What is hepatitis E?
Hepatitis E is an inflammation of the liver caused by the hepatitis E virus (HEV). It often runs without symptoms (asymptomatic) and then often remains undetected. If symptoms occur, they are usually mild and subside on their own. More rarely, severe courses occur with the risk of acute and fatal liver failure (e.g. in pregnant women). Overall, hepatitis E is similar to type A liver inflammation (hepatitis A), which is also caused by a virus.
Hepatitis E usually runs its course acutely. Chronic infection occurs mainly in weakened immune systems, for example in people with HIV or in the case of cancer during chemotherapy.
Frequency
In 2020, nearly 3,246 hepatitis E cases were registered in Germany. Most symptomatic infections affect men over 50 years of age.
Hepatitis E is notifiable in Germany, Austria and Switzerland.
What are the symptoms of hepatitis E?
- Upper abdominal discomfort
- Lack of appetite
- Nausea and vomiting
- Fever
- Fatigue
- Jaundice (icterus): Yellowing of the skin and the white conjunctiva of the eyes (sclera)
- Discolored stool
- Dark urine
Jaundice does not develop in every symptomatic hepatitis E infection!
Some affected individuals show atypical symptoms, especially neurological signs such as Guillain-Barré syndrome or inflammation of the brain (encephalitis).
How do you become infected with hepatitis E?
In regions with poor hygiene standards, where HEV virus types 1 and 2 are widespread, the hepatitis E virus is transmitted primarily by fecal-oral route via smear infection. This means that the pathogens excreted by affected persons in their stool enter the mouths of healthy persons via various routes and also infect them.
Occasionally, hepatitis E is also transmitted parenterally, i.e. bypassing the gastrointestinal tract. This occurs, for example, through the administration of contaminated blood transfusions.
Duration of infectiousness
Incubation period
The period between infection and the appearance of the first symptoms of hepatitis E (incubation period) varies between 15 and 64 days. On average, it is 40 days.
Examinations and diagnosis
The blood sample is also analyzed with regard to other laboratory values. For example, elevated liver values (such as the transaminases AST and ALT) often indicate liver disease.
In pregnant women with hepatitis E, the doctor will ask about stays in Africa or Asia (especially Bangladesh and northern India). If the woman has been there, there is a possibility that the hepatitis E is caused by genotype 1. Then the risk for a severe (fulminant) course is increased.
Therapy
In people with a previously damaged liver (for example, due to alcohol abuse or hepatitis B or C), there is a risk that hepatitis E will take a fulminant course. This means that it occurs very suddenly, progresses quickly and severely, and may even be fatal. Severe courses are also possible in people with suppressed immune systems. Those affected are treated in hospital. Antiviral drugs such as ribavirin are usually used.
Treatment for chronic hepatitis E
In chronic hepatitis E, treatment aims to eliminate the pathogens in the body. Only then will the affected person no longer be infectious and his liver will not suffer further damage.
Hepatitis E therapy: What you can do yourself
In any form of hepatitis, sufferers should absolutely avoid alcohol. Its detoxification would put additional strain on the diseased liver.
Anyone who is taking liver-damaging medication due to another illness should not stop taking it on their own initiative in the event of hepatitis. Instead, it is advisable to consult the attending physician.
A special diet is not necessary in the case of hepatitis E. However, doctors recommend a light diet that is as high in carbohydrates and low in fat as possible. This relieves the liver.
Course and prognosis
In people with a weakened immune system (for example, due to HIV infection or chemotherapy), hepatitis E sometimes takes a chronic course. In this case, too, those affected usually have no pronounced symptoms, but cirrhosis of the liver is more common as a late consequence. In this case, the liver becomes scarred and increasingly loses its function. If the liver fails in the advanced stage of liver cirrhosis, a liver transplant is unavoidable.
Prevention
To protect against hepatitis E viruses in animal foods, meat products and offal should only be eaten thoroughly cooked. This means they should be heated to at least 71 degrees Celsius for at least 20 minutes. This inactivates any hepatitis E viruses.
Those traveling to areas where hepatitis E is more prevalent should take care to protect themselves from potential sources of infection (exposure prophylaxis):
- Do not consume unpeeled fruits and vegetables or raw or inadequately heated foods in these areas. Adhere to the principle of “Cook it, peel it or forget it!” (Cook it, peel it or forget it!).
There is no vaccination against hepatitis E in Europe. There is a vaccine available in China, but it is not licensed in Europe.
