Hepatitis E

Overview

• Hepatitis E is widely spread across the globe and is self - limiting, acute liver disease caused by Hepatitis E virus.  This virus is a non -enveloped, positive - sense, single - stranded ribonucleic acid (RNA) virus with four genotypes (Type 1, 2, 3, and 4).
• Globally,  57  000  deaths  and  3.4  million  cases  of  acute  hepatitis  E  are  attributable to infection with hepatitis E virus genotypes 1 and 2.
• Hepatitis  E is  found  worldwide,  but  the  prevalence  is highest  in  East  and  South Asia with genotype 1 most commonly found in India.

Route of transmission

Hepatitis E virus is usually spread by the fecal - oral route. Other transmission routes identified include

• Foodborne transmission from ingestion of uncooked/cut vegetables and fruits
• Transfusion of infected blood products
• Vertical transmission from a pregnant woman to her foetus.

Symptoms

• The incubation period following exposure to the hepatitis E virus ranges from three to eight weeks, with a mean of 40 days.
• The period of communicability is unknown.
• Symptoms include:
  • Jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools)
  • Anorexia (loss of appetite)
  • An enlarged, tender liver (hepatomegaly)
  • Abdominal pain and tenderness
  • Nausea and vomiting
  • Fever
• Fulminant hepatitis occurs more frequently during pregnancy. Pregnant women are at greater risk of obstetrical complications and mortality from hepatitis E, which can induce a mortality rate of 20% among pregnant women in their third trimester.
• Cases of chronic hepatitis E infection have been reported in immunosuppressed people. Reactivation of hepatitis E infection has also been reported in immunocompromised people.

Diagnosis & Treatment

• Blood (2 -6ml) collected in plain vial for antibody detection and serum, stool for RT - PCR.
• Diagnosis can be confirmed only by testing for the presence of antibody to Hepatitis E or HEV RNA by RT - PCR.
• Hepatitis E usually resolves on its own without treatment.
• There is no available treatment capable of altering the course of acute hepatitis. Prevention is the most effective approach against the disease.

Prevention

• Prevention and control can be achieved through safe and effective HBV vaccines. World Health Orgnisation recommends routine infant vaccination along with catch-up immunization for adolescents and high risk populations.India introduced universal immunization against hepatitis B in 10 states in the year 2002, and in 2011, scaled up this operation countrywide.
• On an individual/community level, infection risk can be reduced by:
• Maintaining quality standards for water supplies;
• Establishing proper disposal systems to eliminate sanitary waste;
• Raising awareness about the risk of HEV among common public through various channels by
  • Maintaining hygienic practices such as hand washing with safe water, particularly before handling food;
  • Use of boiled water for drinking
  • Avoiding drinking water and/or ice of unknown purity;
  • Avoiding eating uncooked and cut food, fruits or vegetables
• Increasing awareness of HEV infection among physicians to enhance its diagnosis and reporting for early epidemiological investigation and outbreak detection.
• Screening and immunization of high-risk groups, such as those with history of exposure, risky practices, and occupational risk.
• Specific measures for prevention of mother-to-child transmission.
• Promoting safe blood supply, safe injections and safe sex are other recommended preventive measures.

Source: National Centre for Disease Control (NCDC)

Related resources

1. WHO Fact sheet on Hepatitis E
2. WHO Infographic on Hepatitis A and E
3. Viral Hepatitis - Prevention, Control and Treatment guidelines by NCDC