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⚠️ Hepatitis E carries a significant risk of fulminant hepatic failure, especially in pregnant women (mortality ~20% in the 3rd trimester) and in immunocompromised patients. It is endemic in parts of Asia, Africa, the Middle East, and Central America, where large outbreaks occur.
About Hepatitis E Virus (HEV)
- 🦠 Non-enveloped, positive-sense, single-stranded RNA virus.
- Often presents as a self-limiting hepatitis, but much more severe in pregnancy.
- Fulminant liver failure risk: ~1% in healthy adults, up to 20% in pregnancy.
Aetiology & Transmission
- 💧 Waterborne infection – contaminated drinking water in areas with poor sanitation.
- Common in Asia, Africa, South America, Middle East.
- Rare zoonotic transmission (e.g., undercooked pork or wild game) reported in developed countries.
- Transmitted by the faeco-oral route.
🩺 Clinical Features
- ⏱️ Incubation period: 2–8 weeks.
- Symptoms resemble hepatitis A:
- Nausea, vomiting, malaise, anorexia.
- 🟡 Jaundice and dark urine.
- Aversion to cigarettes (classic viral hepatitis clue).
- Fever and abdominal pain may occur.
- ⚠️ Fulminant hepatitis:
- Occurs in 0.5–4% of the general population.
- 20% mortality in pregnant women (esp. 3rd trimester).
- Immunocompromised (e.g., transplant, HIV): may progress to chronic HEV.
🔎 Investigations
- Anti-HEV IgM: confirms recent infection.
- Anti-HEV IgG: indicates past exposure or immunity.
- HEV RNA PCR: confirms active infection (blood or stool).
- 📈 LFTs: ALT/AST typically markedly raised, bilirubin may be elevated.
💊 Management
- 🤲 Supportive only – no specific licensed antivirals:
- Rest and hydration.
- Avoid alcohol and hepatotoxic drugs (paracetamol, NSAIDs).
- Nutritional support and anti-emetics if required.
- Pregnant women: require close monitoring and often hospital admission due to high risk of fulminant hepatitis.
- Immunocompromised patients: chronic infection may need antivirals such as ribavirin (off-label, under specialist guidance).
Prevention
- 🚰 Safe water and sanitation are key to preventing outbreaks.
- Hepatitis B vaccination indirectly prevents HDV but NOT HEV (no widely available HEV vaccine except in some regions of China).
- Food safety: avoid undercooked meat, particularly pork and shellfish in endemic areas.
