Criteria

World Health Organization (WHO) suggested outbreak case definition[65]

Presumptive case

  • A person with either or both of the following:

    • Discrete onset of an acute illness with symptoms of acute infectious illness (fever, malaise, fatigue) AND signs of liver damage (anorexia, nausea, jaundice, dark urine, right upper quadrant tenderness); or

    • Raised alanine aminotransferase (ALT) levels more than ten times the upper limit of normal laboratory levels.

Confirmed case

  • Laboratory confirmation: immunoglobulin M (IgM) anti-HEV positive (adding a second test increases specificity - e.g., IgA anti-HEV, IgG anti-HEV, or HEV-RNA); or

  • An epidemiological link with a confirmed case in the context of an aetiologically confirmed outbreak.

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