HEPATITIS E
Section snippets
VIROLOGY
HEV virions are small, nonenveloped, 32- to 34-nm diameter particles with indentations and spikes on their surfaces similar in appearance to those of caliciviruses.19, 101 Analysis of electron micrographs of HEV particles by the Markham rotational method provided images that suggested an icosahedral symmetry for these virions.101 The HEV genome consists of a single-stranded, positive-sense, polyadenylated RNA molecule, approximately 7.5 kilobases (kb) in length.99 It contains short 5′ and 3′
Main Features
HEV infection is endemic in the Indian subcontinent and Southeast and Central Asia, and accounts for a substantial proportion of acute sporadic hepatitis in both children and adults. In disease-endemic areas, hepatitis E occurs as large outbreaks that affect several hundred to several thousand persons.56, 83, 116, 125 In India, HEV infection has been found to account for 50% to 70% of all patients with sporadic viral hepatitis.8, 62 A large outbreak of hepatitis E was identified in China
DIAGNOSIS
Current laboratory tests for the diagnosis of human HEV infection include serologic assays for identification of anti-HEV antibody of IgM or IgG class, and RT-PCR for detection of the virus in stool or serum.
Clinical and Biochemical Manifestations
The incubation period of hepatitis E is believed to range from 2 to 10 weeks based on data from volunteer inoculation experiments and epidemics with a short phase of water contamination.12, 14, 25, 116 Clinical manifestations of HEV infection are similar to those of infection with other hepatitis viruses and encompass a wide spectrum of symptoms, as follows:
- •
Incubation period 2–10 weeks
- •
Variable clinical manifestations, including
Icteric hepatitis
Severe hepatitis leading to
TREATMENT AND PREVENTION
Preventing hepatitis E in disease-endemic areas depends primarily on providing a clean drinking water supply, proper hygiene, and strict attention to sewage disposal. During an epidemic, steps to improve water quality can lead to rapid abatement of the occurrence of new cases.16 Boiling water before consumption appears to reduce the risk of acute hepatitis E.30 Isolation of affected persons is not indicated because person-to-person transmission is uncommon.3
The protective role of anti-HEV
SUMMARY
Hepatitis E, previously known as enterically transmitted non-A, non-B hepatitis, is an infectious viral disease with clinical and morphologic features of acute hepatitis. Its causative agent, hepatitis E virus, consists of small, 32- to 34-nm diameter, icosahedral, nonenveloped particles with a single-stranded, positive-sense, 7.5-kb RNA. The virus has two main geographically distinct strains, Asian and Mexican; recently, novel isolates from nonendemic areas and a genetically related swine HEV
References (125)
- et al.
Hepatitis E virus RNA detection in serum and feces specimens with the use of microspin columns
J Virol Methods
(1998) - et al.
Faecal excretion of hepatitis E virus
Lancet
(1992) - et al.
Hepatitis E: Intrafamilial transmission versus waterborne spread
J Hepatol
(1994) - et al.
Evidence in favour of high infection rate with hepatitis E virus among young children in India
J Hepatol
(1997) - et al.
Outbreak of enterically transmitted non-A, non-B hepatitis among school children
Lancet
(1988) - et al.
The sequence of hepatitis E virus isolated directly from a single source during an outbreak in China
Virus Res
(1993) - et al.
Serological evidence for swine hepatitis E virus infection in Australian pig herds
Vet Microbiol
(1999) - et al.
Role of long-persisting human hepatitis E virus antibodies in protection
Vaccine
(1998) - et al.
Hepatitis E virus transmission to a volunteer
Lancet
(1993) - et al.
Two years' investigation of epidemic hepatitis E virus transmission in West Kalimantan (Borneo), Indonesia
Trans R Soc Trop Med Hyg
(1995)
The unique riverine ecology of hepatitis E virus transmission in South-East Asia
Trans R Soc Trop Med Hyg
Mapping of linear B cell epitopes on open reading frames 2- and 3-encoded proteins of hepatitis E virus using synthetic peptides
FEMS Microbiol Lett
Hepatitis E virus infection in Turkey
Lancet
Solid-phase enzyme-linked immunosorbent assay for hepatitis E virus IgG and IgM antibodies utilizing recombinant antigens and synthetic peptides
J Virol Methods
Enzyme-linked immunosorbent assay for diagnosis of acute sporadic hepatitis E in Egyptian children
Lancet
Fulminant hepatic failure in pregnant women: Acute fatty liver or acute viral hepatitis?
J Hepatol
Antiserum generated by DNA vaccine binds to hepatitis E virus (HEV) as determined by PCR and immune electron microscopy (IEM): Application for HEV detection by affinity-capture RT-PCR
Virus Res
DNA inoculation with a plasmid vector carrying the hepatitis E virus structural protein gene induces immune response in mice
Vaccine
Molecular cloning and sequencing of the Mexico isolate of hepatitis E virus (HEV)
Virology
Vertical transmission of hepatitis E virus
Lancet
Failure to detect chronic liver disease after epidemic non-A, non-B hepatitis
Lancet
Incidence and severity of viral hepatitis in pregnancy
Am J Med
Acute hepatitis E by a new isolate acquired in the United States
Mayo Clin Proc
Seroepidemiological survey of hepatitis E in Hong Kong by recombinant-based enzyme immunoassays
Lancet
Application of two RNA extraction methods prior to amplification of hepatitis E virus nucleic acid by the polymerase chain reaction
J Virol Methods
Protracted viremia during acute sporadic hepatitis E virus infection
Gastroenterology
Frequent sporadic hepatitis E in West Africa evidenced by characterization of a virus-associated antigen in the stool
J Hepatol
Hepatitis E virus genome in stools of hepatitis patients during large epidemic in north India
Lancet
Hospital outbreak of hepatitis E
Lancet
Hepatitis E virus (HEV): Molecular cloning and sequencing of the full-length viral genome
Virology
Epidemiology of hepatitis E virus infection in Turkey
Lancet
Cross-challenge studies in rhesus monkeys employing different Indian isolates of hepatitis E virus
J Med Virol
Role of immune serum globulins in pregnant women during an epidemic of hepatitis E
J Viral Hepatol
Aetiology of acute sporadic non-A, non-B viral hepatitis in India
J Med Virol
Age-specific prevalence of antibodies to hepatitis A and E viruses in Pune, India, 1982 and 1992
J Infect Dis
Epidemiology of hepatitis E virus (HEV) infection in Saudi Arabia
Ann Trop Med Parasitol
Acute viral hepatitis types E, A, and B singly and in combination in acute liver failure in children in north India
J Med Virol
Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route
Intervirology
Hepatitis E virus infection in hemophiliacs
J Med Virol
Epidemic non-A, non-B viral hepatitis in Algeria: Strong evidence for its spreading by water
J Med Virol
Contrasting roles of rivers and wells as sources of drinking water on attack and fatality rates in a hepatitis E epidemic in Somalia
Am J Trop Med Hyg
Infectious hepatitis in the United States
JAMA
Hepatitis E: Epidemiology, aetiology and molecular biology
Rev Med Virol
Aetiologic agent of enterically transmitted non-A, non-B hepatitis
J Gen Virol
Enterically transmitted non-A, non-B hepatitis: Serial passage of disease in cynomolgus macaques and tamarins and recovery of disease-associated 27–34 nm viruslike particles
Proc Natl Acad Sci U S A
Hepatitis E among U.S. travelers, 1989–1992
MMWR Morb Mortal Wkly Rep
Follow up of cases of enterically transmitted non-A, non-B hepatitis
J Assoc Physicians India
Detection of hepatitis E virus infections among domestic swine in the Kathmandu Valley of Nepal
Am J Trop Med Hyg
Viremia, fecal shedding, and IgM and IgG responses in patients with hepatitis E
J Infect Dis
Cattarhal jaundice, sporadic and epidemic, and its relation to acute yellow atrophy of the liver
Q J Med
Cited by (80)
Prevalence of hepatitis E virus and its association with adverse pregnancy outcomes in pregnant women in China
2023, Journal of Clinical VirologyCitation Excerpt :Hepatitis E virus (HEV), a single-stranded positive-sense RNA virus, is a predominant pathogen of acute viral hepatitis worldwide [1,2].
Genetic host specificity of hepatitis E virus
2014, Infection, Genetics and EvolutionCitation Excerpt :Because of the lack of additional data, the HEV3 Pp model could not be evaluated. A strong phylogenetic association between HEV strains and host range is clearly established, with the HEV1 and HEV2 strains infecting humans, whereas HEV3 and HEV4 strains infect animals and humans (Purdy and Khudyakov, 2011; Krawczynski et al., 2000). However, no ancestral associations with host specificity were found among the HEV3 or HEV4 strains despite many attempts to identify a phylogenetic linkage of individual strains to the host origin (Bouquet et al., 2012a; Purdy et al., 2012b; Smith et al., 2012).
Advances in understanding of hepatitis E virus as a food- and waterborne pathogen
2013, Viruses in Food and Water: Risks, Surveillance and ControlViral Hepatitis
2013, Genomic and Personalized MedicineViral Hepatitis
2012, Genomic and Personalized Medicine
Address reprint requests to K. Krawczynski, MD, PhD, Hepatitis Branch, NCID/DVRD, Mail Stop A33, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, e-mail: [email protected]