Hepatitis E virus

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Infection with hepatitis E virus causes only acute hepatitis.

Infection during pregnancy is associated with high mortality (up to 20%).

Sporadic and outbreak are common in developing countries.

Transmission

Transmission is through faecal-oral route especially after drinking contaminated water.

Transplacental transmission is another route of transmission that is well recognised.

Similar virus infects pigs and some experts argue pigs virus may cross species barrier.

Incubation period

The incubation period ranges between 2 weeks to 8 weeks.

Infectious period begin with the onset of illness and continue for up to 2 weeks.

 

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Clinical presentations

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Asymptomatic infection is generally common.

In children

• Nausea and vomiting

• Jaundice

• Clay stool and dark urine

 

In adult

Asymptomatic infection is common.

In endemic countries most adult acquire infection at the early age and they develop life long immunity.

Pregnant women are at particular high risk of developing fulminant hepatitis.

 

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Investigation

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LFT- raised transaminase level

 

Diagnostic tests

Serum for Hepatitis E virus IgM and IgG

Positive Hepatitis E IgM indicate recent/acute infection in endemic countries.

 

Hepatitis E

 

Acute/ recent infection                +                                            +

 

Screening

Screening is not normally required.

 

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Management

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Conservative- low protein diet.

Consumption of alcohol should be discouraged for several weeks after infection.

Patient who has infection with hepatitis E should be isolated (enteric isolation).

Liver transplant may be required for patient with fulminant hepatitis.

 

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Prevention

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Availability of safe and clean water can prevent infection.

Surveillance is very important to detect outbreak and to take appropriate measures.

Inactivated Hepatitis E Vaccine have been tried in India and found to be successful in preventing infection.

 

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