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| {{CMG}} | | __NOTOC__ |
| | {{About1|Hepatitis E Virus}} |
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| {{EH}} | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Hepatitis E}} |
| | {{CMG}}; {{AE}} {{JS}} |
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| ==Overview==
| | {{SK}} Hep E; HEV; HEV infection; Viral hepatitis type E |
| {{DiseaseDisorder infobox | | |
| Name = {{PAGENAME}} |
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| Image = |
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| Caption = |
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| ICD10 = {{ICD10|B|17|2|b|15}}|
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| ICD9 = {{ICD9|070.4}}|
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| DiseasesDB = 5794 |
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| MedlinePlus = |
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| eMedicineSubj = med |
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| eMedicineTopic = 995 |
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| }}
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| {{Taxobox | color=violet
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| | name = ''Hepatitis E virus''
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| | image = Hepatitis E virus.jpg
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| | image_caption = [[Transmission electron microscopy|TEM]] [[micrograph]] of hepatitis E virions.
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| | virus_group = iv
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| | familia = ''[[Hepeviridae]]''
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| | genus = ''[[Hepevirus]]''
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| | species = '''''Hepatitis E virus'''''
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| }}
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| {{SI}}
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| '''Hepatitis E''' is an [[Acute (medical)|acute]] viral [[hepatitis]] (liver inflammation) caused by [[infection]] with a [[virus]] called '''hepatitis E virus''' ('''HEV'''). Infection with this virus was first documented in 1955 during an outbreak in New Delhi, India.<ref>{{cite journal |author=Gupta DN, Smetana HF |title=The histopathology of viral hepatitis as seen in the Delhi epidemic (1955-56) |journal=Indian J. Med. Res. |volume=45 |issue=Suppl. |pages=101-13 |year=1957 |pmid=13438544 |doi=}}</ref>
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| ==Signs and symptoms== | | ==[[Hepatitis E overview|Overview]]== |
| The incidence of hepatitis E is highest in adults between the ages of 15 and 40. Though children often contract this infection as well, they less frequently become symptomatic. Mortality rates are generally low, for Hepatitis E is a “self-limiting” disease, in that it usually goes away by itself and the patient recovers. However, during the duration of the [[infection]] (usually several weeks), the disease severely impairs a person’s ability to work, care for family members, and obtain food. Hepatitis E occasionally develops into an acute severe liver disease, and is fatal in about 2% of all cases. [[Medicine|Clinically]], it is comparable to [[hepatitis A]], but in pregnant women the disease is more often severe and is associated with a clinical syndrome called as 'fulminant hepatic failure'. Pregnant women, especially those in the third trimester, suffer an elevated [[mortality rate]] from the disease ~20%.
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| *Prolonged [[cholestasis]] has been described in up to 60 percent of patients.<ref>{{cite journal |author=Chau TN, Lai ST, Tse C, ''et al'' |title=Epidemiology and clinical features of sporadic hepatitis E as compared with hepatitis A |journal=Am. J. Gastroenterol. |volume=101 |issue=2 |pages=292-6 |year=2006 |pmid=16454833 |doi=10.1111/j.1572-0241.2006.00416.x}}</ref>
| | ==[[Hepatitis E historical perspective|Historical Perspective]]== |
| *[[Jaundice]]
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| *[[Malaise]]
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| *[[Anorexia_(symptom)|Anorexia]]
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| *[[Nausea]]
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| *Vomiting
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| *Abdominal pain
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| *[[Fever]]
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| *[[Hepatomegaly]]
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| *Other less common features include [[diarrhea]], arthralgia, [[pruritus]], and urticarial rash. Some patients have asymptomatic infection.
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| ==Virology== | | ==[[Hepatitis E pathophysiology|Pathophysiology]]== |
| The viral particles are 27 to 34 [[nanometer]]s in diameter, are non-enveloped and contain a single-strand of positive-sense [[RNA]] that is approximately 7300 bases in length. The virus particle was first visualised in 1983<ref>{{cite journal |author=Balayan MS, Andjaparidze AG, Savinskaya SS, ''et al'' |title=Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route |journal=Intervirology |volume=20 |issue=1 |pages=23-31 |year=1983 |pmid=6409836 |doi=}}</ref> but was only molecularly cloned in 1990.<ref>{{cite journal |author=Reyes GR, Purdy MA, Kim JP, ''et al'' |title=Isolation of a cDNA from the virus responsible for enterically transmitted non-A, non-B hepatitis |journal=Science |volume=247 |issue=4948 |pages=1335-9 |year=1990 |pmid=2107574 |doi=10.1126/science.2107574}}</ref>
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| It was previously classified family [[Caliciviridae]]. However, its [[genome]] more closely resembles the [[rubella|rubella virus]]. It is now classified in a new virus family, named as [[Hepeviridae]].
| | ==[[Hepatitis E causes|Causes]]== |
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| ==Epidemiology== | | ==[[Hepatitis E epidemiology and demographics|Epidemiology and Demographics]]== |
| ===Patterns===
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| Hepatitis E is prevalent in most [[developing countries]], and not uncommon in any country with a hot climate. It is widespread in Southeast Asia, northern and central Africa, India, and Central America. It is spread mainly through [[feces|fecal contamination]] of water supplies or food; person-to-person transmission is uncommon. Outbreaks of epidemic Hepatitis E most commonly occur after heavy rainfalls and [[monsoons]] because of their disruption of water supplies. Major outbreaks have occurred in [[New Delhi]], [[India]] (30,000 cases in [[1955]]-[[1956]]), [[Myanmar]] (20,000 cases in [[1976]]-[[1977]]), [[Kashmir]], [[India]] (52,000 cases in [[1978]]), [[Kanpur]], [[India]] (79,000 cases in [[1991]]), and [[China]] (100,000 cases between [[1986]] and [[1988]]).
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| ===Animals as a reservoir=== | | ==[[Hepatitis E risk factors|Risk Factors]]== |
| Domestic animals have been reported as a reservoir for the hepatitis E virus, with some surveys showing infection rates exceeding 95% among domestic pigs.<ref>{{cite journal |author=Satou K, Nishiura H |title=Transmission dynamics of hepatitis E among swine: potential impact upon human infection |journal=BMC Vet. Res. |volume=3 |issue= |pages=9 |year=2007 |pmid=17493260 |doi=10.1186/1746-6148-3-9 |url=http://www.biomedcentral.com/1746-6148/3/9}}</ref> Transmission after consumption of [[wild boar]] meat and uncooked deer meat has been reported as well.<ref>{{cite journal |author=Li TC, Chijiwa K, Sera N, ''et al'' |title=Hepatitis E virus transmission from wild boar meat |journal=Emerging Infect. Dis. |volume=11 |issue=12 |pages=1958-60 |year=2005 |pmid=16485490 |url=http://www.cdc.gov/ncidod/EID/vol11no12/05-1041.htm}}</ref> The rate of transmission to humans by this route and the public health importance of this are however still unclear.
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| ===Recent outbreaks=== | | ==[[Hepatitis E screening|Screening]]== |
| In [[2004]], there were two major outbreaks, both of them in sub-[[Sahara|Saharan]] [[Africa]]. There was an outbreak in [[Chad]] in which, as of September 27 there were 1,442 reported cases and 46 deaths. In [[Sudan]], which has been troubled with conflict recently (see, [[Darfur conflict]]), they are also suffering from a severe Hepatitis E epidemic. As of September 28, there were 6,861 cases and 87 deaths, mainly in the West Darfur Region. [[UNICEF]], [[Doctors Without Borders]], the [[Red Cross]], and other international health organizations are currently working to increase the availability of soap, dig new wells, and [[chlorination|chlorinate]] water supplies and reserves. However, the existing resources are still not enough, and more personnel and funds are severely needed in the region to assure the [[health]] and [[quality of life|welfare]] of the people. Increasingly, hepatitis E is being seen in developed nations with reports of cases in the UK, US and Japan. The disease is thought to be a zoonosis in that animals are thought to be the source. Both deer and pigs have been implicated.
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| == Pathophysiology & Etiology== | | ==[[Hepatitis E differential diagnosis|Differentiating Hepatitis E from other Diseases]]== |
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| *Caused by the Hepatitis E virus (HEV)
| | ==[[Hepatitis E natural history|Natural History, Complications and Prognosis]]== |
| *HEV is found in the stool (feces) of persons and animals with hepatitis E.
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| *HEV is spread by eating or drinking contaminated food or water.
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| *Transmission from person to person occurs less commonly than with hepatitis A virus
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| *Most outbreaks in developing countries have been associated with contaminated drinking water. [http://www.cdc.gov/ncidod/diseases/hepatitis/e/fact.htm]
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| ==Prevention== | | ==Diagnosis== |
| | [[Hepatitis E history and symptoms|History and Symptoms]] | [[Hepatitis E physical examination|Physical Examination]] | [[Hepatitis E laboratory tests|Laboratory Findings]] |
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| Improving [[sanitation]] is the most important measure, which consists in proper treatment and disposal of human waste, higher standards for public water supplies, improved personal hygiene procedures and sanitary food preparation. Thus, prevention strategies of this disease are similar to those of many others that plague developing nations, and they require large-scale international financing of water supply and water treatment projects.
| | ==Treatment== |
| A vaccine based on recombinant viral proteins has been developed and recently tested in a high-risk population (military personnel of a developing country).<ref>{{cite journal |author=Shrestha MP, Scott RM, Joshi DM, ''et al'' |title=Safety and efficacy of a recombinant hepatitis E vaccine |journal=N. Engl. J. Med. |volume=356 |issue=9 |pages=895-903 |year=2007 |pmid=17329696 |doi=10.1056/NEJMoa061847}}</ref> The vaccine appeared to be effective and safe, but further studies are needed to assess the long-term protection and the cost-effectiveness of hepatitis E vaccination.
| | [[Hepatitis E medical therapy|Medical Therapy]] | [[Hepatitis E primary prevention|Prevention]] | [[Hepatitis E cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hepatitis E future or investigational therapies|Future or Investigational Therapies]] |
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| ==References== | | ==Related Chapters== |
| <!-- ---------------------------------------------------------------
| | * [[Hepatitis A]] |
| See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a
| | * [[Hepatitis B]] |
| discussion of different citation methods and how to generate
| | * [[Hepatitis B in China]] |
| footnotes using the <ref> & </ref> tags and the {{Reflist}} template
| | * [[Hepatitis C]] |
| -------------------------------------------------------------------- -->
| | * [[Hepatitis D]] |
| {{Reflist}}
| | * [[Hepatitis F]] |
| | * [[Hepatitis G]] |
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| ==External links== | | ==External links== |
| * [http://www.who.int/mediacentre/factsheets/fs280/en/ WHO hepatitis E factsheet] | | * [http://www.who.int/mediacentre/factsheets/fs280/en/ WHO hepatitis E factsheet] |
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| {{SIB}}
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| {{Viral diseases}} | | {{Viral diseases}} |
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| [[de:Hepatitis E]]
| | {{jb1}} |
| [[es:Hepatitis E]]
| | {{WH}} |
| [[it:Epatite virale E]]
| | {{WS}} |
| [[ja:E型肝炎]]
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| [[ru:Гепатит E]]
| | ==References== |
| [[zh:戊型肝炎]]
| | {{reflist|2}} |
| [[pl:Wirus zapalenia wątroby typu E]]
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| [[Category:Hepatitis|E]] | | [[Category:Hepatitis|E]] |
| [[Category:Viruses]] | | [[Category:Viruses]] |
| | [[Category:Gastroenterology]] |
| | [[Category:Mature chapter]] |
| | [[Category:Emergency mdicine]] |
| | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |
| [[Category:Gastroenterology]] | | [[Category:Hepatology]] |
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