Hepatitis is an inflammation of the liver. This is mainly transmitted by various viruses such as the hepatitis A, B or C virus.
The hepatitis E virus belongs to the group of RNA viruses. It used to be considered as part of the family Caliciviridae, but now it is considered to belong to the monotypic family Hepeviridae. HEV genotypes 1-5 can be distinguished. Genotypes 1-4 are human pathogenic: HEV 1 and HEV 2 are mostly responsible for rice infection. HEV 3 and HEV 4 occur in humans and animals (especially pigs). Genotype 5 occurs only in birds.
Transmission of the pathogen (route of infection) occurs by contact or smear infection (fecal-oral: infections in which pathogens excreted with feces (fecal) are ingested via the mouth (oral), e.g., through contaminated drinking water and/or contaminated food with HEV genotypes 1 and 2). Human-to-human transmission has not been demonstrated to date.
Risk groups include primarily travelers to India, Central/South America, Africa, or the Commonwealth of Independent States (CIS).
In Europe, most cases of hepatitis E are caused by HSV genotype 3, which occurs autochthonously.
The prevalence (disease incidence) for anti-HEV (antibodies against HEV) is 16.8% in Germany.
When hepatitis E virus (HEV) infection is suspected, the following laboratory tests should be performed:
- Serology* – detection of hepatitis E-specific antibodies [Note: In transplanted patients, months to years may pass before measurable antibodies are produced in the context of chronic hepatitis E! → HEV RNA by PCR, see below]
- HEV antigen detection (hepatitis E antigen) in blood or stool [indicates fresh hepatitis E infection].
- Anti-HEV IgM * * – indicative of fresh hepatitis A infection [usually positive only in the 2nd-4th week of illness; falls off quickly after healing].
- Anti-HEV IgG * * – indicates an expired infection or a performed vaccination [contamination in Germany in blood donors about 1.0%; persistence over at least 14 years; indicator of existing immunity to reinfection].
- If necessary, HEV RNA by PCR in blood (EDTA blood) or stool [evidence of a fresh (seronegative) or infectious HEV disease].
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (γ-GT, gamma-GT; GGT), alkaline phosphatase, bilirubin.
* In accordance with the Protection against Infection Act, suspected illness, illness, and death from acute viral hepatitis must be reported by name.* * If anti-HEV is positive, determination of HEV RNA should be performed.
Procedure
Material needed
- Blood serum
- Stool
Preparation of the patient
- Not known
Disruptive factors
- Examine stool sample quickly
Normal values
| Parameter | Normal value |
| HEV antibody | Negative |
| Hepatitis E-PCR | Negative |
Indications
- Suspected hepatitis E infection
Interpretation
Interpretation of increased values
- Hepatitis E
Interpretation of decreased values
- Not relevant to the disease
Further notes
- Suspicion of, illness from, and death due to hepatitis are reportable
