Etiology of enterically-transmitted hepatitis among foreigners in Nepal.

We report the etiology of hepatitis in travelers over a ten year period from January 1994 December 2003. Clinics catering to expatriates and tourists in endemic Nepal provided sera for diagnostic testing from persons with signs and symptoms compatible with clinical hepatitis and alanine transaminase levels 2 1/2 times greater than normal. Hepatitis E was determined with anti-HEV IgM, and HEV RT-PCR, and hepatitis A was determined using HAV-IgM. Thirty-seven cases of hepatitis A and 30 cases of hepatitis E were diagnosed during the study period. The frequency of hepatitis A cases decreased with the increasing use of hepatitis A vaccine while the frequency of hepatitis E cases remained stable. A hepatitis E vaccine would be of benefit for travelers to high to high risk areas.