Hepatitis E.
and Martina Feichter, medical editor and biologistDr. med. Mira Seidel is a freelance writer for the medical team.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
Hepatitis E (type E liver inflammation) is acute inflammation of the liver caused by the hepatitis E virus. The pathogen is mainly transmitted via contaminated drinking water or contaminated food. The disease usually heals on its own. Chronic and severe courses are rare. You can find out everything you need to know about hepatitis E here.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B18B17
Hepatitis E: description
Hepatitis E is a form of liver inflammation caused by a virus. It can proceed without symptoms (asymptomatic) and then often remains undetected. When symptoms occur, they are usually mild and go away on their own. Severe courses with the risk of acute and fatal liver failure (for example in pregnant women) occur less frequently.
Note: Hepatitis E is usually acute. A chronic infection is particularly possible if the immune system is weakened, for example in HIV patients or cancer patients during chemotherapy.
Hepatitis E is similar to type A liver inflammation (hepatitis A), which is also caused by the virus. In fact, hepatitis E was not identified as a disease in its own right until 1980, when a supposed hepatitis A epidemic in India was examined more closely. It was discovered that the disease outbreak was not caused by hepatitis A viruses, but by a new type of virus. It was called the hepatitis E virus.
Different genotypes of hepatitis E viruses are now known. Genotype 3 is common in Germany.
Hepatitis E: frequency
Hepatitis E occurs worldwide. It has been notifiable in Germany since 2001. It shows that the number of cases is increasing every year. But that's probably not because more and more people are getting hepatitis E. The reason is more likely that doctors are becoming increasingly attentive to hepatitis E and are carrying out corresponding examinations more frequently. Improved test methods are also likely to increase the number of cases.
In 2016, almost 2,000 hepatitis E cases were registered in Germany. For comparison: in 2013 there were fewer than 500 reports.
About 75 percent of all reported hepatitis E cases affect people over the age of 40. Most of them are men.
Hepatitis E: contagion
In Germany and other industrialized nations, hepatitis E is mainly transmitted through undercooked pork or game meat or products made from them. The animals are an important reservoir for the pathogen (especially domestic pigs). Infection via seafood (such as mussels), which can filter water and accumulate the pathogen, is also possible. The hepatitis E virus virus genotype 3 (HEV-3), which is widespread in this country, is extremely rarely (if at all) transmitted directly from person to person.
In regions with poor hygiene standards, where genotypes 1 and 2 are common, hepatitis E is mainly transmitted faecal-orally. This means that the hepatitis E viruses excreted by patients in the stool reach the mouths of healthy people in different ways and also infect them. This can happen through smear infection, for example: If patients do not wash their hands properly after defecation, they can transmit the pathogen to door handles or cutlery, for example. If these are touched by a healthy person who then puts his hand to his lips, he can also become infected. Hepatitis E can also be transmitted through water and food contaminated with faeces.
Occasionally, hepatitis E is also transmitted parenterally, that is, bypassing the gastrointestinal tract. This can be done by administering contaminated blood transfusions, for example.
Duration of contagion
So far it is unclear how long patients are contagious. The pathogen can be detected in the stool about a week before to four weeks after the onset of jaundice. Chronic hepatitis E is likely to be contagious for as long as the infection lasts.
Hepatitis E: incubation period
The time span between infection and the appearance of the first symptoms of hepatitis E (incubation period) varies between 15 and 64 days.
Hepatitis E: symptoms
An infection with the genotype of hepatitis E viruses (HEV-3) occurring in this country usually runs without symptoms (asymptomatic infection). When symptoms occur, the infection is referred to as symptomatic: it is usually acute and with mild symptoms that subside on their own within a few weeks. These complaints include, for example:
- Upper abdominal discomfort
- Loss of appetite
- Nausea and vomiting
- fever
- fatigue
- Jaundice (jaundice): yellowing of the skin and the white conjunctiva of the eyes (sclera)
- discolored stool
- dark urine
Caution: Jaundice does not develop with every symptomatic hepatitis E infection!
Some patients have atypical symptoms, especially neurological signs such as Guillain-Barré syndrome or meningitis.
Hepatitis E: examinations and diagnosis
If hepatitis E is suspected, the doctor first collects the patient's medical history (anamnesis) in a detailed discussion. He has the complaints that arise and asks about possible trips to risk areas. This is followed by a physical examination with a blood sample. The blood sample is checked for antibodies against the hepatitis E virus. The detection of IgM antibodies against the virus indicates an acute infection. Specific IgG antibodies, on the other hand, indicate a previous infection.
In addition, the patient's blood or stool can be examined for the genetic material of the pathogen (virus RNA). Such a direct pathogen detection is only necessary in certain cases. This applies, for example, to patients with immunodeficiency (such as HIV patients). Tests for antibodies against hepatitis E are not meaningful for them. Direct detection of the pathogen is also useful in patients who have specific IgM antibodies in their blood but do not show any or only atypical symptoms of a hepatitis E infection.
The blood sample will also be analyzed for other laboratory values. For example, increased liver values (such as GOT, GPT) can indicate a liver disease.
Hepatitis E: therapy
Acute hepatitis E in patients with a healthy immune system usually does not require treatment. It usually heals on its own. If necessary, the symptoms can be alleviated, for example with a medication against nausea and vomiting.
In people with a previously damaged liver (for example through alcohol abuse or hepatitis B or C) there is a risk that hepatitis E will take a fulminant course. That means: It occurs very suddenly, is quick and serious and possibly even fatal. Hepatitis E can also have a fulminant course in people with suppressed immune systems (such as those who are being treated with immunosuppressants or HIV / AIDS). The patients are treated in the hospital. In most cases, antiviral drugs are used (such as ribavirin).
Note: For pregnant women with hepatitis E, the doctor will ask about stays in Africa or Asia (especially Bangladesh and northern India). If the woman has been there, chances are the genotype 1 hepatitis E is caused. Then the risk of a fulminant course is increased.
If the hepatitis E infection has a fulminant course, the liver can fail. Then the currently only treatment option is a liver transplant.
In chronic hepatitis E, treatment aims to eliminate the pathogens in the patient's body. Only then will the patient no longer be contagious and his liver will not be damaged any further.
A chronic course of the disease usually shows in patients with immunodeficiency. This can be due to a disease such as HIV / AIDS or medication (immunosuppressants). If it is possible to reduce the suppression of the immune system (immunosuppression), hepatitis E usually heals on its own. If, on the other hand, the immunosuppression cannot be reduced, the liver inflammation is usually treated with antiviral drugs (such as ribavirin).
Hepatitis E Therapy: What You Can Do Yourself
With any form of hepatitis, patients should definitely avoid alcohol. Detoxifying them would put additional strain on the sick liver.
For the same reason, you should avoid taking any liver-damaging medication such as paracetamol (pain reliever), tetracycline (antibiotics) or methotrexate (anti-cancer and rheumatic drugs). Halothane (anesthetic agent), chlorpromazine (agent for mental illnesses), hormonal contraceptives and anabolic steroids should also be avoided. Before using any medication, ask your doctor whether there is any risk of liver damage.
Caution: Anyone who is treated with liver-damaging medication should not discontinue them on their own in the event of hepatitis. Instead, it is advisable to consult the attending physician.
A special diet is not necessary for hepatitis E. However, doctors recommend a light diet that is as rich in carbohydrates and low in fat as possible. This relieves the liver.
Hepatitis E: prognosis
As a rule, hepatitis E does not represent a particular danger. When symptoms occur, they are usually only mild. In addition, in most cases the infection is acute and heals on its own and without consequences.
Hepatitis E can take a chronic course in people with immunodeficiency. This can happen to HIV / AIDS patients, dialysis patients and transplant recipients, for example.
In the case of existing liver damage and chronic liver disease, hepatitis E can be severe and even fatal. This also applies in particular to pregnant women (if infected with genotype 1): A hepatitis E infection in the last trimester of pregnancy is particularly life-threatening - the mortality rate here is 20 to 25 percent. Premature births or miscarriages are also possible.
Hepatitis E: Prevention
In order to protect yourself against hepatitis E viruses in animal foods in this country, meat products and offal should only be consumed well-cooked. That means: They should be heated to at least 71 degrees Celsius for at least 20 minutes. This inactivates any hepatitis E viruses.
In addition, careful kitchen hygiene should be observed when preparing the food. This avoids cross-contamination, i.e. the virus transmission from (possibly) infected meat products to objects such as knives and other foods.
If you travel to areas where hepatitis E is more common, you should take care to protect yourself from possible sources of infection (exposure prophylaxis):
- Do not consume any unpeeled fruit and vegetables or raw or insufficiently heated food in these areas. Stick to the principle "Cook it, peel it or forget it!" (Cook it, peel it or forget it!).
- Only drink water from sealed bottles or sufficiently boiled tap water. Avoid ice cubes - they could be made from unboiled water.
There is no vaccination against hepatitis E in this country. A vaccine is available in China. However, this is not permitted in Europe.
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