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What

Hepatitis is a general term referring to inflammation of the liver. Hepatitis E is a specific type of hepatitis caused by the Hepatitis E virus (HEV), a single-stranded RNA virus very similar to the other types of hepatitis. HEV is primarily a problem in the developing world and is only very rarely seen in developed nations such as the United States. In the vast majority of cases, hepatitis E is self-limiting and all symptoms disappear on their own, without any long-standing effects.

Who

Hepatitis E is common in the developing world due to substandard sanitation and hygiene. When it is seen in the United States and other parts of the developed world, the individuals affected with the virus usually have recently traveled to parts of the developing world. The virus affects men and women equally and does not show any apparent racial or ethnic preference. Symptomatic HEV is most common in young adults, aged 15-40 years, with children usually only contracting mild cases of the virus. It is worth noting that pregnant women are particularly prone to complications and very severe forms of HEV.

Signs and Symptoms

After an individual has been infected with hepatitis E, the virus usually lies dormant (meaning that no symptoms are evident) for anywhere from 2 weeks to 2 months. Once they appear, the symptoms of hepatitis E are the same as those of other types of hepatitis. These include jaundice (a yellowing of the skin and whites of the eyes), dark-colored urine and light-colored stool, nausea/vomiting, loss of appetite, abdominal pain and tenderness, fever, and malaise. The severity of the disease ranges greatly, from subclinical (meaning that the individual has the virus but does not show any symptoms) to very severe (sometimes referred to as “fulminant”). HEV in children is usually asymptomatic or causes only very slight illness, though some research has recently shown that the virus may be more severe in children when it arises spontaneously (in one or only a few individuals) rather than as part of a large epidemic.

Possible Causes

Hepatitis E is transmitted primarily by the fecal-oral route, meaning that it is passed from one individual to another when food or water is contaminated with the fecal material of an individual with HEV which is then ingested by someone else. Thus, in most cases, HEV is passed along due to a combination of unsanitary living conditions and poor hygiene. It can be contracted by drinking infected water, eating fruits or vegetables washed with infected water, or eating raw/uncooked shellfish that was stored in similarly infected water. Some individuals have come down with HEV after eating undercooked meat, so it is believed that animals can also be affected by the virus and pass it along to humans. Recent research shows that hepatitis E can be passed from mother to fetus during pregnancy, which may be very dangerous to the child. There is no evidence that HEV can be transmitted via sexual contact or blood transfusion.

Diagnosis

Individuals with hepatitis E usually have elevated levels of aminotransferases (liver enzymes) beginning several days before the onset of symptoms and continuing for several months after symptoms have ceased. These levels are commonly measured as part of basic blood screenings. Several additional blood tests are available to definitively diagnosis hepatitis E, including anti-HEV IgM and IgG. These are tests that look for signs that a person’s immune system is reacting to the virus, but they cannot always be clear about whether the infection is ongoing, or if the patient had that infection in the past but has since recovered from it. Special blood tests that look directly for the virus are sometimes useful in making the distinction between an old infection that resolved and an ongoing infection. A liver biopsy or abdominal ultrasound is not usually needed for diagnosis but these tests are sometimes used to determine if other problems are occurring simultaneously.

Treatment

Since hepatitis E is a virus, there is no cure. Antibiotic therapy is ineffective. The virus must simply be allowed to run its course, just as with the flu or a cold. Children with HEV should be given plenty of water and electrolytes (such as popular sports drinks to ensure that they do not become dehydrated. Any additional treatments should be directed at making the patient comfortable (i.e., giving pain relievers for headache/stomachache, etc.). No specific dietary restraints are necessary, nor should children with HEV be prevented from any activity level with which they are comfortable. Hospitalization is only necessary in severe cases of dehydration or in the presence of other unusually severe symptoms. Only very rarely (in about 1% of cases) is HEV directly passed from one infected individual to an uninfected person.

Prognosis

HEV is usually self-limiting, with those infected by the virus recovering fully within several weeks. Severe cases do occur, however, resulting in an overall death rate o 0.5 to 3 percent. The virus is particularly dangerous for pregnant women, for whom the mortality rate rises to 20%. Generally, however, with proper re-hydration and supportive care, individuals who develop hepatitis E are able to recover fully within a few weeks without any long-standing effects.

Connect with other parents

In the spirit of community and support, Madisons Foundation offers the unique service of connecting parents of children with rare diseases. If you would like to be connected to other parents of children with this disease, please fill out this brief form.

Weblinks

World Health Organization: Hepatitis E
This website contains a good amount of information about hepatitis E in an easy-to-understand and easy-to-navigate format. It is also regularly updated by the WHO, ensuring that information is up to date and accurate. The site also contains several links for those seeking more information.

National Center for Infectious Disease: Viral Hepatitis E
This is a brief fact sheet put out by the CDC’s Center for Infectious Disease on HEV. It is very simple and straight-forward, but those looking for great detail should probably look elsewhere.

Google Search for Hepatitis E Virus (HEV)

References and Sources

Flora KD (2004). eMedicine: Hepatitis E. www.emedicine.com/med/topic995.htm Emerson SU, Purcell RH (2004), Running Like Water – The Omnipresence of Hepatitis E, New England Journal of Medicine, 351(23), p 2367-8.