Data on HEV in Ireland

1. 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

2. 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

3. 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

4. Blood Donor Data
• Irish Blood Transfusion Service
(IBTS) carried out 3 studies
on blood donors
• Unpublished data

5. June 2015

6. 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

7. NVRL data
• Unpublished data

8. 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

9. 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

10. HEV to become a notifiable disease
Infectious Diseases (Amendment) Regulations 2015

11. 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

12. 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

13. 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

14. Acknowledgements
Dr Joanne O’Gorman, NVRL
Joanne Moran, NVRL
Dr Joan O’Riordan, NVRL
Tara Mitchell, HPSC
Patricia Garvey, HPSC