Hepatitis E

Hepatitis E: Description

Hepatitis E is a form of viral hepatitis. It can proceed without symptoms (asymptomatic) and then often goes undetected. When symptoms appear, they are usually mild and resolve on their own. Rarely, there are serious cases with the risk of acute and fatal liver failure (such as in pregnant women).

Note: Hepatitis E is usually acute. Chronic infection is particularly possible in weakened immune systems, such as in HIV patients or cancer patients during chemotherapy.

Hepatitis E is similar to the type A virus (hepatitis A), also caused by virus. In fact, hepatitis E was not identified as a disease in 1980 until a more detailed examination of a supposed hepatitis A epidemic in India took place. It was discovered that the disease outbreak is not caused by hepatitis A viruses but by a new type of virus. He was referred to as hepatitis E virus.

In the meantime, different genotypes of hepatitis E viruses are known. In Germany, genotype 3 is widespread.

Hepatitis E: frequency

Hepatitis E is coming worldwide in front. She is in Germany since 2001 notifiable, It shows that the case numbers are increasing every year. But that’s probably not because more and more people get hepatitis E. The reason is more likely that the doctors are becoming increasingly aware of hepatitis E and more frequently perform appropriate investigations. Improved test methods are also likely to increase case numbers.

In 2016, just under 2,000 cases of hepatitis E were registered in Germany. For comparison, in 2013 there were fewer than 500 reports.

About 75 percent of all reported hepatitis E cases affect People over 40 years, Most of them are Men.

Hepatitis E: contagion

In Germany and other industrial nations hepatitis E is mainly overpoorly cooked pork or game meat or products derived therefrom. The animals are an important reservoir for the pathogen (especially domestic pigs). It is also possible a contagion over seafood (like shells), which can filter water and enrich the pathogen. Extremely rare (if at all) the prevalent in this country hepatitis E virus virus genotype 3 (HEV-3) transmitted directly from person to person.

In regions with poor hygiene standards, where genotypes 1 and 2 are common, hepatitis E will be the most prevalent transferred fecal-oral, This means that the hepatitis E virus excreted by the patient via the stool reaches the mouth of healthy persons in different ways and also infects them. That can be through contact infection If patients do not properly wash their hands after having a bowel movement, they can, for example, transfer the pathogen to doorknobs or cutlery. If they are touched by a healthy person, who then reaches for his lips with his hand, he can also become infected. In addition, hepatitis E transmission is also over with fecal matter contaminated water and contaminated food possible.

Occasionally hepatitis E will too transmitted parenterallythat is bypassing the gastrointestinal tract. This can happen, for example, via the administration of contaminated blood transfusions.

Duration of infectivity

So far it is unclear how long patients are contagious. In the stool, the pathogen can be detected about a week before to four weeks after onset of jaundice. Chronic hepatitis E is likely to be contagious for as long as the infection persists.

Hepatitis E: incubation period

The period between infection and the appearance of the first symptoms of hepatitis E (incubation period) varies between 15 and 64 days.

Hepatitis E: Symptoms

An infection with the occurring in this country genotype of hepatitis E virus (HEV-3) usually runs without symptoms (asymptomatic infection). When symptoms occur, it is called one symptomatic infection: It is usually acute and has mild symptoms that disappear within a few weeks. These complaints include, for example:

• Abdominal pain
• loss of appetite
• Nausea and vomiting
• fever
• fatigue
• Jaundice (jaundice): yellowing of the skin and the white conjunctiva of the eyes (sclera)
• discolored stool
• dark urine

Warning: Jaundice does not develop with every symptomatic hepatitis E infection!

Some patients have atypical symptoms, especially neurological signs such as Guillain-Barré syndrome or meningitis.

Hepatitis E: examinations and diagnosis

If there is a suspicion of hepatitis E, the doctor will first raise the patient’s medical history (anamnesis) in a detailed interview. In doing so, he gets a detailed description of the complaints and asks about possible trips to risk areas. Then there is a physical examination With blood collection, The blood sample will open Antibodies to hepatitis E viruses examined. The detection of IgM antibodies to the virus indicates an acute infection. In contrast, specific IgG antibodies indicate a previously experienced infection.

Besides, one can put the blood or the chair of the patient on the Genome of the pathogen (Virus RNA). Such a direct pathogen detection but is necessary only in certain cases. This applies, for example, to patients with immunodeficiency (such as HIV patients). In these tests on antibodies to hepatitis E are not meaningful. Even in patients who have specific IgM antibodies in the blood, but show no or only atypical symptoms of hepatitis E infection, a direct pathogen detection is useful.

The blood sample is also analyzed for further laboratory values. So can about elevated liver values (like GOT, GPT), indicate liver disease.

Hepatitis E: Therapy

A acute hepatitis E in patients with a healthy immune system usually does not need to be treated. It usually heals on its own. If necessary, you can relieve the symptoms, such as a drug for nausea and vomiting.

In people with a previously damaged liver (such as alcohol abuse or hepatitis B or C) there is a risk that hepatitis E will cause a fulminant course takes. That is, it occurs very suddenly, is fast and severe and may even be fatal. Hepatitis E can also be fulminant in people with suppressed immune systems (for example, when treated with immunosuppressants or HIV / AIDS). The patients are treated in the hospital. This usually antiviral drugs are used (such as ribavirin).

Note: For pregnant women with hepatitis E, the doctor will ask for visits to Africa or Asia (especially Bangladesh and North India). If the woman was there, there is a possibility that genotype 1 hepatitis E will be caused. Then the risk of a fulminant course is increased.

In a fulminant hepatitis E infection, the liver can fail. Then there is currently the only therapy option in one liver transplantation.

at chronic hepatitis E The treatment aims to eliminate the pathogens in the body of the patient. Only then is the patient no longer infectious, and his liver is not further damaged.

Chronic disease is usually found in patients with immunodeficiency. This may be due to illnesses such as HIV / AIDS or medications (immunosuppressants). When it is possible to reduce the suppression of the immune system (immunosuppression), hepatitis E usually heals on its own. In contrast, if immunosuppression can not be reduced, liver inflammation is usually treated with antiviral drugs (such as ribavirin).

Hepatitis E Therapy: What you can do yourself

For any form of hepatitis patients should necessarily abstain from alcohol, Their detoxification would additionally burden the ill liver.

For the same reason should preferably no liver-damaging drugs such as paracetamol (analgesics), tetracyclines (antibiotics) or methotrexate (cancer and rheumatism). Also halothane (anesthetics), chlorpromazine (agents for mental illness), hormonal contraceptives and anabolic steroids should be avoided. Ask your doctor before every medication application if there is a risk of liver damage.

Attention: Anyone who is treated with liver-damaging drugs should not stop them in case of hepatitis disease. Instead, a consultation with the attending physician is advisable.

A special diet is not necessary for hepatitis E. Doctors recommend but one light foodcarbohydrate-rich and low-fat. That relieves the liver.

Hepatitis E: Prognosis

In general, hepatitis E is not a particular risk. When symptoms occur, they are usually only mild. In addition, the infection is acute in most cases and heals by itself and without consequences.

In people with immunodeficiency hepatitis E can take a chronic course. This can happen, for example, in HIV / AIDS patients, dialysis patients and transplant patients.

In existing liver damage and chronic liver disease, hepatitis E may be severe and even fatal. This is especially true for pregnant women (in genotype 1 infection): Especially a hepatitis E infection in the last trimester of pregnancy is life-threatening – the mortality rate is here at 20 to 25 percent. Even premature births or miscarriages are possible.

Hepatitis E: Prevention

In order to protect themselves in this country from hepatitis E viruses in animal foods, meat products and offal should only be consumed thoroughly. That means: They should be heated to at least 71 degrees Celsius for at least 20 minutes. This inactivates any hepatitis E viruses.

In addition, care should be taken in the preparation of food on a careful kitchen hygiene. This avoids cross-contamination, ie virus transmission from (possibly) infected meat products to items such as knives and on to other foods.

If you travel to areas where hepatitis E is more prevalent, you should take care to protect yourself from possible sources of infection (exposure prophylaxis):

• Do not eat unpeeled fruits and vegetables in these areas or raw or under-cooked foods. Stick to the principle “Cook it, peel it or forget it!” (Cook it, peel it or forget it!).
• Only drink water from sealed bottles or sufficiently boiled tap water. Avoid ice cubes – they could be made from uncooked water.

Versus Hepatitis E There is no vaccine in this country. There is a vaccine available in China. This is not allowed in Europe.