What is hepatitis E?
Hepatitis E is a form of liver disease caused by the hepatitis E virus (HEV). The disease is also known as acute viral hepatitis due to HEV. This disease is prevalent globally, but the occurrence is highest in Asia. The most prominent symptom of hepatitis E is usually jaundice that lasts for few weeks to months, but in rare cases may develop into fulminant liver failure. HEV is the most common cause of acute viral hepatitis in adults in India.
How does hepatitis E virus spread?
HEV spreads by the faecal–oral route due to contamination of water or food supplies with faeces. Transmission of hepatitis E from person to person is uncommon. Studies have suggested that some domestic animals may act as reservoir for the HEV, with some surveys showing that infection rates are more than 95% in domestic pigs.
Which have been the major outbreaks of hepatitis E?
Many large epidemics of hepatitis E have been documented in last six decades in the Indian cities of Delhi, Srinagar, Kanpur, Ahmedabad and Kolhapur as well as in the neighbouring countries like Myanmar, Bangladesh, Nepal and China. Outbreaks of hepatitis E epidemics usually occur after rainy seasons because of disruption of water supplies that leads to contamination with faecal matter. Worldwide, HEV causes about 20 million infections a year.
What are the clinical features of hepatitis E?
HEV causes ‘acute viral hepatitis’. It is a self-limiting disease that usually resolves itself and the individual recovers. It is very similar to clinical presentation of hepatitis A. The incubation period of hepatitis E (time period between getting infection and getting the first symptom) varies from 3 to 8 weeks. Jaundice usually occurs after a short period of prodromal symptoms of fever, loss of appetite, nausea and vomiting. The symptomatic phase coincides with elevated liver enzymes (AST and ALT). Rarely, hepatitis E may cause very severe liver disease known as acute liver failure or fulminant hepatic failure, which may be fatal.
Is hepatitis E dangerous in pregnant women?
Yes. Pregnant women are more prone to get a severe form of hepatitis E, especially fulminant hepatic failure. These women, especially in the third trimester, have an elevated mortality rate of around 20% from the HEV-related fulminant hepatic failure.
How is hepatitis E diagnosed?
In appropriate clinical context, IgM HEV serology confirms the diagnosis of hepatitis E infection. Liver function tests should be done as indicated and prothrombin time is a test which gives the most accurate indication of severity of disease. Ultrasound of abdomen usually gives an idea about the any pre-existing liver disease.
How can hepatitis E be prevented?
The most important measure for prevention of hepatitis E is sanitation. This consists of proper disposal of human waste, high standards for public water supplies, improved personal hygiene measures and hygienic food preparation. Active research is going on for the development of hepatitis E vaccine.
What is the treatment for hepatitis E?
As the disease is self-limiting, supportive and symptomatic treatment is required in most of the patients. In a small proportion of cases, where acute liver failure develops, liver transplantation may be required.