Understanding Hepatitis
and the Appropriate Barrier Protection

Hepatitis E DEFINITION The Hepatitis E Virus (HEV) was discovered in 1987. The E stands for Enteric (fecal-oral), but the hepatitis A virus does not cause HEV. Hepatitis E is also known as epidemic non-A, non-B hepatitis. Comparable to hepatitis A, it is an acute and short-lived illness, but disparate due to the fact that the clinical presentation of HEV is greater in severity.72,73 CLINICAL MANIFESTATIONS The most common clinical signs and symptoms of acute hepatitis E resemble other types of viral hepatitis and include the following: Jaundice Extreme fatigue Abdominal pain Nausea, vomiting Joint pain Hepatomegaly Anorexia Fever74 INCUBATION PERIOD The incubation period is anywhere from 15-60 days. The average incubation period is 40 days.75 CAUSE The Hepatitis E Virus (HEV) is a major etiologic agent of enterically transmitted non-A, non-B hepatitis worldwide. HEV is a spherical, non-enveloped, single-stranded RNA virus that is approximately 32-34 nm in diameter. HEV belongs to a genus of HEV-like viruses (unassigned genus).76 DIAGNOSIS IgM antibody to HEV will be noted, along with a high bilirubin, up to 8-10 mg/dl. ALT will be high, up to 1000, followed by a noted decrease to a normal value in 3-4 months.77 POST-EXPOSURE PROPHYLAXIS There are no Immunoglobulin-containing HEV antibodies to protect individuals from HEV; however, secondary transmission is uncommon.78 LONG-TERM EFFECTS There is an overall fatality rate of 1-3% and a 15-25% fatality rate for pregnant women. The disease is generally mild and resolves in 2 weeks, with no chronic liver disease. The severity increases with age.79 TRANSMISSION The virus is transmitted through food or water contaminated by feces from an infected person. There is no current method available for routine analysis of foods. No outbreaks have been reported in the United States and Canada, but persons traveling to an endemic region may return with HEV.80 WHO IS AT RISK? People who have come in contact with fecal-contaminated drinking water. People who drink beverages containing ice of unknown purity from endemic areas. People who eat uncooked shellfish and uncooked fruit/vegetables with the peel or food prepared by a traveler from an endemic area. All of the U.S. cases have a history of travel to HEV-endemic areas for all cases of acute hepatitis E. According to the CDC, it is uncommon to become contaminated through person-to-person transmission.81 TREATMENT The overall treatment for hepatitis E is supportive care. To meet this goal, treatment should include keeping the patient comfortable during the recovery period, ensuring infection control measures, and striving to prevent further liver damage by encouraging the patient to avoid substances (medications, alcohol) that might strain the liver while it heals. INFECTION CONTROL AND PREVENTION Infection Control Always follow routine Standard Precautions that include the following: Hand Washing Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. Gloves Wear gloves manufactured with proper barrier protection materials when touching blood, body fluid, secretions, excretions, and contaminated items; put on clean gloves just before touching mucous membranes and non-intact skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another patient, and wash hands immediately to avoid transfer of microorganisms to other patients of environments. Masks, Eye Protection, Face Shields Wear a standard surgical mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and activities that are likely to generate splashes or sprays. Prevention Avoid drinking water and other beverages containing ice that is of unknown purity in endemic areas. Avoid uncooked shellfish in endemic areas. Avoid uncooked fruit/vegetables with the peel or prepared for consumption by a traveler from an endemic area.82 VACCINE RECOMMENDATIONS There is no vaccine available for HEV at this time. FACTS, STATISTICS, AND TRENDS Epidemics normally occur after water supplies are contaminated with sewage following monsoons or flooding. Hepatitis E will usually run its course within a 2-month period. There is an approximate 2% chance that the main infected population will require a liver transplant. The disease predominantly affects those aged 15-40 years. The disease may affect younger age groups, but generally is not recognized and may be sub-clinical.83

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