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Local transmission of hepatitis E virus in Australia: implications for clinicians and public health

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Outbreak indicates that HEV should be considered in cases of acute hepatitis, irrespective of the patient’s travel history

In this issue of the MJA, Yapa and her colleagues report an outbreak of locally acquired hepatitis E virus (HEV) in Australia.1 The authors describe 24 cases of serologically confirmed HEV infection in people who had not travelled overseas during the HEV incubation period. Of these, 17 individuals could be epidemiologically linked to a single restaurant; HEV sequencing studies were consistent with a single source outbreak. Seven other locally acquired infections were also identified that were not linked to this restaurant; in one case, HEV RNA was detected in a pork liver sausage locally produced in Australia. HEV has previously been detected in Australian pigs.2

HEV causes an acute, self-limiting hepatitis, similar to hepatitis A virus (HAV) infection, and can be difficult to distinguish clinically from other causes of acute liver injury.3 Infection during pregnancy is associated with a particularly high mortality rate. As for HAV, resolution of HEV infection generally confers protective immunity. HEV is endemic in many low and middle income countries in Asia and Africa, with seroprevalence rates of up to 20–45% reported in adults.4