Abstract
Hepatitis E virus genotype 1 (HEV G1) is an important cause of morbidity and mortality in Africa and Asia. HEV G1's natural history, including the incubation period, remains poorly understood, hindering surveillance efforts and effective control. Using individual-level data from 85 travel-related HEV G1 cases in England and Wales, we estimate the incubation period distribution using survival analysis methods, which allow for appropriate inference when only time ranges, rather than exact times are known for the exposure to HEV and symptom onset. We estimated a 29.8-day (95% confidence interval (CI) 24.1-36.0) median incubation period with 5% of people expected to develop symptoms within 14.3 days (95% CI 10.1-21.7) and 95% within 61.9 days (95% CI 47.4-74.4) of exposure. These estimates can help refine clinical case definitions and inform the design of disease burden and intervention studies.
Highlights
Hepatitis E virus genotypes 1 and 2 (HEV G1 and HEV G2) are an important cause of acute viral hepatitis E and jaundice worldwide and are thought to be responsible for more than 50 000 deaths annually, primarily in Africa and Asia [1]
We found that the median incubation period (30 days) is consistent with general references in the literature to hepatitis E, the upper and lower tails of the incubation period distribution are more extreme than generally mentioned, potentially reflecting the heterogeneity in the human response to the virus, the virus itself or the inoculum size
The tails of the incubation period distribution can serve as a guide for optimal time windows in which to consider potential exposures related to hepatitis E
Summary
Hepatitis E virus genotypes 1 and 2 (HEV G1 and HEV G2) are an important cause of acute viral hepatitis E and jaundice worldwide and are thought to be responsible for more than 50 000 deaths annually, primarily in Africa and Asia [1]. HEV G1 and G2 are known to be responsible for outbreaks and thought to spread primarily from person-to-person by faecal contamination of food and water [2, 3]. Controlling epidemic hepatitis E has been challenging to the public health community due to the lack of readily available efficacious tools and poor understanding of the epidemiology of the disease [6, 7]. Whether the incubation period differs between G1/G2 compared with other genotypes (e.g. G3/G4) as a result of different transmission routes remains unknown [3, 10,11,12]
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