Hepatitis E

Definition

Hepatitis E is a viral disease transmissible to humans that is rare in Europe but relatively common in other parts of the world, such as Asia and Africa (see below under Epidemiology). In humans, it manifests itself as an often asymptomatic and benign hepatitis that usually resolves within a few weeks. However, in people with a weak immune system, hepatitis E can often be fatal, as shown in a study presented at an April 2018 liver congress in Paris ( The International Liver Congress ). This study also showed that, in rarer cases, hepatitis E can be fatal in people who are not immunosuppressed.

Hepatitis is a zoonosis, that is, it can be transmitted from an infected animal, such as a pig, to humans.

Epidemiology

In 2017, around 20 million people worldwide were infected with hepatitis E, leading to more than 56,000 deaths, according to estimates by the Johns Hopkins Bloomberg School of Public Health in the United States. Hepatitis E is the most common form of acute viral hepatitis in the world, according to a July 2017 press release from the Stellenbosch University of South Africa which has conducted research on this type of hepatitis.

Some Asian countries like India, Pakistan and Bangladesh as well as Africa are particularly affected by this infection. Hygiene problems, including the absence and deficiency of basic sanitation, are probably responsible for cases of hepatitis E.

Death rate
The overall death rate from hepatitis E is about 1%. It is much higher in pregnant women, at around 30% (read more in Complications).

Causes and transmission

Viruses:
Hepatitis E is caused by a virus, the hepatitis E virus (HEV). The virus has no envelope.
4 different genotypes
HEV is present worldwide. It is known that there are at least 4 different genotypes of hepatitis E virus (HEV).
Genotypes 1 and 2:
Genotypes 1 and 2 circulate only among humans and enter the human body via the fecal-oral route, mainly through contaminated water. These genotypes are mainly present in certain regions of Asia, Africa and Mexico1 .
Genotypes 3 and 4:
– In Europe and other industrialized countries, contamination mainly comes from genotypes 3 and 4, which represent zoonotic viruses that mainly infect pigs and game animals (wild boar and deer). Those hepatitises with genotypes 3 and 4 are responsible for sporadic hepatitis, of local transmission (liver infection); it is a zoonotic transmission (from another animal species to the human species).

Transmission:
– As we have seen, in industrialized countries, transmission to humans is mainly due to consumption of food based on raw pig or wild boar liver, contaminated with the hepatitis E virus (genotypes 3 and 4), but also by mussels raw or undercooked.
– In developing countries, transmission of hepatitis E virus (genotypes 1 and 2) is mainly based on the fecal-oral route, mainly through contaminated water.
– Contamination by blood transfusion is also possible, but more rare.

Incubation period: 
The average incubation period is 40 days (median).

Contagiousness:
The duration of contagiousness (period during which the person/animal transmits the disease) is not clearly established.

Symptoms

In the vast majority of cases the disease (infection) is asymptomatic, that is, the virus is present mainly in the stool, but the person does not have any symptoms (asymptomatic). The medical community estimates that over 90% of infections are asymptomatic and that most affected people recover without treatment.2 Swiss press agency Keystone-ATS, with our partner Pharmapro.ch who is a client of the agency. On Jan 24, 2022/efn_note].

Symptomatic cases
However, if symptoms are present, you may notice great fatigue , digestive disorders (abdominal pain), jaundice, loss of appetite and sometimes fever . In addition, dark urine and discolored stools may also appear.
Atypical signs of the disease have been described as a series of neurological manifestations, most often temporary.3 Swiss press agency Keystone-ATS, with our partner Pharmapro.ch who is a client of the agency. On Jan 24, 2022/efn_note].
Observations
According to the Swiss reference sitePharmavista.net, men over 50 years old are at a higher risk of developing hepatitis E with symptoms, especially in the case of underlying chronic liver disease.

Diagnosis

A blood test is usually used to diagnose hepatitis E by looking for antibodies. There is also a stool test that identifies the genetic material of the hepatitis E virus. In addition, the viral RNA of the virus can be demonstrated by PCR, in the same logic as PCR tests to identify the virus that causes Covid-19 (SARS- CoV-2).

In 2017, a study conducted by the Johns Hopkins Bloomberg School of Public Health showed that a saliva test is almost as effective as a blood test. This research paper was published in July 2017 in the journal Journal of Immunological Methods. In 2017, this saliva test was not yet available on the market, as reported by US researchers.

Complications

Severe forms of the disease can be seen in pregnant women, immunocompromised people (especially transplant patients) and people who already have liver disease.

Chronic Cases
In some immunocompromised patients (such as those with AIDS or transplant recipients), the hepatitis E virus has the capacity to become chronic, as noted by Dr. Tongai Maponga of Stellenbosch University, South Africa, in a university press release on July 27, 2017. In immunosuppressed patients, cirrhosis can develop rapidly

Pregnant
women In pregnant women, hepatitis E can progress to acute liver failure. If a pregnant woman becomes infected with the hepatitis E virus, the mortality rate is about 30%. Scientists don’t know why this rate is so high. In comparison, the overall mortality rate from hepatitis E is about 1%.

Neurological disorders
Other rare complications of hepatitis E can be the development of neurological disorders such as Guillain-Barré syndrome.

Treatments

An infection with this virus is cured spontaneously, without the need for medication, in most cases. However, as reported by the Swiss site Pharmavista.net, in transplant patients the prevalence of chronic hepatitis E is estimated to be between 1 and 3%.

Vaccine
In China, there is a vaccine to prevent hepatitis E (HEV 239 recombinant vaccine or Hecolin). According to Pharmavista.net and the WHO, this vaccine was not available in any country other than China as of December 2017.

Tips

– People who are immunosuppressed or have liver disease, the elderly, pregnant women and children should not consume raw or undercooked pork or wild boar products. To avoid any risk of hepatitis E, it is recommended to cook meat products thoroughly before eating them.

Sources and references:
Ministry of Health and Sports – Paris, Pharmavista.net (accessed November 2, 2016), Johns Hopkins School of Public Health press release (July 2017), Stellenbosch University of South Africa press release South (July 2017),  WHO (World Health Organization – WHO)

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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