

• Unpublished data

June 2015

HEV diagnostics - NVRL

• IgM and IgG on request and on all samples for investigation of acute hepatitis – Serology test – Fortress Diagnostics HEV IgG and

IgM CE marked commercial assay

• HEV RNA on request and on all HEV IgM positives– RNA PCR – CE marked commercial assay supplied by

Altona Diagnostics: RealStar HEV RT-PCR kit

• Currently validating a HEV genotyping assay based on sanger sequencing methodologies

• In the past – PHE Colindale for genotyping and quantitative viral load testing

NVRL data

• Unpublished data

Hospital discharge data

Hospital discharges coded to acute hepatitis E between 2002 and 2015 (provisional)

• Total 23 cases (12 in past 3 years)

• 7 female, 16 male

• 22 adults – all age groups

HEV seroprevalence studies

No recent studies

• 1994: 45 haemodialysis patients tested for HEV IgG. All negative

• 1995: 500 antenatal samples – 2 (0.4%) IgG positive

• 1995: 100 samples for hepatitis screening – 4 (4%) IgG positive

Courtney MG et al. Lancet (letter) 1994;344(8930):1166

Lynch M etal. Eur J Clin Microbiol Infect Dis 1995;14(12):1109

HEV to become a notifiable disease

Infectious Diseases (Amendment) Regulations 2015

Case definition – Hepatitis E

Clinical criteria: Not relevant for surveillance purposes

Laboratory criteria:

Acute case

At least one of the following two:

• Hepatitis E virus IgM and IgG antibody positive

• Detection of hepatitis E virus RNA

Chronic case

Hepatitis E virus RNA persisting for at least 3 months

Epidemiological criteria: Not relevant for surveillance purposes

Case classification

Possible case: N/A

Probable: N/A

Confirmed case: Any person meeting the laboratory criteria

Additional measures

recommended

• Enhanced surveillance system

• Public Health operational guidelines

• Collation and reporting of data nationally

• Awareness raising materials for health professionals and public

• Clinical guidelines on testing

• Multidisciplinary/multiagency working

Conclusion – HEV in Ireland

• Limited information on humans, animals or food

• Available information indicates low prevalence in humans

• Likely underdiagnosed

• Increased testing now

• Blood donations to be screened for HEV RNA

• Will be notifiable shortly

• Enhanced surveillance system planned

• Further research, intersectoral collaboration and awareness raising needed

Acknowledgements

Dr Joanne O’Gorman, NVRL

Joanne Moran, NVRL

Dr Joan O’Riordan, NVRL

Tara Mitchell, HPSC

Patricia Garvey, HPSC