Hepatitis E – What it is, Symptoms and Treatments

Hepatitis E – What it is, Symptoms and  Antibiotic Treatments. In addition, Hepatitis E results from Hepatitis E virus (HEV) infection, is transmitted from person to person, through water and food contaminated with fecal matter, and has been responsible for major epidemics in Central and Southeast Asia, in North and West Africa and Central America. In the industrialized world, the virus is almost non-existent, as is the case in Portugal, where the disease is scarce and only manifests itself in individuals who have been in endemic tropical regions.

As a specific human disease, it was only identified in 1980, when tests were carried out to detect hepatitis A antibodies in India, during the study of an epidemic hepatitis transmitted through water, but whose infectious agent was not HAV. At the time, it was considered a virulent liver disease without any other classification and only in 1988, with the discovery of the virus, it was renamed Hepatitis E. The severity of HEV infection is greater than that caused by the hepatitis A virus , but recovery occurs within a short time.

The disease can be fulminant, the mortality rate varies between 0.5 and 4%, and the cases that occur during pregnancy are much more serious, reaching mortality rates in the order of 20% if the virus is contracted during pregnancy. the third quarter. There are also records of premature births, with infant mortality rates reaching 33 percent. In children, co-infection with viruses A and E can result in serious illness, including acute liver failure.

Some experts refer to the possibility of transmission between animals and humans, since several monkeys, pigs, cows, sheep, goats and rodents are susceptible to infection with the Hepatitis E virus . A reading of the statistics indicates that the disease has a higher incidence rate among adults aged 15 to 40 years, but, according to the World Health Organization, the low rate recorded among children may be due to the fact that Hepatitis E , normally not cause any symptoms in the youngest.

Hepatitis E Virus : The HEV is composed entirely of ribonucleic acid (RNA) and viral protein and has a diameter of 27 to 34 nm. Discovered in 1988, it was first classified in the calicivirus family, but currently there are doubts about its classification. The incubation period ranges from 15 to 64 days (three to eight weeks, 40 days on average) and transmission of the virus occurs from the second half of the incubation period to seven days after the onset of jaundice.

HEV is more common in places with warm than temperate climates and, due to the way it spreads, the highest rate of infection is found in developing countries with poor sanitation systems. In addition to India, where it was discovered, it has already been detected in the Middle and Far East, in North and West Africa, in the central republics of the former Soviet Union, in China and also in Central America.

Hepatitis epidemics that occurred in Europe before the 20th century and that until recently were supposed to be caused by hepatitis A virus actually have the epidemiological characteristics of Hepatitis E . Specialists put forward the hypothesis that the HEV has disappeared from industrialized countries in the recent past, just as the hepatitis A virus is now losing importance in these same countries. The virus is found in sick humans, but also in monkeys, pigs, cows, goats, sheep and rodents (at least in those living in endemic regions).

Causes of Hepatitis E:  What causes Hepatitis E is the HEV virus or Hepatitis E virus which can cause inflammation of the liver. This virus takes about 40 days to show signs, often there is no evidence of infection. The most common form of transmission of hepatitis E is via the fecal-oral route, that is, consumption of water or food contaminated by feces. Often this type of contamination occurs in regions of extreme poverty and is related to outbreaks, affecting the entire population. Other ways of contamination can be:

  • Contact with contaminated blood
  • Mother to child transmission
  • Eating raw foods like shellfish

Symptoms of Hepatitis E:  Hepatitis E may have no symptoms, that is, it may be asymptomatic. However, some people have reported the following signs:

  • Jaundice or yellowing of the skin and eyes
  • Lack of appetite
  • nausea and vomiting
  • Fever
  • Abdominal pain
  • light stools
  • dark urine

The HEV virus rarely causes complications, but cases of liver failure and death have been reported. Pregnant women are at a higher risk of mortality, so medical monitoring is necessary throughout this phase.

Hepatitis E Transmission:  Like hepatitis A , the Hepatitis E virus is spread through water and food contaminated by faecal matter, with person-to-person transmission being rarer. There are no reports of transmission through sexual contact or through blood.

Diagnosis of Hepatitis E:  The disease is diagnosed when anti-HEV IgM antibodies are detected after biochemical analysis of liver enzymes. It is during the incubation period and at the beginning of the acute phase that the number of virus in the body reaches its maximum, and the same happens with the amount that is released in the faeces; at this point it is possible to find the viral antigens on the liver cells and conclude, without a shadow of a doubt, that the person concerned is infected.

RNA of the virus can be detected in feces during the acute phase in about 50 percent of cases through genetic amplification tests (“Polymerase Chain Reaction”). The period of infection has not yet been fully determined, but there are studies that indicate that it is at least 14 days after the onset of jaundice, as the presence of the virus in the stool was detected during this period of time and disappears during the recovery phase. .

Antibodies to HEV (IgM and IgG classes) develop when symptoms appear, sometimes even before jaundice. Anti-HEV IgM precede anti-HEV IgG by a few days, and the virus may still be present after the appearance of antibodies. Antibodies of the IgM class disappear during the first phase of recovery, while those of the IgG class persist for much longer periods, up to 14 years, serving as protection against subsequent infections.

Treatment of Hepatitis E:  Hepatitis E , as a viral disease, should not be treated with antibiotics. Infections are generally limited and hospitalization is usually not required, except in the case of fulminant hepatitis .

Prevention of Hepatitis E:  There is still no vaccine for the disease, so prevention measures include extra hygiene care when traveling to areas where the disease is common. Do not consume water or ice that may come from contaminated places, it is better to choose bottled and sealed water. Fruits and vegetables should only be eaten after cooking and eating raw shellfish is not recommended.

Person-to-person transmission is less frequent in Hepatitis E than in Hepatitis A and the possibility of sexual transmission has not been proven, but oral-anal contacts must be taken into account. Chlorine is the chemical element that has been successfully used to disinfect public water in areas where epidemics have occurred. Iodine-based disinfectants have also proven capable of destroying the virus.

There are some measures that can prevent us from contracting the HEV virus, they are:

  • Inform yourself about the water treatment method in your city and avoid drinking water from dubious sources.
  • Take care of hygiene: wash your hands after using the bathroom and before eating.
  • Take preventive measures in cases of open sewage and inform the responsible government of your city.

The first vaccine against Hepatitis E , appeared in China in 2011 and has not yet been released to other countries in the world.

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