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Samreen Ijaz Virus Reference Department Centre for Infections

21/02/2012. 2. Hepatitis E virus . Hepatitis E was not recognised as a separate clinical entity until the 1980sBalayan and colleagues:immune EM identified 27-30nm virus like particlesVirus was successfully transmitted to cynomolgus monkeysENANB (epidemic non-A, non-B or enterically transmitted non-A, non-B)Diagnosis of ENANB was limited to IEM1990s genome was successfully cloned and sequencedThe virus was named Hepatitis E Virus.

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Samreen Ijaz Virus Reference Department Centre for Infections

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    1. 21 February 2012 Samreen Ijaz Virus Reference Department Centre for Infections

    2. 21/02/2012 2

    3. 21/02/2012 3

    4. 21/02/2012 4

    5. 21/02/2012 5 Hepatitis E Virus in endemic regions

    6. 21/02/2012 6 HEV in non-endemic regions

    7. 21/02/2012 7

    8. 21/02/2012 8

    9. 21/02/2012 9 Samples used for this study were accessed from the PHLS (HPA) serological surveillance programme HEV study – a total of 2731 samples from 2 time points 1140 samples from 1991 and 1591 samples from 2004 44% female, 56% male Age range from 1 to 85 years Overall seroprevalence of ~13%

    10. 21/02/2012 10 HEV prevalence by age-group 1991

    11. 21/02/2012 11 HEV prevalence by age-group 1991 vs 2004

    12. 21/02/2012 12 Temporal shift in HEV seroprevalence Increased risk of acquiring HEV appears to be related to time and not to age HEV prevalence: 1991 vs 2004

    13. 21/02/2012 13

    14. 21/02/2012 14

    15. 21/02/2012 15

    16. 21/02/2012 16

    17. 21/02/2012 17 Aurora – cruise liner

    18. 21/02/2012 18 Last week of the cruise………. (last week of March) Contacted about 4 passengers who had become jaundiced Onset dates were between 12th March and 23rd March Determined that 2 of the passengers had been immunised for HAV Recommended that they be tested for HEV markers Passengers disembarked on 28th March in Southampton and samples were obtained Samples were tested locally and all 4 passengers were found to be HEV IgM and IgG positive Recent acute HEV infection Samples sent to HPA, Colindale for confirmation and molecular analysis

    20. 21/02/2012 20 Were these 4 cases just the tip of the iceberg? Passengers had already disembarked and returned home. Contacted all 2500 UK passengers Aurora staff members were not included in the investigation Passengers were contacted and asked to volunteer in the study Volunteers were asked to provide a blood sample and to fill in a questionnaire Aurora Investigation

    21. 21/02/2012 21 Timing of samples was critical

    22. 21/02/2012 22

    23. 21/02/2012 23

    24. 21/02/2012 24

    26. 21/02/2012 26

    27. 21/02/2012 27 Time of Exposure

    28. 21/02/2012 28

    29. 21/02/2012 29

    30. 21/02/2012 30

    31. 21/02/2012 31 Univariate Analysis Significant Gender Alcohol consumption (~11% exceeding recommended weekly intake) Excursions – Honolulu, Hawaii Pago Pago, Samoa Food consumed on board cruise ship Unpasteurised cheese Pate Venison Shellfish

    32. 21/02/2012 32 Multivariable Model Significant Gender Alcohol consumption Consumption of shellfish

    33. 21/02/2012 33 Aurora Investigation Summary 33 acute HEV infections identified Male Alcohol consumption Majority of infections were asymptomatic No breaches of public health on board the ship Analysis suggests that the consumption of shellfish was a potential source of infection LIKELY THAT INFECTION OCCURRED ON BOARD THE SHIP

    34. 21/02/2012 34 Acknowledgements

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