Hepatitis E
Hepatitis E is a viral infectious hepatitis in humans, which is caused by the hepatitis E virus (HEV). Especially in case of flooding in Southeast Asia during the monsoon period, hepatitis E can develop into an epidemic as it is transmitted through water and is also associated with animals as a reservoir of the pathogen. In temperate latitudes, it comes only sporadically before travel as imported disease or as a sporadic infection of unknown source. A vaccine is licensed in the People's Republic of China since April 2012.
Pathogen
The pathogen is hepatitis E virus (HEV). It is a non-enveloped single ( ) strand RNA virus of 32-34 nm size. Formerly considered part of the family Caliciviridae, it is now the monotypic family of Hepeviridae awarded ( Emerson et al., 2004). Several human pathogenic subtypes of HEV have been described. The disease usually occurs in anikterischer form and was first discovered in 1980 in India. It is discussed whether the HEV is a zoonosis, since similar viruses could be detected in pigs, monkeys, deer, mice and sheep. Recent studies bring the consumption of wild boar meat / offal with diseases related and show that some 15% of boars carrying the hepatitis E virus in Germany.
Occurrence
Hepatitis E is the second most common hepatitis in North Africa and the Middle East, especially in Sudan and Iraq. The number of hepatitis E cases increased in recent years. In 2009, Germany reported for 106 diseases. 2007 and 2008 the majority of new cases were lying in the same order of magnitude caused by virus strains indigenous to Germany. 2011, reported 238 cases in Germany and registered already 206 infections for the year 2012 to August. Most cases were discovered after traveling abroad to endemic areas.
Transmission
The transmission is possible by contact infection or contact infection fecal-oral route and over the water. Transmission from person to person (droplet infection) has not been established, so that the improvement of sanitary conditions and the boiling of water or chemical disinfection displaces the disease.
Clinical course
The disease has an incubation period of 30 to 40 days and is clinically indistinguishable from hepatitis A. However, it is heavier in the course, in 0.5 to 4 % of the cases even fatal. Especially pregnant women should not travel to endemic areas, since infection during pregnancy is associated with a mortality rate of around 25% in the expectant mother. After organ transplantation, hepatitis E can turn into a chronic form. and lead to liver cirrhosis.
Therapy
A causal therapy of hepatitis E infection is not yet known. The treatment is limited to symptomatic - supportive measures.
Vaccination
A vaccine is currently in clinical trials. The effectiveness could be detected in March 2007 in a Phase 2 trial, which was conducted in Nepal. 2010 could be detected in a Chinese study involving 56 302 vaccinees and an equally large control group, a statistically significant effect of the vaccine. Of the vaccinated persons nobody ill in twelve months from the disease, while 15 people in the control group affected. The vaccine was given as HEV 239 in the People's Republic of China in April 2012 admission.