Hepatitis E

Hepatitis E

Hepatitis E is an acute, usually self-healing inflammation of the liver and must be reported. In the last few years, chronic forms of the disease (especially in patients after organ transplants) have also been reported. Hepatitis E is particularly widespread in the tropics and subtropics (Southeast Asia, the Indian subcontinent and Central America). In Europe, too, antibodies against hepatitis E viruses can be detected in over 15 percent of adults. There are a total of four hepatitis E virus genotypes (“virus groups” with small differences in the genetic material) that are contagious to humans.

Genotypes one and two occur in Asia and Africa and are transmitted from person to person. Genotypes three and four are transmitted to humans from pigs or wild boars and possibly also from other animals. The genotype three occurs in Europe and many other industrial nations, the genotype four in parts of Asia and Europe.

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• How is hepatitis E transmitted?
• How to prevent hepatitis E.
• How does hepatitis E work?
• What are the symptoms?
• How is the diagnosis made?
• How is hepatitis E treated?
• Whom can I ask?
• How will the costs be reimbursed?

How is hepatitis E transmitted?

The transmission is fecal-oral (intake of feces through the mouth - very small amounts that cannot be seen with the eye are sufficient). Frequently, hepatitis E viruses are transmitted with drinking water, food (in Europe, especially inadequately heated pork or wild boar meat) contaminated by human or pig faeces, and less often, for example, when eating mussels. Transmission from infected mothers to the newborn is also possible at birth. Since hepatitis E viruses can get into breast milk, acutely infected mothers are not advised to breastfeed. Very rarely, the infection can be transmitted sexually. Infection through blood products is also possible. The transmission from person to person through a smear infection is a route of infection for viruses that mainly occur in Asia and Africa. A person positive for hepatitis E is contagious approximately one week before to four weeks after the onset of the disease.

In the environment, the viruses can find their way into surface water if surfaces are fertilized (slurry) with pig excrement. If this is used as drinking water or to irrigate vegetable plants, hepatitis E viruses can be ingested through food. Another way of spreading the virus is "natural fertilizer" (animal excrement) for vegetable plants.

How to prevent hepatitis E

The most important measure for an effective prophylaxis is to carefully observe certain hygiene precautions in endemic areas (areas in which infections occur more frequently). This includes, for example, no consumption of uncooked food or uncooked water or ice and the peeling of fruit. When dealing with people with hepatitis E and their contacts, hand hygiene is the most important protective measure against infection. Vaccination is currently only available in China.

How does hepatitis E work?

Infections with genotypes one or two are usually more severe than infections with genotypes three or four. The incubation period is around two to nine weeks. In contrast to hepatitis A, which affects patients of all ages, but mainly children and adolescents, hepatitis E occurs particularly frequently in adults between the ages of 30 and 40.

Fulminant clinical pictures are very rare. They occur mainly in women in advanced pregnancy (third trimester), especially on the Indian subcontinent, with an infection with genotype one. These courses are associated with a high mortality rate (up to 25 percent). With genotype three, which occurs in Europe, a particularly severe course during pregnancy has not yet been demonstrated. Previous damage to the liver (e.g. through alcohol abuse) also increases the likelihood of a severe course.

Chronic disease courses have been described in patients with immunosuppression - especially in people who have had an organ transplant. Chronic hepatitis E occurs when the virus stays in the body for more than six months. It quickly leads to cirrhosis of the liver. It has not yet been possible to determine whether a person has lifelong immunity after an infection or whether they can be infected with hepatitis E viruses.

What are the symptoms?

Hepatitis E often causes no symptoms. When symptoms occur, they usually begin suddenly with nausea, vomiting and a general feeling of illness, with joint pain and a slight fever. A rash may also develop. Jaundice (jaundice) and ascites (abdominal fluid) or hepatic encephalopathy are rare.

Hepatitis E can cause diseases of the central and peripheral nervous system (e.g. Guillain-Barré syndrome, meningitis, polyneuropathy).

How is the diagnosis made?

Sometimes the doctor can detect signs of an inflammation of the liver during the physical examination - e.g. enlargement of the liver, which may be tender on pressure, and jaundice (jaundice). However, hepatitis E can only be diagnosed by detecting virus components or antibodies against the virus in the blood. If there are signs of fulminant liver inflammation (e.g. with ascites or hepatic encephalopathy), a check is carried out to determine whether hepatitis E viruses can be detected in the blood.

Anti-HEV IgM and IgG serum antibodies are determined in laboratory diagnostics. Direct virus detection in blood or stool is carried out by detecting HEV-RNA using PCR. The higher the liver values (e.g. GGT, GOT, GPT), the more severe the clinical picture.

How is hepatitis E treated?

The treatment is based on the acute symptoms. Bed rest or at least avoidance of physical exertion is recommended. A light, low-fat diet makes sense. Alcohol should definitely be avoided. Since hepatitis E heals within a few weeks, no follow-up care is usually necessary. In fulminant hepatitis E, therapy with pegylated interferon alphabzw. Ribavirin should be carried out.

Note In people who are receiving immunosuppressants, the doctor can make it easier for the body to fight the viruses in chronic hepatitis E by lowering the dose. If the immunosuppressive therapy cannot be changed or if lowering the dose is not sufficient, the affected person can be treated with ribavirin or pegylated interferon alpha.

Liver transplantation must be performed in the event of severe liver failure caused by fulminant hepatitis E.

Whom can I ask?

Diagnosis and treatment of hepatitis E are possible in the following facilities:

• special hospital outpatient department, e.g. hepatological outpatient department,
• Cash outpatient clinics with special hepatology clinics,
• In the private practice area: Specialists in internal medicine with sound hepatological knowledge,
• Department of Internal Medicine (focus on gastroenterology and hepatology) and Department of Transplant Surgery for severe forms of disease.

How will the costs be reimbursed?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. You can find more information under What does a hospital stay cost?

Your resident doctor or outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see What does a hospital stay cost, a doctor's visit: Costs and deductibles.

For certain non-drug treatments (e.g. physical therapy) - in some cases only when a certain level has been reached - approval from the health insurance provider may be required.

For certain services (e.g. medical aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “prescription”. For more information about the respective provisions, please contact your health insurance provider, which you can find on the social security website, for example.