Hepatitis E is more common than hepatitis A among returning travellers presenting to tertiary care

Introduction: Acute viral hepatitis is a relatively common infection resulting in hospital attendance after foreign travel. Travellers and doctors are generally aware of hepatitis A and the fact that safe and effective immunisation is available. In contrast, there is no widely available vaccine for hepatitis E and most physicians’ experience with this condition is limited. Over the last few years, the number of cases of hepatitis E has increased. Methods: We examined the prevalence of hepatitis A and E among patients presenting to the Hospital for Tropical Diseases between 2000 and 2009. Travel history, demographics and laboratory parameters of these patients were compared. Results: The annual incidence of hepatitis A remained static, while that of hepatitis E increased from 1 to 4. Hepatitis E was associated with older age, travel to the Indian sub-continent (ISC), and visiting friends and relatives (VFR). Peak ALT was similar between patients with hepatitis A or E, but as many as a third of those with hepatitis E developed a prolonged INR, compared to 11% of those with hepatitis A. In addition, patients with hepatitis E had a longer hospital admission by a median of 3 days. Conclusion: Hepatitis E is now the commonest cause of faeco-oral viral hepatitis at this centre, and is associated with laboratory features suggestive of more severe liver damage and longer hospital stay.