Hepatitis E is an infectious disease caused by the hepatitis E virus (HEV), a member of the Hepeviridae family. The virus infects the liver and can cause mild to severe acute hepatitis. Patients experience a variety of clinical manifestations, including jaundice, fatigue, nausea, and abdominal pain. Unlike other hepatitis viruses, such as B and C, hepatitis E is most often transmitted through the fecal-oral route, which involves poor sanitation and hygiene and water sources contaminated with excrement. Because the hepatitis E virus primarily infects the liver, prolonged or severe forms of the disease can lead to serious consequences, including liver failure and even death, especially in pregnant women.
History of the disease and interesting historical facts
Hepatitis E was first described in the 1980s among military personnel involved in the conflict in Afghanistan. In 1983, it was determined that the disease was caused by a virus, and in 1990, the genomic structure of the pathogen was isolated. Interestingly, hepatitis E is largely prevalent in developing countries, especially in areas with poor sanitation. The most significant outbreaks have been reported in India, Mexico, and some African countries. However, cases of hepatitis E are also observed in highly developed countries, where the virus may be associated with certain population groups, such as migrants or travelers.
Epidemiology
According to the World Health Organization, hepatitis E affects approximately 20 million people worldwide each year, of which about 3 million are clinically affected. Of particular concern is the high mortality rate among pregnant women, which can reach 20-25% in severe cases. Epidemiological studies show that most cases of the disease are registered in countries with hot climates and water shortages. For example, in 2022, Nigeria recorded several outbreaks affecting more than 5,000 people, with a high mortality rate among women in the third trimester of pregnancy.
Genetic predisposition to this disease
To date, no direct genetic predisposition to hepatitis E has been established, but there is evidence of a number of genes that may influence susceptibility to infection. The most studied are genes encoding proteins of the immune system. For example, polymorphisms in genes responsible for the production of interferons can affect the body's ability to resist the virus. Research shows that the presence of certain mutations in the TNF-α genes can increase the risk of developing severe forms of the disease. Therefore, studying the genomic characteristics of individual population groups can contribute to a deeper understanding of the pathogenesis of hepatitis E.
Risk factors for the development of this disease
There are several risk factors that contribute to the development of hepatitis E, including:
- Inadequate sanitation and lack of clean water, which facilitates the feco-oral route of infection.
- Travel or long-term residence in endemic areas.
- Consumption of uncleaned or potentially contaminated food and water.
- Activities in the field related to wastewater treatment or work with animals, in addition, hunting and cooking wild pigs.
These factors highlight the importance of maintaining health and hygiene standards, especially in high-risk areas. Children and the elderly are particularly vulnerable, as are people with underlying medical conditions, which increases the likelihood of severe disease.
Diagnosis of this disease
Diagnosis of hepatitis E is based on clinical manifestations and laboratory test results. The main symptoms of the disease include:
- Jaundice (the appearance of yellowing of the skin and mucous membranes)
- Nausea and vomiting
- Stomach ache
- Fatigue and general malaise
Laboratory tests for the presence of IgM and IgG antibodies to the hepatitis E virus, as well as polymerase chain reaction (PCR) to detect viral DNA in the blood, are used to confirm the diagnosis. Each of these methods is an important step in establishing an accurate diagnosis and subsequent monitoring of the patient's condition. Radiological methods, such as liver ultrasound, can also help in assessing the extent of organ damage. The differential diagnosis of hepatitis E includes exclusion of other viral hepatitis, as well as various forms of alcoholic and toxic hepatitis.
Treatment
Treatment of hepatitis E is symptomatic and supportive in most cases. There is no specific antiviral therapy for this disease. The main treatment areas include:
- Maintain hydration and electrolyte balance, especially in cases of severe vomiting.
- Use of hepatoprotectors to support liver function.
- In some cases, steroid treatment may be recommended for severe cases.
Surgery is usually not required, but in rare cases liver transplantation may be necessary if acute liver injury develops. It is important to note that if necessary, patients should avoid alcohol and potentially hepatotoxic drugs until recovery is complete.
List of medications used to treat this disease
Although there are no specific antiviral drugs against hepatitis E, it is recommended to use:
- Hepatoprotectors (eg, essential phospholipids)
- Immunostimulants
It should be noted that the choice of treatment depends on the clinical picture and condition of the patient, and therefore should always be discussed with the attending physician.
Disease monitoring
Monitoring of hepatitis E includes regular follow-up examinations to check for liver function recovery and viral activity. The prognosis is generally good, and most patients recover completely without sequelae. However, for pregnant women, the prognosis is negative in 20-25% cases, necessitating close monitoring and, if necessary, hospitalization. Complications may include the development of liver failure and chronic liver disease.
Age-related features of the disease
Hepatitis E manifests itself with varying degrees of severity depending on the patient's age category. In children, the disease usually occurs in a milder form and requires minimal treatment. In older people and pregnant women, the disease can lead to more severe consequences, which is influenced by weakened immunity and concomitant pathologies. These age groups require special attention and observation to diagnose possible complications.
Questions and Answers
- How is hepatitis E transmitted? Hepatitis E is transmitted through the feco-oral route, which is associated with poor sanitation and consumption of contaminated food or water.
- Are there vaccines against hepatitis E? Currently, vaccines against hepatitis E are not registered in most countries, although there are developments in this area.
- How long does the virus stay in the body? The hepatitis E virus can remain in the body for several weeks, during which time the disease may develop.
- Is it possible to avoid the disease? The disease can be avoided by maintaining hygiene, following a diet, and being careful when consuming water and food in endemic areas.
- What complications are possible with hepatitis E? The most serious complications are acute liver injury and liver failure, especially in pregnant women.
Advice from Dr. Oleg Korzhikov
With hepatitis E, it is important to monitor your condition and seek medical attention if you have suspicious symptoms. Vaccination, if available, is an important precaution. I recommend avoiding uncleaned food and water, especially when traveling to high-risk countries. Pay attention to hygiene practices, such as regular hand washing. As a rule, by following these simple recommendations, the likelihood of infection is significantly reduced.
