Hepatitis awareness –Hepatitis E

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hepatitisHepatitis E is the strain of hepatitis caused by hepatitis E virus (HEV) this virus is dominantly transmitted through contaminated drinking water, and is usually self-limiting. It resolves within a period of 4- 6 weeks. Occasionally it might get aggressive enough to leading to acute liver failure and finally death. Globally about 20 million incidents of hepatitis E occurs.

Geographically sporadic cases and outbreaks occur around the world. These outbreaks are usually in countries where access to essential water, sanitation, hygiene and health services are limited leading to several hundreds to thousands of people being affected. Recently war zones and refugee camps are high hit areas.

The epidemiology differs with the genotype of the virus. The genotype 1 is found in developing countries and tends to cause community level outbreaks. While the genotype3 found in developed countries do not cause these outbreaks.

The transmission of HEV is through faecal-oral route due to fecal contamination of drinking water. Other routes include

Food borne transmission from ingestion of products derived from infected animals.
Transfusion of infected blood products.
Vertical transmission from a pregnant woman to her foetus.
Humans are natural hosts for HEV despite this antibodies to HEV are seen some primates and other animal species. Since it is water-borne, some water animals are known to host the virus. Sporadic episodes have been reported after ingestion of uncooked shellfish.

The major risk of HEV is related to poor sanitation.

Symptoms manifest after an incubation period of 3-8 weeks, however the period of communicability is not known. As the HEV is an acute sporadic epidemic disease, the symptoms is most commonly seen in the age group of 15-40yrs. Though in children the disease is so mild and asymptomatic that it could go undiagnosed. The typical signs however are:

Jaundice – yellowing of skin, white of the eyes, dark urine and pale stools.
Loss of appetite anorexia
Pain and tenderness of abdomen
Nausea and vomiting
Fever.
These symptoms are quite indistinguishable from any acute phase of hepatic disorder. In very rare cases this could develop into Fulminant Hepatitis (acute liver failure) and death. The tendency to aggravate to Fulminant hepatitis is more during pregnancy.

Chronic HEV infection has been reported in people with immunosuppression . Reaction of HEV is also known in immunosuppresed individuals.

Diagnosis of HEV is usually based on the detection of specific IgM or IgG as clinically its symptoms are not distinguishable from other acute viral hepatitis. But this requires specialized laboratory facilities. HEV should suspect when the outbreak is waterborne particularly in developing countries more so if the severity is more in pregnant women or if HAV has been ruled out.

HEV has no available treatment, prevention is more effective. The disease is usually self-limiting, hospitalization is generally not required. Hospitalization should be considered for patients of potential Fulminant Hepatitis and pregnant women who exhibit the symptoms.

Prevention is the ideal cure for HEV, this would include

Quality public water supplies – avoid drinking water of questionable quality.
Establishing proper disposal system to eliminate sanitary waste
Maintaining personal hygiene practises, like hand washing with safe water, particularly before and handling food.
Adhering to WHO safe food practises.
If there is a frank epidemic, then identifying the source, mode of transmission would go a long way in prevention. Improving sanitary and hygienic practices is mandatory.

WHO response, is a working group set up in 2013, it networks globally with people working with HEV. These groups identify potential risks and try to prevent the outbreak of the virus. In addition, they work at

Raising awareness, promoting partnerships, and mobilizing resources.
Formulating evidence based policy and data for actions.
o Preventing transmission

o Executing screening care and treatment.

Every year 20 million HEV infections are estimated over 3 million are acute cases, and 56,600 HEV related deaths occur. The disease is usually self-limiting though it can potentially aggravate to Fulminant hepatitis which could be fatal. The mode of transmission is faecal-oral route via contaminated water, it is geographically spread worldwide. China has produced and licensed the first vaccine to prevent hepatitis E though this is not available in the global market as yet.

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