Joe Sasadeusz Victorian Infectious Diseases Service, Royal Melbourne Hospital and Infectious Diseases Unit, The Alfred Hospital, Melbourne VIC Last reviewed: November 2019 Introduction Hepatitis E virus (HEV) infection is an important cause of acute hepatitis, predominantly in residents of, and returned travellers from, countries where HEV infection is endemic. It has a high mortality rate …
HEV is a small non-enveloped, single-stranded RNA virus approximately 27-34 nm in diameter with a genome that is approximately 7.2 kb in length. It is the only member in the Hepeviridae family and is closely related to members of the Calicivirus family.[1] HEV was previously known as enterically-transmitted non-A, non-B hepatitis.[2] There are four recognised genotypes, which …
HEV is the most common cause of acute hepatitis and jaundice in the world, although it is uncommon in the developed world. It has been estimated to cause at least 3.3 million cases of hepatitis per year and result in approximately 70,000 deaths.[4] In endemic areas, seroprevalence rates of HEV infection range between 30-80%, usually due …
The diagnosis of HEV infection is based upon the direct detection HEV RNA in serum or stool by polymerase chain reaction (PCR) or by the detection of antibodies to HEV. Serological and nucleic acid tests (qualitative and quantitative HEV RNA) currently form the basis of HEV testing and have been used for both epidemiological and …
The incubation period of HEV infection ranges from 3-8 weeks. It generally has a short prodromal phase and a symptomatic period, which is usually associated with jaundice, lasting several days to weeks. Acute HEV infection is usually self-limited, although fulminant hepatitis can develop. Case fatality averages 5% but ranges between 0-10%.[1] Chronic HEV infection does not …
A subset of patients who undergo solid organ transplantation develop chronic HEV infection as evidenced by the presence of persistently elevated transaminase levels, detectable serum HEV RNA, histologic findings compatible with chronic viral hepatitis and absence of other viral causes.[29] In one study of solid organ transplant recipients, 5% acquired HEV infection of whom half developed …
Basic sanitation is the cornerstone of HEV prevention in resource-poor countries; however standard interventions in recent outbreaks have not been successful, highlighting the need for more specific preventative measures such as vaccination.[34] Travellers to endemic areas should practise preventive measures, such as avoiding drinking water of unknown purity, eating uncooked shellfish and uncooked fruits or vegetables. …
Two HEV vaccines are in development. A recombinant vaccine developed in China has proven to be 87% protective over 4.5 years of follow-up. It uses a 30 μg dose in a 3 dose schedule administered at 0, 1 and 6 months and was also found to be safe.[35] A second recombinant vaccine, evaluated in the Nepalese …
Hoofnagle JH, Nelson KE, Purcell RH. Hepatitis E. N Engl J Med 2012; 367:1237-44. Wong DC, Purcell RH, Sreenivasan MA, et al. Epidemic and endemic hepatitis in India: evidence for a non-A, non-B hepatitis virus aetiology. Lancet 1980; 2:876-9. Meng XJ. From barnyard to food table: the omnipresence of hepatitis E virus and risk for …
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