Therapy and Prophylaxis
After the diagnosis is made by talking to the patient (anamnesis), physical examination and evaluation of the blood count (antibodies of the IgM and IgG type against HEV can be detected in the blood serum), a symptomatic therapy begins. Since acute hepatitis E takes time to heal, only the symptoms can be controlled and general measures can be taken to spare the liver. This includes, for example, abstaining from alcohol and liver-damaging medication, if this is possible.
Physical protection (bed rest) is indispensable.For nausea, diarrhea and pain, liver-friendly medication is given accordingly. 98% of all acute HEV infections heal completely. Only about 2-3% take the fulminant course described above.
For pregnant women the figure is 20%. A Hepatitis E vaccine has now been successfully tested. The vaccination is an active immunization, i.e. the body is stimulated to produce antibodies against the virus.
Three vaccinations after zero, one and six months are necessary for an approx. 90% protective effect. Since infections occur only very occasionally in our latitudes, vaccination is not obligatory.
Passive immunization is not yet available for hepatitis E. In passive immunization, the patient is injected directly with effective antibodies against the HEV after possible infection. Although these are broken down by the body, they bridge the time required by the organism to produce antibodies during active immunization. When travelling to HEV-prone countries, adequate food and drinking water hygiene is required.
Water from the tap must be boiled for a sufficiently long time. Since pigs and sheep can be natural reservoirs of HEV, their meat should not be eaten raw in endangered regions. In addition, it is recommended to perform hygienic hand disinfection after contact with infected persons as a preventive measure.
Currently, there is no approved vaccine against Hepatitis E in Germany, but in China, for example, a vaccination against Hepatitis E has been approved since 2012. However, this vaccine is probably only effective against the hepatitis E viruses there (genotype 1) and not against the European hepatitis E virus types (genotype 3). Since the vaccine has already been successful in China, there will certainly be a vaccination against the hepatitis E viruses common in this country in the next few years, after sufficient studies have been conducted. Until then, the only prevention (prophylaxis) against infection with hepatitis E is to cook meat products and offal (especially from pigs and wild animals) at temperatures of at least 70°C. In areas with a higher risk of infection with hepatitis E, uncooked fruit and vegetables should only be eaten cooked or peeled if possible, and water should only be drunk from sealed bottles.
