Hepatitis E: Causes, prevention and treatment

Hepatitis E (HEV) is the last in the group of five Hepatitis viruses that affect the liver. It is commonly described as an inflammation of the liver primarily caused by the Hepatitis E virus. This virus has been an emerging cause of viral hepatitis that is mainly transmitted through the fecal-oral route. According to the World Health Organization (WHO), there are an estimated 20 million Hepatitis E infections worldwide every year. Out of these infections, an estimated 3.3 million cases are recorded as being symptomatic cases of Hepatitis E. As of 2015, the WHO estimated that there were up to 44 000 deaths annually worldwide. These incidents of death from hepatitis E accounted for 3.3 percent of the mortality due to viral hepatitis.

Hepatitis E is more common in Kenya than Hepatitis D which is rare in the East African region. Research conducted by the National Centre for Biotechnology Information singles out Kenya’s informal settlement areas as high-risk areas for Hepatitis E. “Residents of [areas such as] Kibera area in Nairobi are at risk for fecal-orally transmitted infections including Hepatitis E,” the report said.

According to the WHO, the Hepatitis E virus is excreted through the stool of someone who has been infected. It is then mainly transmitted through the drinking of contaminated water. As such, the virus makes its way into the body through the intestines. This is what makes it more common in low and middle-income countries because they are prone to have problems with housing and sanitation. Areas such as Kibera or Mathare slums will be more densely populated, have poor access to clean water, and have higher open deposits of sewerage and human waste than areas such as Kileleshwa or Kilimani. “In areas with limited access to essential water, sanitation, hygiene and health services, the disease occurs both as outbreaks and as sporadic cases,” the WHO states. “The outbreaks usually follow periods of faecal contamination of drinking water supplies and may affect several hundred to several thousand persons. However, in areas with better sanitation and water supply, hepatitis E infection is infrequent, with only occasional sporadic cases.”

The symptoms

Although the mode of transmission for this virus varies, symptoms a patient will exhibit will be similar to those of other Hepatitis viruses, with only mild variations. These symptoms will include fever, reduced appetite, nausea, vomiting, abdominal pain, itching, joint pain, skin rash, jaundice, dark urine, pale stool, and enlarged liver. Fever, reduced appetite, nausea, and vomiting will be the initial symptoms a patient will exhibit and they will last for just a few days. The other symptoms, including a slightly enlarged and tender liver, will pop up as the disease progresses unabated. Altogether, these symptoms will last up to six weeks.

Risks and treatment

According to the WHO, Hepatitis E poses a great risk for pregnant women. “Pregnant women with hepatitis E, particularly those in the second or third trimester, are at increased risk of acute liver failure, fetal loss, and mortality. Up to a quarter of all pregnant women who get Hepatitis E in the third trimester are at risk of death,” states the WHO. Amongst the general population, it is possible to contract this disease and overcome it without going for medical attention if you have a strong immune system. The WHO says this is because Hepatitis E is self-limiting. “Hospitalisation is generally not required,” the WHO states. However, hospitalisation will be necessary for any person with acute liver failure and any pregnant woman who has symptomatic Hepatitis E. Although there is no specific treatment for Hepatitis E, there are medications that will be administered to manage its severity. WHO recommends that medication for the management of Hepatitis E should be avoided as much as possible. “Unnecessary medications should be avoided. Acetaminophen, paracetamol, and medication against vomiting should be used sparingly or avoided,” the WHO states. Since there is no proven and approved vaccination, proper sanitation is the recommended mode of prevention against Hepatitis E. “Boiling and chlorination of water inactivates the Hepatitis E virus. It is also important for people to stop consuming raw pork,” cites the CDC. This is echoed by the WHO which recommends communal maintenance of quality standards for public water supplies and proper disposal systems for human waste.