What is hepatitis E?

Early this week, there were reports of an outbreak of hepatitis E infection in Uganda. Most of us are fairly familiar with hepatitis B. The outbreak, however, necessitates the need for us to understand more about hepatitis E also.

Hepatitis E virus commonly causes liver disease. It is transmitted mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within four to six weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death. Globally, there are approximately 20 million incidents of hepatitis E infections every year.  Most cases of hepatitis E are observed in regions where low standards of sanitation increase the risk for transmission of the virus. The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Other transmission routes include ingestion of products derived from infected animals; transfusion of infected blood products; and vertical transmission from a pregnant woman to her foetus. Since hepatitis E is a waterborne disease, contaminated water or food supplies have been implicated in major outbreaks. Sporadic cases follow ingestion of raw or uncooked shellfish.

The risk factors for hepatitis E are related to poor sanitation and shedding of the hepatitis E virus in faeces. The signs and symptoms include yellow discolouration of the skin and sclera of the eyes, dark urine and pale stools; loss of appetite; an enlarged, tender liver; abdominal pain and tenderness; nausea and vomiting; and fever.

Diagnosis of hepatitis E infection is based on the detection of specific antibodies to the virus in the blood. There is no available treatment capable of altering the course of acute hepatitis. Prevention is the most effective approach against the disease. As hepatitis E is usually self-limiting, hospitalization is generally not required. The infection risk can be reduced by maintaining hygienic practices such as hand washing with safe water, particularly before handling food; avoiding drinking water of unknown purity; avoiding eating uncooked shellfish, and uncooked fruits or vegetables that are not peeled or well cleaned.