Everything you need to know about hepatitis E!

**Hepatitis E is an inflammation of the liver caused by infection with the hepatitis E virus (HEV). Every year, about 20 million people become infected with HEV, resulting in 3.3 million symptomatic hepatitis E cases. Although hepatitis E is found worldwide, the disease is most common in East and South Asia. This virus is transmitted through feces, orally, and mainly through contaminated water.**

**Hepatitis E disease** **What is it?** **We all have heard a lot about hepatitis A, B and C diseases, but for many people, hepatitis E disease may be a lesser known disease. Hepatitis E is an inflammatory disease caused by the hepatitis E virus (HEV).** **This virus has at least 4 different types: genotypes 1, 2, 3, and 4. Genotypes 1 and 2 have only been found in humans, and genotypes 3 and 4 circulate without causing disease in several animals, including pigs, wild boars, and deer, and occasionally infect humans.** **The virus is placed in the feces of infected people and enters the human body through the intestine. However, it is mainly transmitted through contaminated drinking water. The infection is usually self-limiting and resolves within 2 to 6 weeks. But sometimes this infection develops into a serious disease called fulminant hepatitis (acute liver failure), which can be fatal.** - **Hepatitis E** **with short-term infection** **Hepatitis E can be observed as a short-term or several-week infection. Hepatitis E is a short-term infection, and in most cases, people's bodies are able to recover and fight the infection, and the virus is gone. People usually recover without treatment after a few weeks.** - **chronic hepatitis E** **Chronic hepatitis E is a long-term infection and occurs when the body is unable to fight the virus and the virus does not disappear. Chronic hepatitis E is rare and only occurs in people with weakened immune systems. For example, hepatitis E may become chronic in people who use drugs that weaken their immune systems after an organ transplant, or in people who have had a foreign transplant or AIDS.**

### **Methods of hepatitis E transmission** **Hepatitis E infection is found worldwide but is common in low- and middle-income countries with limited access to safe water and sanitation services. In these areas, the disease occurs both in the form of contagion and sporadic cases.** **In areas with better sanitation and water supply, outbreaks of hepatitis E infection are rare and only sporadic cases may be seen. Most of these cases are caused by the genotype 3 virus and are caused by infection with the virus of animal origin, usually through eating undercooked animal meat (including animal liver). These cases are not related to water or other food contamination.**

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**Symptoms of Hepatitis E** **The usual signs and symptoms of hepatitis are:** - **Initial stage of mild fever, loss of appetite (anorexia), nausea and vomiting for several days** - **abdominal pain, itching, skin rash or joint pain** - **Jaundice (yellow color of the skin), dark urine and pale stools** - **Slightly large and sensitive liver (hepatomegaly).** - **mild flu-like symptoms** - **abdominal pain** - **fever (high temperature)** - **itching** - **nausea and vomiting** - **joint and muscle pain** - **Changing the color of urine to dark or brown** - **Tingling, numbness and weakness in the arms and legs** - **Severe fatigue that can last for some time after the virus is cleared.** These symptoms are often indistinguishable from those experienced in other liver diseases and usually last 1 to 6 weeks. In rare cases, hepatitis E can be acute and lead to fulminant hepatitis (acute liver failure). These patients are in danger of death.** **After the virus enters the person's body, there may be no symptoms for a period of two to nine weeks, which is known as the incubation period. Direct transmission of the disease from one person to another is unusual. However, people who have the virus may be infectious for up to two weeks after symptoms appear. During this period, they should not prepare food for others, and if possible, they should limit contact with others, especially those who are pregnant or already have chronic liver disease.** **If a person is infected with hepatitis E, it is likely to be a short illness. Most people recover within a month. Infection with hepatitis E usually results in a full recovery with few or no symptoms. However, some patients with suppressed immune systems may not be able to clear the virus and develop chronic infection. Such patients may suffer from liver cirrhosis.** **In some people, hepatitis E can affect the nervous system, which can lead to severe pain in the arms and legs. In some cases, symptoms may go away completely within three to six months, but for others, symptoms may last longer.** **Pregnant women with hepatitis E, especially those in the second or third trimester, are at increased risk of acute liver failure, fetal loss, and death. 20 to 25% of pregnant women may die if infected with hepatitis E in the third trimester of pregnancy.** **Hepatitis E is generally mild unless you have pre-existing liver disease or are pregnant. Chronic infection (long-term infection of more than six months) from hepatitis E is very rare and is usually only reported in immunosuppressed patients, for example in patients taking drugs to prevent rejection after an organ transplant.**

** Ways to diagnose the disease** **Hepatitis E** **Testing for hepatitis usually starts with a blood test to determine if the liver is working well or if it is damaged. If the tests show hepatitis, doctors will do other blood tests to check for hepatitis viruses. These blood tests can detect parts of specific viruses (antigens), specific antibodies that the body produces to fight the virus, and sometimes the genetic material of the virus.** **Doctors do not routinely test people for hepatitis E. However, a blood test to detect antibodies produced by a person's immune system in response to the hepatitis E virus, if any, is done when two of the following are present:** **1) The tests do not detect hepatitis A, B or C, but the person has typical symptoms of viral hepatitis.** **2) The person has recently traveled to an area where hepatitis E is common.** **Treatment** **Hepatitis E** **There is no specific treatment that can change the progression of acute hepatitis E. Because the condition is usually self-limiting, hospitalization is usually not required. Unlike other forms of hepatitis, the hepatitis E virus does not usually lead to long-term illness or serious liver damage. Most patients recover within a few months.** **The most important thing is to avoid unnecessary drugs. Acetaminophen, paracetamol and antiemetics should be used sparingly or avoided. Hospitalization is necessary for people with fulminant hepatitis and should also be considered for symptomatic pregnant women. Immunosuppressed people with chronic hepatitis E benefit from special treatment using ribavirin, an antiviral drug. In some specific situations, interferon has also been used successfully.** **If a person already has liver disease or is pregnant, hepatitis E can cause severe illness that often results in hospitalization. There is no specific treatment for hepatitis E infection that lasts less than six months. It is considered a self-limiting disease, which means it has a defined or limited course. Most people with hepatitis E recover completely within four weeks of the onset of symptoms.** **Treatment for acute hepatitis E includes rest, drinking plenty of fluids, and eating healthy foods to help relieve symptoms. Before taking any prescription or over-the-counter medications, vitamins, or other dietary supplements, a person should consult his or her doctor because these substances may damage the person's liver**.

** Ways to prevent disease** **Hepatitis E** **Prevention is the most effective method against infection. At the population level, HEV transmission and hepatitis E infection can be reduced by:** - ** Maintaining quality standards for public water supply** - **Creating suitable disposal systems for human feces.** **On an individual level, the risk of infection can be reduced by:** - **maintain hygiene measures** - **Avoid consumption of water and ice of unknown purity** **How to reduce the risk of getting hepatitis E** **?** **There is currently no vaccine available for hepatitis E, so you should practice good hygiene. Always wash your hands properly after taking a bath and before preparing or eating food. If soap and water are not available, use alcohol-based hand gel or wet wipes to clean your hands.** **When traveling to areas where hepatitis E is common, you are advised to avoid the following:** - **drinking tap water (if possible, drink bottled water)** - **adding ice cubes in drinks** - **cleaning the teeth with tap water** - **drinking unpasteurized milk** - **Eating uncooked meat and shellfish** - **Eating unpeeled fruits and uncooked vegetables, including salads, not prepared by you**. ** Many complementary and alternative medicines can reduce the symptoms of liver disease. Of course, before taking any medication, you should consult your doctor because most of these drugs are processed by the liver, so they can be toxic to people with liver diseases. Some of them can damage the liver and make a person seriously ill.** **Some people choose to use complementary therapies alongside conventional medical treatments for symptom relief and emotional well-being. Therapeutic methods such as massage, meditation or acupuncture are used as complementary treatments. To ensure that the chosen treatment does not adversely affect your health or medical treatment, you should discuss any treatment you are considering with your doctor.**

**The last word is…** **Hepatitis E is caused and transmitted by a virus, similar to hepatitis B and C. The most important methods of transmission of this disease are through water contaminated with the virus or feces of an infected person. Fortunately, there is not a large spread of this disease at the moment, and by observing health tips, you can avoid contracting it.** **Symptoms and symptoms of hepatitis E virus infection include yellowing of the eyes and skin, nausea and vomiting, pain in the right side of the abdomen, dark or brown urine and light stools. Hepatitis E is contagious from one week before the onset of symptoms to four weeks after. Some people have no signs or symptoms and do not know that they are contagious.** **There is no specific drug or treatment to treat and cure hepatitis E, moreover, currently the only country that provides hepatitis E vaccination is China. Most people don't have long-term liver problems from it. Hepatitis E does not cause chronic hepatitis except in some people with weakened immune systems, especially after organ transplant**. **You can contact us for more information and advice.** Stay in touch with us

**\*Gastroenterologist in Mashhad\***