Epidemiology of acute hepatitis E in Singapore

Objectives: We undertook an epidemiological review to determine the trend and characteristics of acute hepatitis E in Singapore over the last 12 years.

Methods: We analysed the epidemiological records of all laboratory-confirmed cases of acute hepatitis E maintained at the Communicable Diseases Division, Ministry of Health, from 2000 to 2011.

Results: A total of 540 laboratory-confirmed cases of acute hepatitis E was reported with more than half imported, mainly from India and Bangladesh. Among the indigenous cases, the mean annual incidence per 100,000 population increased from 0.05 in 2000-2002 to 0.92 in 2009-2011. There was a male predominance and the median age was 46 years. Among the 3 major ethnic groups of Singapore residents, Chinese and Indians had higher mean annual incidence rate compared to Malays. All the indigenous cases occurred singly and sporadically and could not be epidemiologically linked to one another by person, place or time. No common food item was implicated.

Conclusions: Indigenous acute hepatitis E has emerged as a major cause of acute viral hepatitis in Singapore. While epidemiological investigations are ongoing to elucidate the risk factors and modes of transmission, travellers should be reminded to practise a high standard of personal and food hygiene when visiting endemic countries.