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hepatitis E virus

Epidemiology: 1) uncommon in USA (< 5% of cases of acute viral hepatitis) 2) endemic throughout Central & Southeast Asia, India, Middle East, North Africa, & Mexico 3) accounts for 1/2 of cases of epidemic acute viral hepatitis in Mexico 4) fecal-oral transmission 5) pigs are likely reservoir & source of human infection 6) prevalence in blood supply 0.035% in southeastern England [3] Clinical manifestations: 1) acute, but NOT chronic hepatitis 2) mean incubation period is 40 days 3) generally causes mild, self-limited disease 4) may cause chronic disease in immunocompromised patients [4] Laboratory: - hepatitis E virus serology - hepatitis E virus IgM in serum [5] - hepatitis E virus RNA (serum &/or feces) [5] - diagnosis & proof of cure [6] - urine protein [6] - testing available through the Centers for Disease Control & Prevention (CDC) * testing for HEV recommended for - all immunosuppressed patients with unexplained abnormal liver function tests [6] - travelers with hepatitis returning from areas endemic for HEV genotype 1 or 2 - patients presenting with neuralgic amyotrophy, Guillain-Barre syndrome, & encephalitis/myelitis [6] - all patients with hepatitis - patients presenting with suspected drug-induced liver injury - patients with abnormal LFTs after receiving blood products [6] - blood donor services [6] Complications: - high case fatality rates (15-25%) in pregnant women [4,5] Management: - ribavirin treatment may be considered in cases of severe acute hepatitis E or acute-on-chronic liver failure - ribavirin monotherapy for 12 weeks for persistent HEV [6] - pegylated interferon-alpha if no response to ribavirin [6] - of uncertain risk/benefit [5] - prevention: - avoid consumption of undercooked meat & shellfish [6] - investigational hepatitis E vaccine [4]

Related

hepatitis E virus antibody Hepatitis E virus antigen Hepatitis E virus genotyping Hepatitis E virus RNA hepatitis virus viral hepatitis

General

caliciviridae

Properties

KINGDOM: virus GENOME-TYPE: RNA SINGLE-STRANDED POSITIVE-STRAND GENOME-SIZE: 8 kB ENVELOPE: NONE CAPSID-SYMMETRY: ICOSAHEDRAL

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Li RC et al Seroprevalence of hepatitis E virus infection, rural southern People's Republic of China Emerg Infect Dis 2006, 12:1682
  3. Hewitt PE et al Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. The Lancet, Early Online Publication, 28 July 2014 PMID: 25078306 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961034-5/abstract
  4. Zhang J et al. Long-term efficacy of a hepatitis E vaccine. N Engl J Med 2015 Mar 5; 372:914. PMID: 25738667 http://www.nejm.org/doi/full/10.1056/NEJMoa1406011
  5. Rothaus C A Man with Acute Liver Injury. Now@NEJM. November 24th, 2016 http://blogs.nejm.org/now/index.php/man-acute-liver-injury/2016/11/24/
  6. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol. 2018 Jun;68(6):1256-1271. PMID: 29609832 https://www.journal-of-hepatology.eu/article/S0168-8278(18)30155-7/fulltext
  7. De Keukeleire S, Reynders M. Hepatitis E: An Underdiagnosed, Emerging Infection in Nonendemic Regions. J Clin Transl Hepatol. 2015 Dec 28;3(4):288-91. Epub 2015 Dec 15. PMID: 26807386 Free PMC Article