VIRAL HEPATITIS E
mkolar@med.muni.cz EPI; Autumn 2019
Hepatitis E Virus
Hepatitis E - Clinical Features
• Incubation period: Average 40 days
Range 15-60 days
• Case-fatality rate: Overall, 1%-3%
Pregnant women, 15%-25%
• Illness severity: Increased with age
• Chronic sequelae: None identified
Hepatitis E Virus Infection
Typical Serologic Course
Weeks after Exposure
Titer
Symptoms
ALT
IgG anti-HEV
IgM anti-HEV
Virus in stool
0 1 2 3 4 5 6 7 8 9 10 11 12 13
• Most outbreaks associated with
fecally contaminated drinking water
• Minimal person-to-person transmission
• U.S. cases usually have history of travel
to HEV-endemic areas
Hepatitis E Epidemiologic
Features
Geographic Distribution of Hepatitis E
Outbreaks or Confirmed Infection in >25% of Sporadic Non-ABC Hepatitis
• Avoid drinking water (and beverages with ice) of unknown
purity, uncooked shellfish, and uncooked fruit/vegetables not
peeled or prepared by traveler
• IG prepared from donors in Western countries does not
prevent infection
• Unknown efficacy of IG prepared from donors in endemic
areas
• Vaccine?
Prevention and Control Measures for
Travelers to HEV-Endemic Regions
Viral hepatitis (VH)
A B C D E
Causative agent Picornaviridae Hepadnaviridae Raviviridae Deltaviridae Hepeviridae
nucleic acid RNA DNA RNA RNA RNA
Clinical features fever, malaise and abdominal discomfort
Association with cirrhosis and
hepatocelular carcinom no + + with VHB no
fulminant %)
0,1 0,1-1,0 50 5 - 20 1-2 (10-20 in pregnancy)
Incubation period (days) 15-50 28-180 15-160 ??? 15-45
The period of infectivity Incubation period last 2 weeks last 2 months last 2 months ?? ??
acute illness first day entire period entire period ?? ??
transition to chronicity % no 1 - 10 50 possible no
Output Port - infectious
biological material
faeces ++++ - - - +++
blood + viremia 1 day +++ ++ + --
genital secretions - +++ ++ ? Mode
of transmission fecal-oral + - - - +
by blood rarely + + + sexual
contact + + rarely +
vertical - + rarely + -
Imunization
Inactivated hepatitis A
vaccines
active + passive
imunization
no no no