Hepatitis E is a liver disease caused by the Hepatitis E virus (HEV). HEV infection usually results in a self-limited, acute illness.
Hepatitis E is most common in developing countries like India with inadequate water supply and environmental sanitation. Large hepatitis E epidemics have been reported. People living in refugee camps or overcrowded temporary housing after natural disasters can be particularly at-risk.
Hepatitis E virus is usually spread by the fecal-oral route. The most common source of infection is fecally contaminated drinking water.
There is a possibility of zoonotic spread of the virus. HEV RNA had been extracted from meat and organ of some animal species including pigs, boar, and deer. Foodborne infection could occur from consumption of uncooked/undercooked products from infected animals.
When they occur, the signs and symptoms of Hepatitis E are similar to those of other types of acute viral hepatitis and can include:
- Loss of Appetite
- Abdominal Pain
- Dark Urine
- Clay-colored Stool
- Joint Pain
The ratio of symptomatic to asymptomatic infection in outbreak settings is reported to range from 1:2 to 1:13.
Symptomatic illness following HEV infection acquired sporadically or during outbreak commonly occur among older adolescents and young adults (aged 15–44 years). Children infected with HEV usually have mild or no symptoms. Pregnant women are more likely to experience severe illness including fulminant hepatitis, and death.
When symptoms occur, they usually develop 15 to 60 days (mean: 40 days) after exposure.
The period of communicability has not been clearly determined, but virus excretion in stool has been demonstrated up to 14 days after the onset of jaundice.
Most people with Hepatitis E recover completely. The overall case-fatality rate is about 1%. However, for pregnant women, Hepatitis E can be a serious illness with mortality reaching 10%–30% among pregnant women in their third trimester of pregnancy. Hepatitis E could also be serious among persons with pre-existing chronic liver disease resulting in decompensation and mortality.
To date, there is no report of progression of acute hepatitis E to chronic Hepatitis E in developing countries. However, more and more cases of Hepatitis E with progression to chronic hepatitis and chronic liver disease are being reported among cases acquired in the developed countries. These chronic cases are exclusively among persons who are on immunosuppressive treatment for solid organ transplant.
Because cases of Hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis can be confirmed only by testing for the presence of antibody to Hepatitis E or HEV RNA. A detailed history regarding sources of drinking water, uncooked food, and contact with jaundiced persons should be obtained to aid in diagnosis.
Hepatitis E usually resolves on its own without treatment. There is no specific antiviral therapy for Hepatitis E. Physicians should offer supportive therapy. Patients are typically advised to rest, get adequate nutrition and fluids, and avoid alcohol. Hospitalization is sometimes required in severe cases and should be considered for pregnant women.
Prevention of Hepatitis E relies primarily on good sanitation and the availability of clean drinking water. Boiling and chlorination of water will inactivate HEV.
No FDA-approved vaccine for Hepatitis E is currently available.