Acute viral hepatitis – Should the current screening strategy be modified?
Section snippets
Background
Viral hepatitis is one of the most common of the severe infectious diseases. The five most established viral causes include hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV) [1]. These diverse viruses are members of different virus families. They are all are associated with acute hepatitis, and typically target hepatocytes leading to their destruction. Several herpes viruses, such as cytomegalovirus (CMV) and
Objectives
The aim of this study was to establish the viral aetiology of hepatitis in Lothian region, South-Eastern Scotland, to collect clinical data and to use that information to modify the diagnostic algorithm currently followed in the Specialist Virology Centre at the Royal Infirmary Edinburgh, which conducts routine testing for the region.
Study design
A total of 3426 serum samples obtained from individuals with acute hepatitis were submitted to the Specialist Virology Centre at the Royal Infirmary of Edinburgh between July 2010 and December 2012. The subjects tested for HAV, HBV, HCV, HEV, EBV and CMV were identified from the laboratory database. The information collected included name, date of birth, specimen number, hospital number, location, virological test result as well as ALT level if done within 5 days from virology testing. Clinical
Results
A total of 3426 samples obtained from individuals with suspected acute hepatitis were examined during the 30-month study period. Of those, 25% had biochemical evidence of acute hepatitis (n = 854; ALT > 100 IU/l), 43% had marginally abnormal ALT levels (n = 1492; ALT >50 IU/l and <100 IU/l), 10% had normal ALT levels (n = 334; ALT < 50 IU/l) and 22% had not had ALT measured (n = 782).
All 3426 samples were screened for HAV, HBV and HCV, a subset of 409 samples were screened for HEV and a subset of 835 samples
Discussion
Laboratory testing is essential to identify the aetiology of viral hepatitis, which will determine treatment and public health interventions. In a 30-month study period, a total of 3426 samples were obtained for testing from individuals with suspected acute hepatitis. However, only 25% of them had biochemical evidence of acute hepatitis. Over 30% had either normal ALT levels or had not had their ALT levels measured at all. All confirmed cases of acute HAV, HEV, EBV and CMV infections were
Funding
None.
Competing interests
None.
Ethical approval
The East of Scotland Research Ethics Committee (10/S1402/33).
Acknowledgements
We thank Dr Gina McAllister and Mr Andrew Mitchell for a Cognos search and Dr Donald Smith for helpful comments during the preparation of the manuscript.
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