Hepatitis E

Abstract

Hepatitis E is inflammation of the liver caused by infection with the hepatitis E virus. [1][2] It is one of five known human hepatitis viruses: A, B, C, D, and E. HEV is a positive-sense, single-stranded, nonenveloped, RNA icosahedral virus. HEV has mainly a fecal-oral transmission route. [3][4][5] Infection with this virus was first documented in 1955 during an outbreak in New Delhi, India [6]. A preventive vaccine (HEV 239) is approved for use in China. [7] Although hepatitis E often causes an acute and self-limiting infection (the viral infection is temporary and the individual recovers) with low death rates in the western world, it bears a high risk of developing chronic hepatitis in people with a weakened immune system with substantially higher death rates. Organ transplant recipients who receive medications to weaken the immune system and prevent organ rejection are thought to be the main population at risk for chronic hepatitis E. [8]. Hepatitis E infection has a clinical course comparable to hepatitis A, but in pregnant women, the disease is more often severe and is associated with a clinical syndrome called fulminant liver failure. Pregnant women, especially those in the third trimester, have a higher rate of death from the disease of around 20%. [9][10][4] In total there are 8 genotypes; genotypes 3 and 4 cause chronic hepatitis in the immunosuppressed. [11][12] Hepatitis E incidence in 2017 was more than 19 million. [13] Signs and symptoms Acute infection The incubation period of hepatitis E varies from 3 to 8 weeks. After a short prodromal phase symptoms lasting from days to weeks follow. They may include jaundice, fatigue, and nausea, though the majority of HEV infections are asymptomatic. The symptomatic phase coincides with elevated hepatic aminotransferase levels. [14][15]

Global burden of acute viral hepatitis and its association with socioeconomic development status, 1990–2019

“…Low-and J o u r n a l P r e -p r o o f low-middle SDI locations recorded the highest age-standardized incidence and DALYs rates of AHA, whereas high SDI locations had the lowest rates (Fig. 2A, 2B; appendix pp [26][27][28][29][30][31][32][33][36][37][38][39][40][41][42][43]. Between 1990 and 2019, a dramatically decreasing pattern was observed in the age-standardized DALYs rates of AHA in both males and females compared with the incidence rates, which remained stable (Fig.…”

“…3,4 Previously, HEV was thought to be limited to certain developing countries. On the contrary, HEV is endemic in most high-income countries, 37,38 and it manifests as locally acquired zoonotic infections where the pig acts as the true primary host. 39 Genotypes 1 and 2 of HEV are obligate pathogens that spread by the fecal-oral route via contaminated water, 39 and they are often linked to large outbreaks and epidemics in developing countries.…”

"Pros and Cons of Viral Zoonotic Diseases: A Public Health Nutrition Perspective and Policy Implication in Nigeria"

“…The vaccine in use now is called HEV 239 produced in China in 2012 but good and adequate hygiene and sanitation has been found to be a most probable and important measure to prevent the infection. This include proper treatment and disposal of human waste, good hygienic standard and supply of potable water for all, adequate personal hygiene and maintenance of good sanitary procedures in food preparation and thorough cooking of meat before consumption (WHO [67] Anis, et al [68]).…”