If a patient has traveled to China, is there increased risk of exposure to hepatitis E, hepatitis G and yellow fever and thus a need to test for these if there is evidence of liver damage or reduced liver function?

 Hepatitis E:

Conclusion: China is an area that is endemic for hepatitis E, but it is usually a self-limiting disease (except in the setting of pregnancy)

1. Summary of epidemiology of hepatitis E including geographic distribution: Hepatitis E. In Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 10th ed.

China is endemic for hepatitis E. Infection rates during outbreaks range from 1-15% and are higher for adults than for children. Mortality rate is high in pregnant women (15%-25%).

2. Taniguchi M, et al. Epidemiology of hepatitis E in northeastern China, South Korea and Japan. Journal of Infection. 2009;58(3):232-237.

Epidemiologic study that randomly selected subjects from participants (aged 40 and over; men and women) in a previous study comparing Korean immigrants to indigenous people in China and Japan.

The prevalence of hepatitis E antibodies:

Indigenous Chinese (n=300): 47.7%

Indigenous Korean (n=300): 34.0%

Koreans living in China (n=300): 50.7%

Indigenous Japanese (n=300): 6.0%

3. Rong-Cheng Li, et al. Seroprevalence of Hepatitis E Virus Infection, Rural Southern People’s Republic of China. Emerging Infect Dis. 2006;12(11):1682-8.

Cross-sectional study that reports prevalence of hepatitis E antibodies in participants (from several communities in rural southern China.) For 3,431 participants who were tested in 2003 and again in 2004, prevalence of antibodies in serum was 46.2% in 2003 and 49.1% in 2004.

4. The evidence on incidence of hepatitis E infection progressing to liver failure comes from case series. The conclusion is that rates of liver failure and fatality are much higher in pregnant women (15%-25%) with hepatitis E infection than for other demographic groups.

“Hepatitis E Virus Infection” In:UptoDate

“Hepatitis E” In:Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 2006

“Viral Hepatitis” In: Tropical Infectious Diseases, 2006

Hepatitis G:

Conclusion: No evidence for change in risk between travel to China and no travel

Hepatitis caused by other viruses. In: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 10th ed.

Hepatitis G has a worldwide distribution, with different genotypes of the virus predominating in different regions of the world. There is no documented evidence that Hepatitis G is associated with clinical disease.

Yellow fever:

Conclusion: No health risk

WHO has no records of yellow fever outbreaks in China back to 2000. http://www.who.int/csr/don/archive/disease/yellow_fever/en/

Review article of yellow fever also states that there have been no outbreaks in China. Tomori O. Impact of yellow fever on the developing world. Adv Virus Res. 1999;53:5-34.


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Clinical Informationist at EUH Branch Library
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