Abstract

Against the background of hepatitis prevention and control in Belgium, an important focus is on healthcare and occupational medicine settings. Most Belgian healthcare workers in training are administered a combined hepatitis A/B vaccine by occupational health services. A female healthcare trainee presented herself to her General Practitioner (GP) with general fatigue after receipt of the first two doses (0, 1, 6 months scheme) of her vaccination course. Serum Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Gamma-Glutamyl Transferase (GGT), and Alkaline Phosphatase (ALP) concentrations were severely elevated, while Total Bilirubin (TBIL) and Lactate Dehydrogenase (LDH) levels both fell within the normal range. The patient was Anti-HAV Immunoglobulin M (IgM) and Immunoglobulin G (IgG) positive, and HBV surface Antigen (HBsAg) and Anti-HBV core antigen (Anti-HBc) negative. Her serum Anti-HBs concentration mounted to 302 IU/l. Anti-HCV antibody concentrations were below the detection limit. It was originally assumed that the patient was HAV-infected due to hepatitis A vaccine failure. Additional blood examination, performed before the third vaccine dose was administered, revealed the occurrence of Anti-HEV IgM and IgG. Consensus was reached that the initial Anti-HAV IgM and IgG levels were due to vaccination, while a coinciding HEV infection resulted in fatigue, high ALT and AST levels, and Anti-HEV IgM and IgG positivity. HEV is the most common cause of acute hepatitis worldwide. Since autochthonous HEV infection is becoming more frequent and can easily be overlooked in occupational medicine and general practices, serological testing for hepatitis E deserves special attention in comparable circumstances.

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