Coastal clustering of HEV; Cornwall, UK

Jeremy G. Hunter, Richie G. Madden, Ashleigh M. Stone, Nick Osborne, Ben Wheeler, Louisa Vine, Amanda Dickson, Maggie Barlow, James Lewis, Richard P. Bendall, Nan X. Lin, William E. Henley, William H. Gaze, Harry R. Dalton*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Background and aims Autochthonous hepatitis E virus (HEV) infection is a porcine zoonosis and increasingly recognized in developed countries. In most cases the route of infection is uncertain. A previous study showed that HEV was associated geographically with pig farms and coastal areas. Aim The aim of the present research was to study the geographical, environmental and social factors in autochthonous HEV infection. Methods Cases of HEV genotype 3 infection and controls were identified from 2047 consecutive patients attending a rapidaccess hepatology clinic. For each case/control the following were recorded: distance from home to nearest pig farm, distance from home to coast, rainfall levels during the 8 weeks before presentation, and socioeconomic status. Results A total of 36 acute hepatitis E cases, 170 age/sex-matched controls and 53 hepatitis controls were identified. The geographical spread of hepatitis E cases was not even when compared with both control groups. Cases were more likely to live within 2000m of the coast (odds ratio= 2.32, 95% confidence interval =1.08-5.19, P=0.03). There was no regional difference in the incidence of cases and controls between west and central Cornwall. There was no difference between cases and controls in terms of distance from the nearest pig farm, socioeconomic status or rainfall during the 8 weeks before disease presentation. Conclusion Cases of HEV infection in Cornwall are associated with coastal residence. The reason for this observation is uncertain, but might be related to recreational exposure to beach areas exposed to HEV-contaminated 'run-off' from pig farms. This hypothesis merits further study.

Original languageEnglish
Pages (from-to)323-327
Number of pages5
JournalEuropean Journal of Gastroenterology and Hepatology
Issue number3
Publication statusPublished - 28 Jan 2016

Bibliographical note

Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.


  • Environment
  • Epidemiology
  • Flooding
  • Hepatitis E virus
  • Jaundice
  • Pigs
  • Socioeconomic status


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