Hepatitis E

In up to four percent of cases, the course of the disease can be severe with life-threatening consequences. The hepatitis E virus causes damage to the liver cells. Transmission occurs through contaminated drinking water or food. A vaccination against the disease has so far only been approved in China. For this reason, people planning a stay in one of the risk areas in particular should inform themselves about the preventive measures. Hepatitis E is subject to mandatory reporting in Switzerland.

Overview: What is hepatitis E?

The hepatitis E virus, which triggers acute liver inflammation, is an RNA virus (single-stranded ribonucleic acid). Transmission routes are contaminated drinking water or contaminated food. Infection is possible from animals to humans or via viral blood. The presence and transmission of the hepatitis E virus is facilitated by poor hygiene in warm or tropical climates. In industrialized countries, infection usually occurs via raw or undercooked meat.

Almost all cases of hepatitis E heal themselves, although the process can take several weeks. In patients with previous liver damage and in pregnant women, a severe course is also possible, which can lead to acute liver failure and further serious damage. If a person has had a hepatitis E infection, unlike hepatitis A or hepatitis B, they are not immune to the virus. Vaccination is not yet available in Europe. Therefore, only responsible behavior protects against infection.

Hepatitis E – frequency and obligation to report

The main areas of distribution of the hepatitis E virus are in North Africa and the Middle East. In Southeast Asia, there is often a seasonal hepatitis E epidemic during and after the rainy season. Floods contaminate drinking water and the hepatitis E pathogen can spread across the whole of Europe within a very short time. Such a hepatitis E zoonosis (infections that can be transmitted between animals and humans) is caused by raw or undercooked meat from domestic pigs, wild boar or game. According to the Epidemics Act and other ordinances, cases of hepatitis E must be reported by doctors or hospitals in Switzerland. Laboratories are also obliged to report analytical findings.

Hepatitis E: causes and risk factors

The route of infection is fecal-oral. This means that the virus enters the mouth from stool. This means that infection is possible via contact or smear infection. The virus can get into drinking water due to poor sanitary and hygienic conditions. In industrialized countries, most infections occur through the consumption of contaminated meat that has not been sufficiently heated. transmission routes directly to humans:

• contaminated water such as drinking water and bathing water,
• raw or undercooked meat (especially pork and game),
• vegetables, fruit and salads fertilized with faeces and
• very rarely blood, blood products or shared syringes.

People with a history of liver disease and pregnant women are particularly at risk. These two groups have an increased risk of a severe course of the disease. In principle, transmission of the hepatitis E virus is possible in all situations in which stool can be ingested directly or indirectly via the mouth. If you are in a risk area, prudent behavior is the best protection.

Symptoms: Hepatitis E

After an incubation period of 15 to 64 days (duration from infection to outbreak), the hepatitis E virus multiplies in the liver cells. It spreads in the blood and is excreted via the intestines. The risk of infection is very high during the acute illness. Sometimes it is accompanied by a general malaise. However, many sufferers are not even aware of the hepatitis E infection and it often heals completely unnoticed by itself. If symptoms appear, these are in the initial course:

• Exhaustion
• Fatigue
• Weight loss
• Headache
• Joint and muscle pain
• Loss of appetite
• Nausea
• Vomiting
• Diarrhea
• Elevated temperature to fever
• Feeling of pressure or pain in the liver area (right upper abdomen)

Some people with hepatitis E show further symptoms:

• Jaundice (icterus): An increase in bilirubin in the blood causes the skin, mucous membranes and eye whites to turn yellowish, urine becomes dark and stools discolored.
• Enlargement of the liver, spleen or lymph nodes
• Severe itching

The liver inflammation is usually over after a few weeks. A healthy diet, regular exercise and a health-conscious lifestyle can significantly support a favorable course of the disease.

Hepatitis E: Diagnosis with us

If you visit your doctor with flu-like symptoms, it is helpful for him or her to know if you have recently traveled to risk areas. You should also inform him or her whether you belong to a risk group. During a physical examination, we can feel a possible enlargement of the liver or spleen. If more severe symptoms of hepatitis (especially jaundice) occur, we will determine certain values by means of a blood test. Hepatitis A is very similar to hepatitis E, and the flu and Epstein-Barr viruses also have similar symptoms. These diseases must be ruled out. In addition to various parameters such as bilirubin, gamma-GT, GOT and GPT, the presence of antibodies against the hepatitis E virus is evidence of acute type E liver inflammation. The virus can also be detected directly via blood and stool in the early course of the disease, but this test is rare. If hepatitis E is suspected or confirmed, the doctor treating the patient is obliged to report it.

Hepatitis E: Further diagnostic procedures

As most hepatitis E diseases are benign, further diagnostic procedures by a doctor are not initially necessary. Pregnant women and people with a previously damaged liver are more likely to experience an unfavorable course of the disease. Here we will monitor the progress by constantly monitoring the blood values and check the condition of the liver using various ultrasound procedures. In the case of pregnant patients, the doctors caring for them hold interdisciplinary discussions in order to minimize the risk of miscarriage or premature birth. In severe cases of hepatitis E, those affected can be examined for possible secondary damage such as cirrhosis or liver cancer using MRI (magnetic resonance imaging) and biopsy (tissue sampling).

Hepatitis E: prevention, early detection, prognosis

Pregnant women and people with various other pre-existing conditions should take special precautions against hepatitis E infection. But even if you do not belong to a risk group, it makes sense to avoid illness as far as possible. Curing liver inflammation takes a lot of energy and makes the body more susceptible to other illnesses. Unlike hepatitis A and hepatitis B, there is currently only an approved vaccination against hepatitis E in China. Therefore, responsible travel to risk areas is the best way to prevent infection. This is the best way to protect yourself:

• Wash or peel fruit and vegetables thoroughly with boiled water
• Only drink bottled mineral water or boiled water
• No ice cubes
• Careful personal hygiene
• Be careful when eating at snack stands
• Avoid ice cream and raw dishes (e.g. salad, seafood)

Basically, when you’re on the go: cook, fry, peel or do without.

You can also become infected with the hepatitis E pathogen at home by eating raw or undercooked meat. This is why pregnant women in particular should heat meat to at least seventy degrees for at least twenty minutes. This kills the viruses and bacteria in the meat – a simple rule that can save lives.

Course and prognosis of hepatitis E

Hepatitis E infection usually lasts a few weeks. A chronic course with subsequent liver cirrhosis is considered an exceptional case and may occur if the patient was already significantly immunocompromised (e.g. due to an organ transplant). In previously damaged livers or pregnant women, type E liver inflammation can lead to reduced liver function and even acute failure. A transplant may have to be performed. Further consequences of fulminant hepatitis (most severe liver inflammation) may be inflammation of the lungs, pancreas or heart muscle. In addition, pregnant women with hepatitis E have an increased risk of premature birth, low birth weight of the newborn and possibly death of mother and child. In the vast majority of cases, however, the body’s ability to heal itself is sufficient to survive hepatitis E.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.

Hepatitis E: Treatment

As the human body normally copes with hepatitis E on its own, treatment is not necessary. While the immune system is fighting the infection, you should avoid alcohol. Medication that puts a strain on the liver can also be reduced to a minimum or discontinued in consultation with us. In principle, all measures that support and strengthen overall health and the liver in particular make sense. As the person affected, you have a major influence on your health through prevention, support for healing and aftercare.