Hepatitis E – A new era in understanding

Abstract

Hepatitis E virus [HEV], the last of the five hepatotropic viruses to be discovered, was originally considered to cause an acute, travel-associated self-limiting illness restricted to humans; however, new research shows that there are animal reservoirs and zoonotic transmission. Additionally, HEV is now considered as a major health burden worldwide, leading to significant morbidity and mortality; therefore, the topic of hepatitis E is of re-emerging importance, having brought to light important questions such as the transmission of HEV, especially in developed countries, as well as treatment and vaccination options. HEV belongs to the genus Hepevirus in the Hepeviridae family. The HEV genome sequence is relatively stable; however, there is a diversity of genotypes which are helpful in comprehending the epidemiological phenomena. HEV is classified based on the nucleotide sequences of the genome and is now characterised as a single serotype with four major genotypes . Hepatitis E cases are not clinically distinguishable from other types of acute viral hepatitis, although diagnosis can be strongly suspected in certain epidemiological settings. It is imperative to raise awareness among physicians about the importance of HEV, with the aim of helping recognise, prevent and treat HEV infections. This review article highlights the current developments of HEV in microbiology, epidemiology, clinical features, treatment and prophylaxis.

New insights into the ORF2 capsid protein, a key player of the hepatitis E virus lifecycle

“…In industrialized countries, gt3 and gt4 are zoonotic and mainly infect mammals, where pigs and game are the main reservoirs 5 . The major transmission routes of gt3 and gt4 are direct contact with infected animals, consumption of contaminated food and transfusion of blood products 6 .…”

Autoimmune liver disease-associated serologic profiling in Chinese patients with acute hepatitis E virus infection

“…Twenty-seven of the 69 autoantibody-positive patients at the time of acute HEV infection had follow-up data available for autoantibodies. Autoantibodies disappeared in 11 patients at a follow-up of 2 to 6 months, while autoantibodies were still present in the other 16 patients at a median (IQR) 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) months of follow-up. As shown in Table 2, the patients whose autoantibodies became negative had higher serum IgE levels at baseline when compared with the patients who had remained positive for autoantibodies at follow-up.…”

“…Hepatitis E, an infectious disease caused by the hepatitis E virus (HEV), has worldwide prevalence [8]. HEV has extensive genetic diversity: HEV genotype (GT)-1 and GT-2 infections are waterborne and causative for epidemics in the tropics, while GT-3 and GT-4 infections are sporadic zoonotic diseases and are mainly transmitted by ingestion of undercooked food [9][10][11].…”

Viruses Associated With Foodborne Infections

“…For those with acute symptoms or for high risk individuals, hospitalisation is required. The antiviral drug ribavirin may be given, although in pregnant women this must be carefully considered, due to the teratogenic nature of this antiviral compound (Krzowska-Firych et al, 2017). A recombinant subunit vaccine to prevent hepatitis E virus infection exists in China but is not licenced elsewhere (Nan et al, 2018).…”