Hepatitis E (patient information)

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Hepatitis E
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
When to seek urgent medical care?
Diagnosis
Treatment options
Where to find medical care for Hepatitis E?
What to expect (Outlook/Prognosis)?
Possible complications
Hepatitis E On the Web
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Risk calculators and risk factors for Hepatitis E

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S; João André Alves Silva, M.D. [2]

Overview

Hepatitis E is a liver disease caused by the hepatitis E virus. The hepatitis E virus is transmitted mainly through contaminated drinking water. Common symptoms include: fever, jaundice, loss of appetite, nausea and vomiting. Diagnosis is based on antibody detection and detection of the viral RNA. It is usually a self-limiting infection and resolves within 4–6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death. There is no available treatment capable of altering the course of acute hepatitis. Prevention is the most effective approach against the disease. Possible complications include: chronic hepatitis and liver failure.

What are the symptoms?

The incubation period following exposure to the hepatitis E virus ranges from three to eight weeks, with a mean of 40 days.

The incidence of hepatitis E is highest in adults between the ages of 15 and 40. Though children often contract this infection as well, they less frequently become symptomatic.

Typical signs and symptoms of hepatitis include:

• Fever
• Jaundice (yellow discolouration of the skin and sclera of the eyes, dark urine and pale stools)
• Malaise
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Fever
• Hepatomegaly
• Other less common features include diarrhea, arthralgia, pruritus, and urticarial rash

Some patients have asymptomatic infection.

Diagnosis

Cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis.

Diagnosis of hepatitis E infection is, therefore, usually based on:

• Detection of specific IgM and IgG antibodies to the virus in the blood
• Reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis E virus RNA in blood and/or stool, but this assay may require specialized laboratory facilities.

Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded.

The following tests are done to identify and monitor liver damage from hepatitis B:

• Albumin level
• Liver function tests
• Prothrombin time

Transmission

The hepatitis E virus is transmitted mainly through the fecal-oral route due to fecal contamination of drinking water.

Other transmission routes have been identified, including:

• Foodborne transmission from ingestion of products derived from infected animals
• Transfusion of infected blood products
• Vertical transmission from a pregnant woman to her fetus
• Ingestion of raw or uncooked shellfish has also been identified as the source of sporadic cases in endemic areas.

Although humans are considered the natural host for the hepatitis E virus, antibodies to the hepatitis E virus or closely related viruses have been detected in primates and several other animal species.

Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks.

The risk factors for hepatitis E are related to poor sanitation in large areas of the world and shedding of the hepatitis E virus in faeces.

Treatment options

There is no available treatment capable of altering the course of acute hepatitis. Prevention is the most effective approach against the disease.

As hepatitis E is usually self-limiting, hospitalization is generally not required. However, hospitalization is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant women.

Possible Complications

Possible complications include:

• Chronic hepatitis
• Liver failure

What to expect (Outlook/Prognosis)?

Mortality rates are generally low, for Hepatitis E is a “self-limiting” disease, in that it usually goes away by itself and the patient recovers. In rare cases, acute hepatitis E can result in fulminant hepatitis (acute liver failure) and death.

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.

Prevention

The risk of infection and transmission can be reduced by:

• Maintaining quality standards for public water supplies
• Establishing proper disposal systems to eliminate sanitary waste

On an individual level, infection risk can be reduced by:

• Maintaining hygienic practices such as hand washing with safe water, particularly before handling food
• Avoiding drinking water and/or ice of unknown purity
• Adhering to WHO safe food practices

In 2011, the first vaccine to prevent hepatitis E infection was registered in China. Although it is not available globally, it could potentially become available in a number of other countries.

Guidelines for epidemic measures

• In epidemics, WHO recommends:

• Determining the mode of transmission
• Identifying the population specifically exposed to increased risk of infection
• Eliminating a common source of infection
• Improving sanitary and hygienic practices to eliminate fecal contamination of food and water.

Diseases with similar symptoms

• Hepatitis A
• Hepatitis D
• Hepatitis E

Sources

http://digestive.niddk.nih.gov/ddiseases/pubs/viralhepatitis/#hepe
World Health organization