Table of Contents

What is Hepatitis E?

Hepatitis E is an infection of the liver cells that leads to inflammation of the liver cells; it is caused by a virus known as the Hepatitis E Virus (HEV). Hepatitis E incubation period ranges from 3 weeks to 9 weeks and has a high mortality rate in pregnant women. Its symptoms are like that of Hepatitis A but it is more severe. The symptoms last for about 2 weeks. It can cause epidemic and can also occur sporadically. Hepatitis E occurs commonly in people between the ages of 15 to 40 years

Structure and Antigens of the Hepatitis E virus

Hepatitis E Virus

Hepatitis E, just like Hepatitis C is a single positive strand RNA virus belonging to the Orthohepevirus genus and the Hepeviridae virus family; it is also similar to the Calicivirus family and also to the Rubella Virus. It is a non-enveloped virus. The International Committee on the Taxonomy of Viruses earlier placed Hepatitis E Virus (HEV) under a unique family known as the Hepatitis E-like family.

HEV is a zoonotic disease in that it can be transmitted from animals to humans because of the genotypes: HEV 3 and 4. In the United States, about 80 to 100 percent of commercial swine farms show evidence of infection with HEV, hence properly cooking of pork is required to a temperature of more than 160^o F or 71^o C for a minimum of 20 minutes.

Hepatitis E transmission and mode of spread

Hepatitis E is transmitted by faeco-oral route, which means it is transmitted when you eat food or drink water with contaminated feces.

Hepatitis E is self-limiting and does not cause chronic disease such as liver cirrhosis or hepatocellular carcinoma). Hepatitis E virus has been found in breast milk but it is not yet known if breastfeeding can transmit Hepatitis E, however, it can be transmitted from mother to child during pregnancy. This virus can also be spread by direct contact with an infected person especially when living in the same household. Oysters (shell fish) contaminated with sewage can transmit the infection.

Hepatitis E symptoms and signs

Feeling of being sick
Poor appetite (anorexia)
Abdominal pains
Tiredness
Vomiting
Pale stool
Nausea
Yellowish eyes
Fever
Dark colored urine like cola

Young children often do not show symptoms of Hepatitis E but they can transmit to other people.

Diagnosis of Hepatitis E

Laboratory testing of blood and stool specimens is used for diagnosis of this infection. Reverse transcriptase polymerase chain reaction (RT-PCR) is reliable for assay of Hepatitis E antibodies: Immuno Globulin G (IgG) and Immuno Globulin M (IgM) known as anti-HEV; theyare found in the blood of infected individuals and the HEV RNA can be found in the stool or blood.

HEV antigen in tissues can be detected using Immunohistochemistry and in-situ hybridization.

Complications of Hepatitis E

Encephalopathy
Renal failure
Miscarriage in pregnant women
Premature delivery in pregnant women

Complications occur more in pregnant women especially in the last 3 months of pregnancy (last trimester) and also in patients with chronic liver disease (CLD). Out of 100 pregnant women infected by Hepatitis E, about 15 to 25 of the pregnant women may die from the disease.

Hepatitis E treatment

There is currently no treatment for Hepatitis E and management of this disease is currently aimed at the symptoms rather than the disease. No anti-viral drugs have been effective in the treatment of Hepatitis E. Recovery from Hepatitis E infection occurs after 2 weeks except in pregnant women in which fulminant (life threatening) disease can occur and can cause miscarriage or premature delivery.

Hepatitis E Prognosis

Infection with Hepatitis E virus can easily be cleared by the bodys immune system except in a few and has the worst outcome in pregnant women (reason not yet known).

Prevention of Hepatitis E

Avoid drinking contaminated water
Practice personal hygiene by properly washing your hands with soap over running water before eating and after coming back home.
Properly cooking pig meat (pork) or its products especially in Australia, USA etc
Getting Hepatitis E vaccine

Hepatitis E vaccination

There is a vaccine for Hepatitis E and is known as Hecolin (HEV 239). It was first approved for human use in China in 2012 and can be used for prevention of this disease especially in pregnant women. It is a recombinant vaccine and is commercially available and has been shown to offer about 100% protection with no unexpected side effects. You should note that vaccination against Hepatitis B or A does not offer protection against Hepatitis E unless you have specifically been vaccinated against Hep E.