Hepatitis E: Symptoms, Transmission & Treatment

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Liver inflammation: The right diet for hepatitis

What is hepatitis E?

Hepatitis E is an inflammation of the liver caused by an infection with the hepatitis E virus (HEV). Genotypes 1 to 4 are particularly relevant as pathogens for humans, with genotype 3 being particularly widespread in Europe.

In Germany, the number of cases has increased in recent years. However, experts assume that the increasing numbers are due to more frequent examinations for hepatitis E. The German Liver Foundation estimates that around 100,000 people in Germany become newly infected every year, with the infection remaining asymptomatic in 99 percent of cases.

Hepatitis E was included in the Infection Protection Act (IfSG) in 2001 as a notifiable disease.

Symptoms of hepatitis E

For most people who get sick, the infection clears up without any consequences and without even being noticed. If symptoms occur, it takes around 15 to 64 days for the first signs of illness to appear (incubation period).

Possible complaints if the course is symptomatic are:

Some affected people also experience:

• Jaundice (jaundice) with yellowing of the skin, mucous membranes and/or sclera of the eyes, dark discoloration of the urine, possibly itching in various parts of the body

• Liver or lymph node enlargement

• neurological symptoms (such as Guillain-Barré syndrome)

Severe courses of hepatitis E

If the immune system is weakened or artificially suppressed (immunosuppression), for example after an organ transplant, chronic forms that last longer than six months are also possible. If left untreated, viral hepatitis can then lead to liver cirrhosis.

People with liver disease also have an increased risk of complications such as liver failure. The same applies to pregnant women. However, complications mainly occur with infections with genotypes 1, 2 or 4, which are widespread in countries in Asia and Africa.

Hepatitis E: This is how it is transmitted

In countries in Southeast and Central Asia, the Middle East, North and West Africa, and Central America (such as Mexico), infection occurs primarily through drinking water contaminated with human feces.

In industrialized countries like Germany, most people become infected with HEV through eating contaminated meat (especially pork and game meat) that has not been heated or has been heated insufficiently.

Infected people excrete the hepatitis E virus in their stool between two to four weeks after infection. Direct transmission of the virus from person to person is unlikely. Nevertheless, to be on the safe side, infected people should not prepare food for other people.

Other transmission routes are also being discussed. Some experts suspect that infection is also possible during sexual intercourse, although this is considered rather unlikely. Contaminated blood donations may be further sources of infection.

Diagnosis: How is hepatitis E diagnosed?

Laboratory analyzes of blood samples are the most important tests for diagnosing hepatitis E. In this way, defensive reactions of the immune system to the hepatitis E virus can be determined in the blood: The body forms antibodies that are specifically directed against the virus and can be detected in the blood.

If the findings are unclear or in people with weakened immune systems, blood or stool can also be tested directly for the virus using a PCR test (HEV-RNA).

Further laboratory tests should check whether, for example, the concentrations of liver values ​​have increased, which could indicate a disorder of liver function. Other laboratory markers to be analyzed include, for example, parameters that can be increased during inflammation in the body.

Treatment of hepatitis E

Acute hepatitis E usually requires no or only symptomatic treatment in healthy people. It is generally recommended to avoid fatty foods and alcohol in order not to put additional strain on the liver. After consulting with your doctor, it may also make sense to temporarily stop taking liver-damaging medications.

In immunosuppressed patients with chronic hepatitis E, adjusting the immunosuppressants may in some cases be sufficient to bring about independent healing. If this is not possible, treatment with the antiviral ribavirin is sometimes considered.

How can you protect yourself from infection with hepatitis E?

There is currently no approved vaccine in Germany that protects against HEV. In addition, there is no specific hepatitis E therapy. It is therefore all the more important to adhere to certain hygiene standards when traveling to risk areas. This includes:

• Always wash or peel fruits and vegetables
• do not eat raw salads or seafood
• do not drink tap water
• Do not use ice cubes made from tap water
• Boil water
• Avoid public toilets if possible

Even at home, you should remember that eating raw or undercooked meat, as well as pork or game offal, can cause hepatitis E. In particular, pregnant women, people who have had organ transplants or people with HIV should only consume meat that is well cooked. The viruses become inactive at around 70 degrees Celsius.