Hepatitis E in new zealand.

BACKGROUND AND AIM: Locally acquired hepatitis E virus (HEV) infection has been described in a number of developed countries and is thought to be zoonotic from pigs. Little is known about hepatitis E in humans in New Zealand (NZ) but 90% of NZ pigs show evidence of HEV infection. The aim of this study was to investigate the epidemiology of hepatitis E infection in NZ by documenting HEV immunoglobulin (Ig) G seroprevalence in NZ blood donors, testing patients with unexplained hepatitis for HEV, and comparing genetic sequences of human HEV with local porcine isolates. METHODS: In total, 265 blood donors were tested for HEV IgG and 77 patients with unexplained hepatitis were tested for HEV. Viral sequences were compared with known HEV isolates including those from NZ pigs. RESULTS: The HEV IgG seroprevalence was 4%. HEV genotype 3 was isolated in four patients with unexplained hepatitis. Clinical and sequencing data suggest that two cases were acquired in Europe and two in NZ. All cases were in elderly patients, one of whom was asymptomatic and initially misdiagnosed as a drug reaction. The NZ-acquired cases were most similar to HEV from Japan, and bore little sequence homology to HEV isolated from NZ pigs. CONCLUSIONS: Hepatitis E does occur in NZ in patients who have not traveled to endemic areas and seems to affect the elderly. The seroprevalence data suggest that subclinical/unrecognized infection is common. Sequencing data suggest that some reservoir other than pigs could be the source of HEV in NZ. It is recommend that all patients with unexplained hepatitis, whatever their age or travel history, are tested for HEV.

New Zealand's HIV infected population under active follow-up during 2000.

AIM: To audit New Zealand's HIV infected population currently under active follow-up. METHODS: Multiple sources were used to determine anonymously the demographic and management characteristics of HIV infected individuals being monitored with HIV viral load measurements and/or receiving antiretroviral therapy during 2000. RESULTS: 593 people (480 males and 113 females) were under active follow-up. The most common transmission risk was male homosexual contact (56%) followed by heterosexual contact (28%), injecting drug use (3%) and mother to infant transmission (1%). Ethnicity data showed a disproportionate number of Africans (13%) compared to recent census figures. Anti-retroviral therapy was used in 71% of the cohort of whom 62% had HIV viral load measurements below 400 copies/mL. An upper estimate of diagnosed HIV individuals living in New Zealand at 30/9/2000 was 801. CONCLUSIONS: This is the first time that the demographic and clinical state of HIV infected individuals has been assessed throughout New Zealand. The results suggest a slightly lower number of HIV infected individuals currently living in New Zealand than previously estimated. Anti-retroviral therapy is being used effectively within the HIV infected population. The changing demographics, with a higher proportion of people under care from Africa, increasing numbers of females, and an increase in the proportion with heterosexual risk factors are particular challenges.