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HEV is responsible for most of the epidemics of hepatitis in the developing world and is transmitted through contaminated water.
In the absence of an effective vaccine (but the signs are it is coming) , public health measures such as clean water supply, improved sanitation and public education are the major tools to prevent HEV epidemics in developing nations.
This is a good review and it is ‘sensitive’ to the problems of ‘developing’ countries. A pity it is not ’open access’ but have a look at these socalled ‘related articles ‘in Pubmed – many are available full text.
1 Hepatitis E virus: epidemiology, diagnosis, pathology and prevention.
Acharya SK, Panda SK.
Trop Gastroenterol. 2006 Apr-Jun;27(2):63-8. Review.
PMID: 17089614
Infection with hepatitis E virus (HEV) may be diagnosed by the presence of HEV RNA or anti-HEV antibodies. An enzyme immunoassay (EIA) was developed for the detection of antigen. This will help to diagnose acute hepatitis E, particularly in the window period prior to seroconversion to anti-HEV.
2 Detection of HEV antigen as a novel marker for the diagnosis of hepatitis E.
Zhang F, Li X, Li Z, Harrison TJ, Chong H, Qiao S, Huang W, Zhang H, Zhuang H, Wang Y.
J Med Virol. 2006 Nov;78(11):1441-8.
PMID: 16998897
:
This is important – a comparative hepatology is long overdue – the differences between ‘east and west’ should be seen as heuristic.
Clinical hepatitis E in the West, as in Japan, manifests more commonly in older people (>60 years) and in men, but fulminant hepatitis appears less frequent than in Japan. There, specific gastronomic and culinary risk factors associated with disease are being identified, but in the West, data implicating hepatitis E as being foodborne have yet to emerge. While hepatitis E virus subgenomic sequences in Western case patients are found to be closely related to swine hepatitis E virus, a porcine linkage to their infection remains to be established.
The authors conclude that Hepatitis E is indigenous to developed countries and that it is a distinct clinico-epidemiological entity. Humans, animals, food and the environment contribute and interact to cause human disease, and to sustain hepatitis E virus endemicity and enzooticity.
3 Hepatitis E indigenous to economically developed countries: to what extent a zoonosis?
Teo CG.
Curr Opin Infect Dis. 2006 Oct;19(5):460-6. Review.
PMID: 16940870
A new method was established to assay anti-HEV IgA, which could be detected in the middle phase of the infection. Anti-HEV IgA assay was compared with anti-HEV IgM and anti-HEV IgG assay in sera from 60 patients with positive HEV-RNA.
Conclusion of the study: ‘The duration of anti-HEV IgA in serum is longer than that of anti-HEV IgM, and thus , anti-HEV IgA assay is a good method to detect HEV infection’.
It’s from the World Journal of Gastroenterology and it is ‘Open Access’
4 Significance of serum IgA in patients with acute hepatitis E virus infection.
Tian DY, Chen Y, Xia NS.
World J Gastroenterol. 2006 Jun 28;12(24):3919-23.
PMID: 16804983
So, it is not only travelers who take back hepatitis E. The authors conclude that
Hepatitis E can be considered an autochthonous infection in South West France. (The English consider it indigenous also)
The aim of this study was to describe patients with acute hepatitis E in South West France and compare them with patients with acute hepatitis A.
All strains sequenced were related to genotype III. When compared to hepatitis A, HEV-infected patients were older, had lower ALT levels and had a lower incidence of travel outside of Europe.
5 Hepatitis E is an autochthonous disease in industrialized countries. Analysis of 23 patients in South-West France over a 13-month period and comparison with hepatitis A.
Peron JM, Mansuy JM, Poirson H, Bureau C, Dupuis E, Alric L, Izopet J, Vinel
Gastroenterol Clin Biol. 2006 May;30(5):757-62.
PMID: 16801899
Seroepidemiological studies were conducted to assess antibody prevalence to hepatitis E virus (HEV) in 5,233 sera from 11 countries. The results show that the prevalence of anti-HEV IgG increased with age in these tested countries. HEV is spreading worldwide, not only in developing countries, but also in more industrialized countries than previously thought.
6 International collaborative survey on epidemiology of hepatitis E virus in 11 countries.
Abe K, Li TC, Ding X, Win KM, Shrestha PK, Quang VX, Ngoc TT, Taltavull TC, Smirnov AV, Uchaikin VF, Luengrojanakul P, Gu H, El-Zayadi AR, Prince AM, Kikuchi K, Masaki N, Inui A, Sata T, Takeda N.
Southeast Asian J Trop Med Public Health. 2006 Jan;37(1):90-5.
PMID: 16771218
The epidemiology and clinical features of Hepatitis A and E are compared.
The conclusion: ‘Hepatitis E is a more severe disease entity as compared with hepatitis A and significant proportion of them are imported cases from an endemic area’
7 Epidemiology and clinical features of sporadic hepatitis E as compared with hepatitis A.
Chau TN, Lai ST, Tse C, Ng TK, Leung VK, Lim W, Ng MH.
Am J Gastroenterol. 2006 Feb;101(2):292-6.
PMID: 16454833
Hepatitis E is clinically similar to other forms of acute viral hepatitis except in pregnant women, in whom the illness is particularly severe and has a high mortality rate.
This study looked at prevalence and risk factors for HEV infection in pregnant women in Turkey.
Education seems to be the key factor the authors conclude: ‘the prevalence of HEV seropositivity was significantly lower (2.5%) in women with a higher education level when compared to women with a lower education level (9.7%) (p=0.023)’.
8 Prevalence and risk factors for HEV infection in pregnant women.
Med Sci Monit. 2006 Jan;12(1):CR36-39. Epub 2005 Dec 19.
PMID: 16369469