hepatitis E virus
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Epidemiology
- uncommon in USA (< 5% of cases of acute viral hepatitis)
- endemic throughout Central & Southeast Asia, India, Middle East, North Africa, & Mexico
- accounts for 1/2 of cases of epidemic acute viral hepatitis in Mexico
- fecal-oral transmission
- pigs are likely reservoir & source of human infection
- prevalence in blood supply 0.035% in southeastern England[3]
Clinical manifestations
- acute, but NOT chronic hepatitis
- mean incubation period is 40 days
- generally causes mild, self-limited disease
- may cause chronic disease in immunocompromised patients[4]
Laboratory
- hepatitis E virus serology
- hepatitis E virus RNA (serum &/or feces)[5]
- diagnosis & proof of cure[6]
- urine protein[6]
- testing available through the Centers for Disease Control & Prevention (CDC)
* testing for HEV recommended for
- all immunosuppressed patients with unexplained abnormal liver function tests[6]
- travelers with hepatitis returning from areas endemic for HEV genotype 1 or 2
- patients presenting with neuralgic amyotrophy, Guillain-Barre syndrome, & encephalitis/myelitis[6]
- all patients with hepatitis
- patients presenting with suspected drug-induced liver injury
- patients with abnormal LFTs after receiving blood products[6]
- blood donor services[6]
Complications
- high case fatality rates (15-25%) in pregnant women[4][5]
Management
- ribavirin treatment may be considered in cases of severe acute hepatitis E or acute-on-chronic liver failure
- ribavirin monotherapy for 12 weeks for persistent HEV[6]
- pegylated interferon-alpha if no response to ribavirin[6]
- of uncertain risk/benefit[5]
- prevention:
- avoid consumption of undercooked meat & shellfish[6]
- investigational hepatitis E vaccine[4]
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Li RC et al Seroprevalence of hepatitis E virus infection, rural southern People's Republic of China Emerg Infect Dis 2006, 12:1682
- ↑ 3.0 3.1 Hewitt PE et al Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. The Lancet, Early Online Publication, 28 July 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25078306 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961034-5/abstract
- ↑ 4.0 4.1 4.2 4.3 Zhang J et al. Long-term efficacy of a hepatitis E vaccine. N Engl J Med 2015 Mar 5; 372:914. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25738667 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1406011
- ↑ 5.0 5.1 5.2 5.3 5.4 Rothaus C A Man with Acute Liver Injury. Now@NEJM. November 24th, 2016 http://blogs.nejm.org/now/index.php/man-acute-liver-injury/2016/11/24/
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol. 2018 Jun;68(6):1256-1271. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29609832 https://www.journal-of-hepatology.eu/article/S0168-8278(18)30155-7/fulltext
- ↑ De Keukeleire S, Reynders M. Hepatitis E: An Underdiagnosed, Emerging Infection in Nonendemic Regions. J Clin Transl Hepatol. 2015 Dec 28;3(4):288-91. Epub 2015 Dec 15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26807386 Free PMC Article