Understanding Hepatitis E: Symptoms, Causes, Risks, Treatment, Prevention Methods
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Hepatitis E is a common liver infection caused by the hepatitis E virus (HEV). It’s the fifth main type of viral hepatitis and causes millions of symptomatic cases worldwide and is the leading cause of acute viral hepatitis. Each year 3.3 to 20 million symptomatic infections occur resulting in tens of thousands of deaths. Although it often resolves on its own it can still be a big problem for certain groups like pregnant women and people with weak immune systems.
In some cases hepatitis E can lead to acute liver failure especially in pregnant women and requires hospitalization due to high mortality rates, making it unique among ither Hepatitis strains such as Hepatitis B and Hepatitis C.
Table of Contents
- Global Reach and Key Statistics of Hepatitis E Virus
- Four Hepatitis E Virus Genotypes
- Types of Hepatitis E Infection
- Routes of Transmission of Hepatitis E Virus
- Symptoms
- High Risk Groups for Hepatitis E Virus Infection
- Diagnosis and Treatment
- Chronic Hepatitis and Liver Damage
- Prevention and Vaccination
- Closing Thoughts
- References
Global Reach and Key Statistics of Hepatitis E Virus
Hepatitis E is found almost everywhere in the world, but the pathways of transmission and the dominant genotypes vary by region [6]. For example in areas with poor sanitation or limited access to clean water large outbreaks can occur through contaminated water [1]. In other areas undercooked pork or wild game can harbor the virus and when people eat contaminated meat they can get infected [7].
Four Hepatitis E Virus Genotypes
Scientists group HEV into four main genotypes each with distinct patterns of transmission and disease [3].
- HEV1 and HEV2: These are more common in developing countries where outbreaks are waterborne [4]. They spread fast in communities with poor sanitation increasing the risk of severe illness.
- HEV3 and HEV4: Found in developed countries these genotypes can move from animals to people [8]. They are mainly linked to eating undercooked meat especially pork. Recently there have been concerns about transmission through blood transfusions [2].
Types of Hepatitis E Infection
Hepatitis E can occur in two forms: acute and chronic. Acute hepatitis E is a short term infection that resolves on its own within a few weeks. Most people with acute hepatitis E will have symptoms like fatigue, loss of appetite and jaundice but will recover without lasting liver damage. Chronic hepatitis E is a long term infection that can cause significant liver damage and even liver failure. Chronic hepatitis E is rare and occurs in individuals with weakened immune systems like organ transplant recipients. These patients may develop chronic hepatitis which requires more intense medical management to prevent severe liver complications.
Routes of Transmission of Hepatitis E Virus
HEV spreads in a few ways. Contaminated water is the main route in countries with poor sanitation [1]. Meanwhile zoonotic transmission occurs through infected animals especially pigs or wild game in areas with better infrastructure [8]. Parenteral transmission is also growing where infected blood is given to patients needing a transfusion [9]. Knowing these routes helps guide public health measures to prevent new cases.
Symptoms
Most often hepatitis E causes an acute infection that the body can fight off by itself [3]. Common symptoms include tiredness, loss of appetite, pain in the right upper part of the abdomen and sometimes jaundice (yellowing of the skin or eyes) [1]. However severe or long lasting disease can occur in people with weak immune systems like organ transplant recipients [2]. In severe cases especially in pregnant women there is a risk of acute liver failure which may require hospitalization and has high mortality rates. Research has also linked hepatitis E to extrahepatic symptoms beyond the liver. These include nervous system problems like Guillain-Barré syndrome and kidney complications [7]. While less common these extrahepatic symptoms can make the disease harder to detect and treat.
High Risk Groups for Hepatitis E Virus Infection
Anyone can get hepatitis E but certain populations are at bigger risk [4].
- Pregnant women: Research shows higher chance of complications or worse outcomes especially during the third trimester [1].
- Older men: Studies suggest older males suffer more intense symptoms and liver damage [6].
- People with existing liver problems: When the liver is already damaged hepatitis E can worsen the damage [10].
- Immunocompromised individuals: People on immunosuppressive medications (like transplant recipients) may develop chronic hepatitis E infection [5]. Chronic HEV infection has been seen in organ transplant recipients on immunosuppressive medications. Diagnosing chronic HEV infection in these individuals is crucial to manage the disease.
Diagnosis and Treatment
Doctors rely on blood tests that detect antibodies or viral genetic material [1]. Accurate diagnosis is important for monitoring vulnerable patients. In rare cases where hepatitis E is not common RT-PCR tests are needed to confirm chronic HEV infection which is not clinically distinguishable from acute viral hepatitis. In many cases supportive care including rest, balanced diet and hydration is enough [3] . If infections become chronic stronger treatments like antiviral medications may be needed [5]. Research into new antiviral drugs and vaccines is ongoing and some have shown success in clinical trials [9].
Chronic Hepatitis and Liver Damage
Chronic hepatitis E can cause significant liver damage and in severe cases liver failure. When the hepatitis E virus causes prolonged inflammation in the liver it can cause scarring and fibrosis which impairs the liver’s function. Over time this damage can progress to liver failure where the liver cannot perform its functions and toxins build up in the blood. Chronic hepatitis E can also increase the risk of liver cancer making it a serious concern for those affected. Monitoring and managing chronic hepatitis E is crucial to prevent these severe outcomes.
Prevention and Vaccination
Preventing hepatitis E infection is the best way to protect against the disease. Good personal hygiene, proper sanitation and safe food handling practices are key to reducing the risk of infection. Avoiding undercooked pork and wild game meat can also help prevent the spread of the virus. In some countries like China a hepatitis E vaccine is available and recommended for people at high risk of infection including travelers to areas where hepatitis E is common. By following these preventive measures and considering vaccination individuals can reduce their risk of getting hepatitis E.Experts advocate for a “One Health” approach which looks at the connections between human, animal and environmental health [2]. By studying how the virus moves between livestock and people they hope to develop better ways to detect and prevent HEV infection. This approach also addresses improving water quality, screening animal products and safe blood supplies [8]. It’s a broad approach that recognizes we can’t tackle hepatitis E by focusing on people alone.
Closing Thoughts
Hepatitis E is a major public health issue but there is hope. Improved sanitation, better vaccine research and advanced blood screening can reduce new cases [4]. Strengthening health systems in vulnerable areas can prevent large outbreaks linked to contaminated water. At the same time raising awareness about cooking meat thoroughly and good hygiene can go a long way in limiting the spread of the virus [3]. Overall more collaboration between doctors, veterinarians and local communities is key to controlling this disease [2].
References
[1] Aslan, A. T., & Balaban, H. Y. (2020). Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment. World journal of gastroenterology, 26(37), 5543–5560. https://doi.org/10.3748/wjg.v26.i37.5543
[2] Larrue, H., Abravanel, F., & Péron, J. M. (2020). Hepatitis E, what’s the real issue?. Liver international : official journal of the International Association for the Study of the Liver, 40 Suppl 1, 43–47. https://doi.org/10.1111/liv.14351
[3] Kamar, N., Izopet, J., Pavio, N., Aggarwal, R., Labrique, A., Wedemeyer, H., & Dalton, H. R. (2017). Hepatitis E virus infection. Nature reviews. Disease primers, 3, 17086. https://doi.org/10.1038/nrdp.2017.86
[4] Larrue, H., Abravanel, F., & Péron, J. M. (2020). Hepatitis E, what’s the real issue?. Liver international : official journal of the International Association for the Study of the Liver, 40 Suppl 1, 43–47. https://doi.org/10.1111/liv.14351
[5] Velavan, T. P., Pallerla, S. R., Johne, R., Todt, D., Steinmann, E., Schemmerer, M., Wenzel, J. J., Hofmann, J., Shih, J. W. K., Wedemeyer, H., & Bock, C. T. (2021). Hepatitis E: An update on One Health and clinical medicine. Liver international : official journal of the International Association for the Study of the Liver, 41(7), 1462–1473. https://doi.org/10.1111/liv.14912
[6] Krawczynski, K., Aggarwal, R., & Kamili, S. (2000). Hepatitis E. Infectious disease clinics of North America, 14(3), 669–687. https://doi.org/10.1016/s0891-5520(05)70126-4
[7] Iqbal, H., Mehmood, B. F., Sohal, A., & Roytman, M. (2023). Hepatitis E infection: A review. World journal of virology, 12(5), 262–271. https://doi.org/10.5501/wjv.v12.i5.262
[8] Guerra, J. A. A. A., Kampa, K. C., Morsoletto, D. G. B., Junior, A. P., & Ivantes, C. A. P. (2017). Hepatitis E: A Literature Review. Journal of clinical and translational hepatology, 5(4), 376–383. https://doi.org/10.14218/JCTH.2017.00012
[9] Lhomme, S., Marion, O., Abravanel, F., Izopet, J., & Kamar, N. (2020). Clinical Manifestations, Pathogenesis and Treatment of Hepatitis E Virus Infections. Journal of clinical medicine, 9(2), 331. https://doi.org/10.3390/jcm9020331
