Hepatitis E

What Is Hepatitis E?

Hepatitis E is an infection caused by the Hepatitis E virus, or HEV, which causes inflammation of the liver. Its symptoms are similar to those of other types of viral hepatitis, including yellowing of the skin and eyes, fatigue, and pain in the upper right side of the abdomen.

The infection is commonly transmitted through contaminated food or drinking water and is found in many countries, including Thailand.

Most patients recover without specific treatment. However, some people-particularly pregnant women and those with underlying liver disease-may develop severe symptoms or acute liver failure. It is therefore important to recognise the warning signs and receive appropriate medical assessment.

Hepatitis E differs from hepatitis A, B, and C because there is no widely used vaccine for it, and it usually does not cause chronic infection in the general population. Chronic infection may, however, occur in some people with weakened immune systems.

How Many Genotypes of HEV Are There?

HEV has several genotypes that can infect humans and animals. Each genotype is associated with different routes of transmission.

๐ Genotypes 1 and 2 are found only in humans. They are mainly transmitted through contaminated water and commonly cause outbreaks in developing countries.

๐ Genotypes 3 and 4 are found in both humans and animals, including pigs, wild boars, and deer. Infection may occur after eating undercooked meat.

In Thailand, genotypes 3 and 4 are commonly found. Eating raw or undercooked food, particularly raw or partially cooked pork liver, is therefore an important risk factor.

Causes and Routes of Transmission

Hepatitis E is mainly transmitted through the faecal-oral route.

Common routes of infection include:

๐ Consuming contaminated food or water, such as drinking water or ice from an unclean source

๐ Eating vegetables or fruit washed with contaminated water

๐ Eating undercooked pork, wild boar, deer, or other raw or partially cooked food contaminated with the virus

๐ Contact with contaminated secretions or surfaces, including the faeces of an infected person

๐ Preparing food without washing the hands properly

๐ Animal-to-human transmission, particularly through pigs and pork products

๐ Mother-to-child transmission, which is uncommon but may cause severe illness in both the mother and baby

Symptoms of Hepatitis E

The incubation period is approximately 2-8 weeks. Symptoms may develop gradually and can be divided into three stages.

Stage Before Jaundice

This stage may resemble a general viral illness.

๐ Low-grade fever

๐ Severe fatigue

๐ Muscle aches

๐ Nausea and vomiting

๐ Loss of appetite

๐ Abdominal pain or bloating

Jaundice Stage

At this stage, liver inflammation becomes more noticeable.

๐ Yellowing of the skin and eyes

๐ Dark urine resembling fish sauce

๐ Pale stools

๐ Pain or tightness under the right rib cage

๐ Generalised itching in some patients

Recovery Stage

Symptoms gradually improve, and liver enzyme levels such as AST and ALT begin to decrease.

Most patients recover within approximately 4-6 weeks.

Symptoms Requiring Urgent Medical Attention

Seek medical care promptly if any of the following symptoms develop:

๐ Increasing yellowing of the skin or eyes

๐ Severe drowsiness or fatigue that prevents normal activities

๐ Refusing or being unable to eat

๐ Persistent vomiting

๐ Easy or unusual bleeding, which may indicate liver failure

Who Is at Higher Risk of Severe Disease?

Pregnant Women

Pregnant women are considered the highest-risk group.

Possible complications include:

๐ Acute liver failure

๐ Premature delivery

๐ Miscarriage

๐ Foetal or newborn death

The risk of death may be considerably higher than in non-pregnant women.

People with Chronic Liver Disease

People with conditions such as hepatitis B, hepatitis C, or cirrhosis may develop more severe illness.

People with Weakened Immune Systems

This includes:

๐ Organ transplant recipients

๐ People taking immunosuppressive medication

๐ People living with HIV

People Who Work Closely with Animals or Raw Meat

Higher-risk occupations include:

๐ Slaughterhouse workers

๐ Pig farmers

๐ Pork sellers

๐ People who regularly handle raw pork or animal carcasses

Diagnosis of Hepatitis E

The doctor will assess the symptoms, perform a physical examination, and order blood tests.

Liver Function Tests

Liver enzymes such as ALT and AST may be significantly elevated, indicating active liver inflammation.

Anti-HEV IgM Test

The presence of Anti-HEV IgM antibodies helps confirm a current acute infection.

HEV RNA PCR Test

Testing directly for viral genetic material using HEV RNA PCR is highly accurate.

It is often used in complicated cases, such as:

๐ Pregnant women

๐ People with weakened immune systems

๐ Patients with unclear or persistent symptoms

Bilirubin and INR Tests

These tests help assess liver function and the severity of the illness, including the risk of liver failure.

Treatment of Hepatitis E

Hepatitis E is generally treated with supportive care, as most patients recover naturally within several weeks.

Recommended care includes:

๐ Getting enough rest

๐ Avoiding alcohol

๐ Avoiding medicines that may damage the liver, such as excessive doses of paracetamol

๐ Avoiding herbal products from unknown or unreliable sources

๐ Drinking enough water to prevent dehydration

๐ Eating easily digestible foods and reducing fatty foods

Possible Complications

Although most cases are not severe, some patients may develop serious complications.

๐ Acute liver failure, particularly in pregnant women and people with chronic liver disease

๐ Abnormal bleeding, caused by the liver’s inability to produce enough blood-clotting proteins

๐ Pregnancy-related complications, especially when infection occurs during the third trimester

๐ Premature birth or foetal death

๐ Chronic hepatitis E infection, particularly in people taking immunosuppressive medication, such as organ transplant recipients

When Should You See a Doctor?

Seek medical assessment if you experience symptoms that may suggest hepatitis E, including:

๐ Severe fatigue

๐ Dark urine

๐ Pale stools

๐ Pain under the right rib cage

๐ Loss of appetite

๐ Yellowing of the skin or eyes

 

Reference :

Phyathai 2 Hospital Hepatitis E

ArokaGO Providers Phyathai 2 Hospital