July 30, 2024
Hepatitis E is a viral infection that causes inflammation of the liver, primarily spread through contaminated water. It is prevalent worldwide, but it’s most common in regions with inadequate sanitation, such as East and South Asia. According to the World Health Organization (WHO), an estimated 20 million hepatitis E virus (HEV) infections occur globally each year, resulting in 3.3 million symptomatic cases and around 44,000 deaths.
What is Hepatitis E?
Hepatitis E is caused by the hepatitis E virus (HEV), which belongs to the Hepeviridae family. There are four major genotypes of HEV, with genotypes 1 and 2 affecting humans exclusively, while genotypes 3 and 4 are zoonotic, found in animals like pigs and wild boars, and occasionally transmitted to humans.
The virus spreads mainly through the fecal-oral route, particularly via drinking water contaminated by feces. Although the infection is often self-limiting, resolving within 2–6 weeks, it can sometimes result in acute liver failure (fulminant hepatitis), which can be fatal, particularly in pregnant women.
How is Hepatitis E Transmitted?
Hepatitis E is common in low- and middle-income countries where access to clean water, sanitation, and healthcare is limited. The virus is primarily transmitted through:
- Contaminated water supplies: Outbreaks often follow water contamination, especially in conflict zones or refugee camps where safe water and sanitation are inadequate.
- Consumption of undercooked meat: In countries with better water quality, infection can occur through undercooked meat, particularly pork. This is more common in regions where genotype 3 is prevalent.
Symptoms of Hepatitis E
The symptoms of hepatitis E are often similar to other liver conditions, making diagnosis based on symptoms alone difficult. Symptoms typically appear 2 to 10 weeks after exposure to the virus, with an average of 5 to 6 weeks, and may include:
- Mild fever, nausea, vomiting, and loss of appetite
- Abdominal pain, joint pain, skin rashes, and itching
- Jaundice (yellowing of the skin and eyes), dark urine, and pale stools
- Slightly enlarged and tender liver
Most people recover within 1–6 weeks, but in rare cases, the condition can lead to acute liver failure, especially in pregnant women during their second or third trimester.
Diagnosis and Treatment
Hepatitis E is diagnosed through blood tests that detect specific antibodies (IgM) against the virus or through molecular tests (RT-PCR) that detect viral RNA. There is no specific treatment for acute hepatitis E, as it is generally self-limiting. However, hospitalization may be necessary in severe cases, particularly for pregnant women or those with fulminant hepatitis.
Patients with chronic hepatitis E, particularly those with weakened immune systems, can benefit from antiviral medications like ribavirin.
Prevention of Hepatitis E
Preventing hepatitis E relies on improving access to clean water and proper sanitation. Key preventive measures include:
- Ensuring access to clean drinking water and proper sewage disposal
- Practicing good personal hygiene, including hand washing with clean water
- Avoiding consumption of unsafe water or ice and undercooked meat
Global Efforts and Vaccination
A vaccine for hepatitis E (Hecolin) has been developed and is licensed in China. WHO recommended its use for outbreak response in 2015, and it was first used in a campaign in South Sudan in 2022. Global health initiatives continue to focus on improving water and sanitation, as well as scaling up vaccination efforts in high-risk areas.