Hepatitis E primary prevention: Difference between revisions
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{{CMG}}; {{AE}} {{JS}} | {{CMG}}; {{AE}} {{JS}} | ||
==Overview== | ==Overview== | ||
Hepatitis E is a [[zoonosis]] that may be prevented by avoiding contact with the [[HEV|virus]], and by [[immunization]] through [[vaccination]]. In order to avoid [[infection]], measures such as appropriate sanitation, hygiene, and maintenance of the quality of the public water supplies should be observed. Also, thorough cooking of pork meat and avoidance of shellfish in [[endemic]] regions should be pursued. [[Blood transfusions]] represent a rare form of [[transmission]] that may be minimized | Hepatitis E is a [[zoonosis]] that may be prevented by avoiding contact with the [[HEV|virus]], and by [[immunization]] through [[vaccination]]. In order to avoid [[infection]], measures such as appropriate sanitation, hygiene, and maintenance of the quality of the public water supplies should be observed. Also, thorough cooking of pork meat and avoidance of shellfish in [[endemic]] regions should be pursued. [[Blood transfusions]] represent a rare form of [[transmission]] that may be minimized by [[screening]] blood donations. Two [[vaccines]] have been developed so far, and one of them has been approved in China. However, no further studies have been conducted regarding the distribution of the [[vaccine]] worldwide. | ||
==Prevention== | ==Prevention== | ||
| Line 10: | Line 10: | ||
*[[Immunization]] through [[vaccination]] | *[[Immunization]] through [[vaccination]] | ||
Hepatitis E is a [[zoonosis]], therefore [[prevention]] of the disease should start by avoiding [[transmission]] of the virus from animals to humans. As almost | Hepatitis E is a [[zoonosis]], therefore [[prevention]] of the disease should start by avoiding [[transmission]] of the virus from animals to humans. As almost every [[HEV infection]] is spread by the faecal - oral route, improving [[sanitation]] is the most important measure, along with good personal hygiene. High quality standards for public water supplies and proper disposal of sanitary waste have resulted in a low prevalence of [[HEV infection]]s in many well developed societies.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | ||
For travellers to high [[endemic]] areas, the usual elementary food hygiene precautions are recommended. These include:<ref name=WHO>{{cite web | title = Hepatitis E | url = http://www.who.int/csr/disease/hepatitis/whocdscsredc200112/en/index5.html }}</ref> | For travellers to high [[endemic]] areas, the usual elementary food hygiene precautions are recommended. These include:<ref name=WHO>{{cite web | title = Hepatitis E | url = http://www.who.int/csr/disease/hepatitis/whocdscsredc200112/en/index5.html }}</ref> | ||
| Line 18: | Line 18: | ||
*Avoid eating shellfish | *Avoid eating shellfish | ||
Although rare, [[transmission]] has been reported through [[blood transfusions]]. Because [[infection]] is often [[asymptomatic]], and most blood products are not tested for the presence of the [[HEV|virus]], [[transmission]] of hepatitis E may | Although rare, [[transmission]] has been reported through [[blood transfusions]]. Because [[infection]] is often [[asymptomatic]], and most blood products are not tested for the presence of the [[HEV|virus]], [[transmission]] of hepatitis E may occur unnoticed. This represents a concern for [[immunosuppressed]] patients, and for those with [[chronic liver disease]], who are at risk of developing chronic hepatitis E. Hence, [[screening]] of blood products is considered a preventive measure.<ref name="pmid22549046">{{cite journal| author=Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J et al.| title=Hepatitis E. | journal=Lancet | year= 2012 | volume= 379 | issue= 9835 | pages= 2477-88 | pmid=22549046 | doi=10.1016/S0140-6736(11)61849-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22549046 }} </ref><ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075 }} </ref> | ||
===Guidelines for Epidemic Measures=== | ===Guidelines for Epidemic Measures=== | ||
| Line 25: | Line 25: | ||
*Identification of the population with an increased risk of [[infection]] | *Identification of the population with an increased risk of [[infection]] | ||
*Elimination of a common source of [[infection]] | *Elimination of a common source of [[infection]] | ||
*Improvement of sanitary and hygienic practices to eliminate | *Improvement of sanitary and hygienic practices to eliminate fecal contamination of food and water | ||
==Vaccination== | ==Vaccination== | ||
Patients who have recovered from [[HEV infection]] show [[immunity]] against [[HEV]], which seems to offer life-long protection against the development of [[symptomatic]] hepatitis E.<ref name="pmid20728932">{{cite journal| author=Zhu FC, Zhang J, Zhang XF, Zhou C, Wang ZZ, Huang SJ et al.| title=Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. | journal=Lancet | year= 2010 | volume= 376 | issue= 9744 | pages= 895-902 | pmid=20728932 | doi=10.1016/S0140-6736(10)61030-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20728932 }} </ref> [[Vaccination]] can also induce protective [[immunity]]. So far 2 [[vaccines]] have been developed:<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448 }} </ref><ref name="pmid22549046">{{cite journal| author=Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J et al.| title=Hepatitis E. | journal=Lancet | year= 2012 | volume= 379 | issue= 9835 | pages= 2477-88 | pmid=22549046 | doi=10.1016/S0140-6736(11)61849-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22549046 }} </ref> | Patients who have recovered from [[HEV infection]] show [[immunity]] against [[HEV]], which seems to offer life-long protection against the development of [[symptomatic]] hepatitis E.<ref name="pmid20728932">{{cite journal| author=Zhu FC, Zhang J, Zhang XF, Zhou C, Wang ZZ, Huang SJ et al.| title=Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. | journal=Lancet | year= 2010 | volume= 376 | issue= 9744 | pages= 895-902 | pmid=20728932 | doi=10.1016/S0140-6736(10)61030-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20728932 }} </ref> [[Vaccination]] can also induce protective [[immunity]]. So far 2 [[vaccines]] have been developed:<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448 }} </ref><ref name="pmid22549046">{{cite journal| author=Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J et al.| title=Hepatitis E. | journal=Lancet | year= 2012 | volume= 379 | issue= 9835 | pages= 2477-88 | pmid=22549046 | doi=10.1016/S0140-6736(11)61849-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22549046 }} </ref> | ||
* The first [[vaccine]] showed 96% efficacy in Nepalese soldiers, after administration of 3 doses. It is expressed by insect cells. Unfortunately, no further developments were made to the [[vaccine]].<ref name="pmid17329696">{{cite journal| author=Shrestha MP, Scott RM, Joshi DM, Mammen MP, Thapa GB, Thapa N et al.| title=Safety and efficacy of a recombinant hepatitis E vaccine. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 9 | pages= 895-903 | pmid=17329696 | doi=10.1056/NEJMoa061847 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17329696 }} </ref> | * The first [[vaccine]] showed 96% efficacy in Nepalese soldiers, after administration of 3 doses. It is expressed by insect cells. Unfortunately, no further developments were made to the [[vaccine]].<ref name="pmid17329696">{{cite journal| author=Shrestha MP, Scott RM, Joshi DM, Mammen MP, Thapa GB, Thapa N et al.| title=Safety and efficacy of a recombinant hepatitis E vaccine. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 9 | pages= 895-903 | pmid=17329696 | doi=10.1056/NEJMoa061847 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17329696 }} </ref> | ||
* A second [[vaccine]] has been developed and approved in China, with 94-100% [[efficacy]] in preventing acute hepatitis E. The [[vaccine]] is produced by bacterial cells ([[E. coli]]), does not show relevant side-effects, and is safe for administration | * A second [[vaccine]] has been developed and approved in China, with 94-100% [[efficacy]] in preventing acute hepatitis E. The [[vaccine]] is produced by bacterial cells ([[E. coli]]), does not show relevant side-effects, and is safe for administration in pregnant women. Further studies are required in high-risk groups, such as [[immunocompromised]] and end-stage [[liver disease]] patients.<ref name="pmid21212772">{{cite journal| author=Wedemeyer H, Pischke S| title=Hepatitis: Hepatitis E vaccination--is HEV 239 the breakthrough? | journal=Nat Rev Gastroenterol Hepatol | year= 2011 | volume= 8 | issue= 1 | pages= 8-10 | pmid=21212772 | doi=10.1038/nrgastro.2010.207 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21212772 }} </ref> | ||
==References== | ==References== | ||
Revision as of 03:40, 29 August 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Hepatitis E is a zoonosis that may be prevented by avoiding contact with the virus, and by immunization through vaccination. In order to avoid infection, measures such as appropriate sanitation, hygiene, and maintenance of the quality of the public water supplies should be observed. Also, thorough cooking of pork meat and avoidance of shellfish in endemic regions should be pursued. Blood transfusions represent a rare form of transmission that may be minimized by screening blood donations. Two vaccines have been developed so far, and one of them has been approved in China. However, no further studies have been conducted regarding the distribution of the vaccine worldwide.
Prevention
Hepatitis E may be prevented by two ways:[1]
- Limiting exposure to the virus
- Immunization through vaccination
Hepatitis E is a zoonosis, therefore prevention of the disease should start by avoiding transmission of the virus from animals to humans. As almost every HEV infection is spread by the faecal - oral route, improving sanitation is the most important measure, along with good personal hygiene. High quality standards for public water supplies and proper disposal of sanitary waste have resulted in a low prevalence of HEV infections in many well developed societies.[2]
For travellers to high endemic areas, the usual elementary food hygiene precautions are recommended. These include:[3]
- Avoiding drinking water and/or ice of unknown purity
- Eating uncooked shellfish, uncooked fruits or vegetables that are not peeled or prepared by the traveller
- Cook pork thoroughly
- Avoid eating shellfish
Although rare, transmission has been reported through blood transfusions. Because infection is often asymptomatic, and most blood products are not tested for the presence of the virus, transmission of hepatitis E may occur unnoticed. This represents a concern for immunosuppressed patients, and for those with chronic liver disease, who are at risk of developing chronic hepatitis E. Hence, screening of blood products is considered a preventive measure.[1][4]
Guidelines for Epidemic Measures
The following measures should be observed in an epidemic situation:[3]
- Determination of the mode of transmission
- Identification of the population with an increased risk of infection
- Elimination of a common source of infection
- Improvement of sanitary and hygienic practices to eliminate fecal contamination of food and water
Vaccination
Patients who have recovered from HEV infection show immunity against HEV, which seems to offer life-long protection against the development of symptomatic hepatitis E.[5] Vaccination can also induce protective immunity. So far 2 vaccines have been developed:[6][1]
- The first vaccine showed 96% efficacy in Nepalese soldiers, after administration of 3 doses. It is expressed by insect cells. Unfortunately, no further developments were made to the vaccine.[7]
- A second vaccine has been developed and approved in China, with 94-100% efficacy in preventing acute hepatitis E. The vaccine is produced by bacterial cells (E. coli), does not show relevant side-effects, and is safe for administration in pregnant women. Further studies are required in high-risk groups, such as immunocompromised and end-stage liver disease patients.[8]
References
- ↑ 1.0 1.1 1.2 Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J; et al. (2012). "Hepatitis E." Lancet. 379 (9835): 2477–88. doi:10.1016/S0140-6736(11)61849-7. PMID 22549046.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ 3.0 3.1 "Hepatitis E".
- ↑ Hoofnagle JH, Nelson KE, Purcell RH (2012). "Hepatitis E." N Engl J Med. 367 (13): 1237–44. doi:10.1056/NEJMra1204512. PMID 23013075.
- ↑ Zhu FC, Zhang J, Zhang XF, Zhou C, Wang ZZ, Huang SJ; et al. (2010). "Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial". Lancet. 376 (9744): 895–902. doi:10.1016/S0140-6736(10)61030-6. PMID 20728932.
- ↑ Wedemeyer H, Pischke S, Manns MP (2012). "Pathogenesis and treatment of hepatitis e virus infection". Gastroenterology. 142 (6): 1388–1397.e1. doi:10.1053/j.gastro.2012.02.014. PMID 22537448.
- ↑ Shrestha MP, Scott RM, Joshi DM, Mammen MP, Thapa GB, Thapa N; et al. (2007). "Safety and efficacy of a recombinant hepatitis E vaccine". N Engl J Med. 356 (9): 895–903. doi:10.1056/NEJMoa061847. PMID 17329696.
- ↑ Wedemeyer H, Pischke S (2011). "Hepatitis: Hepatitis E vaccination--is HEV 239 the breakthrough?". Nat Rev Gastroenterol Hepatol. 8 (1): 8–10. doi:10.1038/nrgastro.2010.207. PMID 21212772.