Hepatitis E

Hepatitis E is a viral hepatitis (liver inflammation)

caused by infection with avirus called hepatitis E
virus (HEV). It is one of five known
human hepatitisviruses: A, B, C, D, and E. HEV is a
positive-sense single-stranded RNA icosahedral
virus with a 7.5 kilobase genome. HEV has a fecaloral transmission route. Infection with this virus was
first documented in 1955 during an outbreak in New
Delhi, India.[1] A preventative vaccine (HEV 239) is
approved for use in China.
Although Hepatitis E often causes an acute and selflimiting infection (it usually goes away by itself and
the patient recovers).

Symptoms
Acute infection:
The incubation period of hepatitis E varies from
3 to 8 weeks. After a short prodromal
phase symptoms lasting from days to weeks
follow. They may include jaundice, fatigue
and nausea. The symptomatic phase
coincides with elevated
hepaticaminotransferase levels.

Chronic infection:
While usually an acute disease, in
immunocompromised subjectsparticularly
in solid organ transplanted patients
hepatitis E may cause a chronic
infection. Occasionally this may cause liver
fibrosis and cirrhosis

Classification
There is only one serotype of the virus and
classification is based on the nucleotide
sequences of the genome. Genotype 1 has
been classified into five subtypes, genotype
2 into two subtypes and genotypes 3 and 4
have been into ten and seven subtypes
respectively.

Transmission
Hepatitis E is prevalent in most developing
countries, and common in any country with a
hot climate. It is widespread in Southeast
Asia, northern and central Africa, India, and
Central America. It is spread mainly by
the fecal-oral route due to fecal
contamination of water supplies or food;
person-to-person transmission is
uncommon.

Prophilaxis&prevention
Sanitation:
Improving sanitation is the most important
measure in prevention of hepatitis E; this
consists of proper treatment and disposal of
human waste, higher standards for public
water supplies, improved personal hygiene
procedures and sanitary food preparation.

Vaccines:
A vaccine based on recombinant viral proteins
was developed in the 1990s and tested in a
high-risk population (military personnel of
Nepal) in 2001. The vaccine appeared to be
effective and safe, but development was
stopped for economic reasons, since
hepatitis E is rare in developed countries.
There is no licensed hepatitis E vaccine for
use in the US.

Treatment
Apart from supportive care, no specific validated
treatment exists for acute hepatis E
infection. Although ribavirin is not registered
for Hepatitis E treatment, there is off-label

experience for treating chronic Hepatitis E

with this compound. The use of low doses,
600 to 800 milligrams per day,
of ribavirin over a three-month period has
been associated with viral clearance in about
two-thirds of chronic cases. Other possible
treatments include peginterferon or a
combination of ribavirin and peginterferon.

Epidimology
The hepatitis E virus causes around 20 million
infections a year. These result in around
three million acute illnesses and as of 2010,
57,000 deaths annually. It is particularly
dangerous for pregnant women, who can
develop an acute form of the disease that is
lethal in 20 percent of cases. The virus (HEV)
is a major cause of illness and of death in the
developing world and disproportionate
cause of deaths among pregnant women.
Among indigenous people, a significant
prevalence of hepatitis E virus-specific
antibody has been reported in several
amerindian Yupka tribes in South America