Hepatitis E is a form of liver inflammation that is transmitted through contaminated water or certain foods – for example, meat from infected animals. It usually heals on its own. However, infection during pregnancy can lead to dangerous complications. There is no medication against the hepatitis E virus, so only the symptoms can be treated. Infection can cause the typical symptoms of liver inflammation such as fever, nausea and jaundice, but in many cases there are no symptoms and the infection goes unnoticed. Since a vaccine is still under development, hygiene is the only preventive measure.
Hepatitis E: transmission and spread
Hepatitis E virus primarily affects animals such as pigs, sheep, and rats and is transmitted to humans by what is known as fecal-oral smear infection. This means that the pathogen is ingested by humans via water contaminated with animal feces. Possible sources of infection are unclean drinking water or meat from infected animals. Floods also increase the risk of infection with the virus. In contrast to hepatitis B and C, the disease is not transmitted by blood or body fluids. Thus, there is also no known direct infection from person to person. Due to poor hygienic conditions, the hepatitis E virus is particularly widespread in Africa and Asia. The disease is therefore considered a typical travel disease, but isolated infections also occur in Germany.
Symptoms of infection with hepatitis E
An infection with the hepatitis E virus proceeds similarly to a hepatitis A infection. Two to eight weeks after infection with the pathogen, patients may initially experience flu-like symptoms such as fever, nausea, abdominal pain, and vomiting. Occasionally, muscle or joint pain occurs. This is followed by the typical symptoms of liver disease:
- Yellowing of the skin and the whites of the eyes (jaundice).
- Pressure pain in the right upper abdomen
- Enlargement of the liver
- Discolored stool and beer-brown urine
- Itching of the skin
However, these symptoms do not always manifest themselves to the same extent. In about half of all cases of this disease complaints are completely absent (asymptomatic course) and the infection goes unnoticed by those affected.
Diagnosis of hepatitis E infection
If the symptoms indicate hepatitis, the diagnosis is made by a blood test. First, liver enzymes are determined to detect existing damage to the liver. If the suspicion of liver inflammation is confirmed, differentiation from other forms of hepatitis is made by detecting specific antibodies against the hepatitis E virus in the blood. In the case of infection, the diagnosis can also be confirmed by components of the virus in the stool and blood.
Course and therapy
In most cases, hepatitis E infection heals on its own within a few weeks. Because there are no active substances against the virus to date, therapy is limited to treatment of the symptoms with painkillers and antipyretic and nausea medications. To protect the damaged liver, patients should avoid alcohol for several months. Unlike hepatitis B and C, chronic courses of hepatitis E infections are not known. Rarely, a severe (fulminant) course with acute liver failure occurs, which can lead to brain swelling and impaired consciousness up to coma. In about 0.5 percent of cases, the disease is fatal.
Pregnancy and hepatitis E
For unknown reasons, pregnancy significantly increases the risk of a severe course, resulting in a 15 to 20 percent mortality rate among pregnant women with hepatitis E infection. Therefore, travel to high-risk areas during pregnancy should be avoided whenever possible. In addition, pregnant women should consume meat only when well cooked and avoid consuming pork liver.
Vaccination still under development
Research on a vaccine against the hepatitis E virus has been ongoing for several years, but vaccination is not currently possible. However, you can reduce the risk of contracting the disease by taking hygiene measures when traveling to a high-risk area:
- Boil tap water before using it to brush your teeth and drink only bottled water from stores.
- Avoid ice cubes in drinks.
- Eat fruits and vegetables only peeled or cooked.
- Consume meat only from hygienic preparation.
- Pay attention to general hygiene measures such as frequent hand washing.
