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. 2020 Nov 9;27(7):taaa132.
doi: 10.1093/jtm/taaa132.

Travel-related hepatitis E: a two-decade GeoSentinel analysis

Laura Ambra P Nicolini  1 , Rhett J Stoney  2 , Andrea Della Vecchia  3   4 , Martin Grobusch  5 , Philippe Gautret  6 , Kristina M Angelo  2 , Perry J J van Genderen  7 , Emmanuel Bottieau  8 , Karin Leder  9 , Hilmir Asgeirsson  10 , Daniel T Leung  11 , Bradley Connor  12 , Prativa Pandey  13 , Federica Toscanini  1 , Federico Gobbi  14 , Francesco Castelli  15 , Matteo Bassetti  1   3 , Davidson H Hamer  16   17   18
Affiliations

Travel-related hepatitis E: a two-decade GeoSentinel analysis

Laura Ambra P Nicolini et al. J Travel Med. .

Abstract

Background: Hepatitis E virus (HEV) is widely distributed worldwide and is endemic in developing countries. Travel-related HEV infection has been reported at national levels, but global data are missing. Moreover, the global availability of HEV diagnostic testing has not been explored so far. The aim of this study is to describe the epidemiology of HEV infections in returning travellers and availability of HEV diagnostic testing in the GeoSentinel surveillance network.

Methods: This was a multicentre retrospective cross-sectional study. All confirmed and probable HEV travel-related infections reported in the GeoSentinel Network between 1999 and 2018 were evaluated. GeoSentinel sites were asked to complete a survey in 2018 to assess the availability and accessibility of HEV diagnostic procedures (i.e. serology and molecular tests) throughout the study period.

Results: Overall, 165 travel-related HEV infections were reported, mainly since 2010 (60%) and in tourists (50%). Travellers were exposed to hepatitis E in 27 countries; most travellers (62%) were exposed to HEV in South Asia. One patient was pregnant at the time of HEV infection and 14 had a concomitant gastrointestinal infection. No deaths were reported. In the 51% of patients with information available, there was no pre-travel consultation. Among 44 GeoSentinel sites that responded to the survey, 73% have access to HEV serology at a local level, while 55% could perform (at a local or central level) molecular diagnostics.

Conclusion: Reported access to HEV diagnostic testing is suboptimal among sites that responded to the survey; this could negatively affect diagnosing HEV. Pre-travel consultations before travel to South Asia and other low-income and high-prevalence areas with a focus on food and water precautions could be helpful in preventing hepatitis E infection. Improved HEV diagnostic capacity should be implemented to prevent and correctly diagnose travel-related HEV infection.

Keywords: HEV; epidemiology; geosentinel; hepatitis; travel.

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Conflict of interest statement

Conflict of interest

The authors have declared no conflict of interest.

Figures

Figure 1.
Figure 1.
Countries of exposure among travellers with hepatitis E virus infection reported to GeoSentinel, 1999–2018; footnote includes 157 (95%) of 165 travellers with a single country of exposure listed in the patient record
See this image and copyright information in PMC

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