Viral hepatitis, caused by any of the five hepatotropic viruses, i.e., hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV), represents a major health problem worldwide.All of them are contagious and some are life threatening too. Hepatitis A and E are waterborne; Hepatitis B, C and D are transmitted by bodily fluids (via syringes, needles, injections, toothbrush, and razors).

Incidence

Hepatitis E is the most common form of acute viral hepatitis in adults in India. The first well-documented epidemic of hepatitis E infection in India was the epidemic of 1955–56 in New Delhi, affecting a total of 29 000 people; this occurred due to fecal contamination of drinking water.Based on the 2010 global burden of diseases study, it has been estimated that as many as 20.1 million people were infected with HEV genotypes 1 and 2 in 2005. This represents 71% of the world’s population, with 3.4 million symptomatic cases, 70 000 deaths, and 3000 stillbirths. The death rate was higher among symptomatic pregnant women that among symptomatic non-pregnant women

Transmission

The virus is present in stools of infected person. It is also believed to have foodborne and water borne transmission, blood-borne transmission and perinatal transmission by contaminated maternal blood or feces intra-partum. Risk factors for Hepatitis E include socio economic status, household size, and limited access to sanitation facilities, travel, immigration, intravenous drug use, homosexuality, and childcare employees. Millions of HEV infections occur in south-east Asia annually.

Clinical Features

The incubation period is 15 to 45 days. The clinical illness starts with prodromal phase with symptoms of malaise, weakness, fever, anorexia and non-specific symptoms and lasts from a period of days to weeks. It is followed by an icteric phase lasting 2 to 4 weeks and is characterized by jaundice where the person turns yellow, the eyes and urine are prominently appearing yellow. During this phase bilirubin rises and can exceed 20 mg/dl and transaminases rise to a range of 500-2000 IU/L. In the final Convalescent phase of the disease, the virus is cleared, the patient recovers and biomarkers become normal.

A small proportion of patients develops severe hepatitis and may develop fulminant hepatitis and acute liver failure (ALF). It can even cause acute on chronic liver failure (ACLF) in persons suffering from some form of chronic liver disease. In India, HEV forms the most common cause of ALF in pregnant females. It is advisable to avoid eating any outside/unhygienic food during pregnancy, especially during the third trimester as the chance of developing liver failure is more than 20%.

Prevention

As there is no specific treatment the best alternative is prevention. It can be prevented by general approaches. Because the predominant mode of virus transmission is by poor sanitation, improving access to adequate hygiene and sanitation, including the appropriate disposal of human waste and provision of clean drinking water, is an important contributor to prevention of HAV. Good hand washing, can contribute to preventing transmission.

If you are suffering from any of the above mentioned symptoms or would like to know more about the disease 
Contact US

Hepatitis E