Prompted by cases of acute hepatitis in expatriate workers presenting at Alkhor Hospital, Qatar, a limited prospective observational study was conducted from July 2005 to June 2006 to determine the epidemiological and clinical features of patients (predominantly Nepalese) presenting with acute hepatitis. Countrywide during that period samples from 86 Nepalese presenting at different centers were found to be anti-HEV IgG positive and 50 of thesewere also positive for anti-HEV IgM. Fifty-eight of those Nepalese were seen and treated at AlkhorHospital and of them43were confirmed as cases of acute HEV, being positive for both anti-HEV IgM and IgG. The remaining 15 were diagnosed as probable cases of acute HEV on the basis of clinical and epidemiological similarity. It seemslikely that transit inKathmandu in reportedly unsanitary conditions was the focus of infection. In some of those examined at Alkhor, ultrasound detected a thickened gallbladder wall in 30 of 39 (76.9%) with two cases having clinical acalcular cholecystitis. Higher levels of alanine aminotransferaseandaspartateaminotransferase were associated with severe disease and derangement in coagulation. On the available evidence hepatitis E was imported by expatriate workers and it is clear that medical screening of these workers pre- and post-arrivalmust be improved to prevent further outbreaks. It is also essential that health care workers in Qatar are made aware of this ongoing problem of imported HEV and understand the variable presentation of the condition. © 2009 Wiley-Liss, Inc.

Qatar Nepal Acute hepatitis Hepatitis E Clinical manifestations

prospective study vomiting Alanine Transaminase alanine aminotransferase blood level alanine aminotransferase abdominal pain clinical feature human Qatar cholecystitis blood clotting gallbladder pathology acute disease pruritus nausea Aspartate Aminotransferases screening disease course Young Adult Humans virus detection worker male female ultrasound observational study Disease Outbreaks Article epidemic blood major clinical study adult fever aspartate aminotransferase migration aspartate aminotransferase blood level disease severity Transients and Migrants Nepal immunoglobulin G disease association anorexia hepatitis antibody Hepatitis E immunoglobulin M Hepatitis Antibodies