Hepatitis E infection

  • Axel Schmidt
  • Manfred H. Wolff
Part of the Birkhäuser Advances in Infectious Diseases book series (BAID)


Hepatitis E — formerly called ‘enterically transmitted non-A non-B hepatitis’ — is transmitted by the faecal-oral route. The Hepatitis E Virus (HEV) is a positive-sense single-stranded RNA virus and has great similarities to the caliciviruses. Virus replication appears to be limited to the hepatocyte. The disease is especially endemic and/or epidemic on the Indian sub-continent. Epidemics are mostly waterborne infections. Also in other ‘developing regions’ outbreaks of HEV infection are observed. In industrialised countries this disease only plays a minor role in hepatitis infections. HEV causes epidemics, endemics and sporadic cases of acute hepatitis. The incubation period for hepatitis E varies from 2–9 weeks. The course of disease is usually mild and self-limiting and resolves within a 2 weeks period. Fulminant cases of infection are rare. HEV infection does not induce chronic courses of hepatitis or liver disease. In clinically apparent cases of infection jaundice, pruritus, clay-coloured faeces and generalised lymphadenopathia may be observed. Fatal infections of fulminant hepatitis E are rare. Pregnant women appear to be exceptionally susceptible to severe disease forms, with an excessive mortality of infected mothers of about 20% in this group. HEV infections appearingly induce mostly life-long immunity to re-infection. To date there is no therapy against HEV infection available. The attempts in generating a vaccine against HEV infections are promising. Improving the socioeconomic situation — including hygienic conditions — is the most effective measure of disease prevention.


Fulminant Hepatitis Waterborne Infection Positive Sense Single Strand Acute Sporadic Hepatitis Serum Alanine Amino 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Khudyakov Y, Fields HA (2002) HEV-Like-Viruses. In: CA Tidona, G Darai (eds) In: The Springer Index of Viruses. Springer Publ, Berlin, 1251–1254CrossRefGoogle Scholar
  2. 2.
    Gorbach SL, Bartlett JG, Blacklow NR (eds) (1998) Infectious Diseases. WB. Saunders, PhiladelphiaGoogle Scholar
  3. 3.
    Reyes GR, Huang CC, Tam AW, Purdy MA (1993) Molecular organization and replication of hepatitis E virus (HEV). Arch Virol 7: 15–25Google Scholar
  4. 4.
    Chauhan A, Diliwari JB, Kaur U, Ganguly NK, Bushnurmath S, Chawla YK (1994) Atypical strains of hepatitis E virus (HEV) from north India. J Med Virol 44: 22–29PubMedCrossRefGoogle Scholar
  5. 5.
    Krawczynski K (1993) Hepatitis E. Hepatology 17: 932–941PubMedCrossRefGoogle Scholar
  6. 6.
    Huang R, Li D, Wei S, Li Q, Yuan X, Geng L, Li X, Liu M (1999) Cell culture of sporadic hepatitis E virus in China. Clin Diagn Lab Immunol 6: 729–733PubMedGoogle Scholar
  7. 7.
    Viswanathan R, Sidhu AS (1957) Infectious hepatitis: clinical findings. Ind J Med Res 45: 49–58Google Scholar
  8. 8.
    Wong DC, Purcell RH, Sreenivasan MA, Prasad SR, Pavri KM (1980) Epidemic and endemic hepatitis in India: evidence for a non-A, non-B hepatitis virus aetiology. Lancet 2(8200): 876–879PubMedCrossRefGoogle Scholar
  9. 9.
    Balayan MS, Andjaparidze AG, Savinskaya SS, Ketiladze ES, Braginsky DM, Savinov AP, Poleschuk VF (1983) Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route. Intervirology 20: 23–31PubMedCrossRefGoogle Scholar
  10. 10.
    Goldsmith R, Yarbough PO, Reyers GR, Fry KE, Gabor KA, Kamel M, Zakaria S, Amer S, Gaffar Y (1992) Enzyme-linked immunosorbent assay for diagnosis of acute sporadic hepatitis E in Egyptian children. Lancet 339: 328–331PubMedCrossRefGoogle Scholar
  11. 11.
    Koff RS (1998) Hepatitis E. In: SL Gorbach, JG Bartlett, NR Blacklow (eds) In: Infectious Diseases. W.B. Saunders, Philadelphia, 871–873Google Scholar
  12. 12.
    Arankalle VA, Chadha MS, Tsarev SA, Emerson SU, Risbud AR, Banerjee K, Purcell RH (1994) Seroepidemiology of water-borne hepatitis in India and evidence for a third enterically-transmitted hepatitis agent. Proc Natl Acad Sci USA 91: 3428–3432PubMedCrossRefGoogle Scholar
  13. 13.
    Velazquez O, Stetler HC, Avila C, Ornelas G, Alvarez C, Hadler SC, Bradley DW, Sepúlveda J (1990) Epidemic transmission of enterically transmitted non-A, non-B hepatitis in Mexico, 1986–1987 JAMA 263: 3281–3285PubMedCrossRefGoogle Scholar
  14. 14.
    Pujol FH, Favorov MO, Marcano T, Esté JA, Magris M, Liprandi F, Khudyakov YE, Khudyakova NS, Fields HA (1994) Prevalence of antibodies against hepatitis E virus among urban and rural populations in Venezuela. J Med Virol 42: 234–236PubMedCrossRefGoogle Scholar
  15. 15.
    Nanda SK, Ansari IH, Acharya SK, Jameel S, Panda SK (1995) Protracted viremia during acute sporadic hepatitis E virus infection. Gastroenterology 108: 225–230PubMedCrossRefGoogle Scholar
  16. 16.
    Jilani N, Das BC, Husain SA, Baweja UK, Chattopadhya D, Gupta RK, Sardana S, Kar P (2007) Hepatitis E virus infection and fulminant hepatic failure during pregnancy. J Gastroenterol Hepatol 5: 676–682CrossRefGoogle Scholar
  17. 17.
    Boccia D, Guthmann JP, Klovstad H, Hamid N, Tatay M, Ciglenecki I, Nizou JY, Nicand E, Guerin PJ (2006) High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan. Clin Infect Dis 42: 1679–1684PubMedCrossRefGoogle Scholar
  18. 18.
    Bryan JP, Tsarev SA, Iqbal M, Ticehurst J, Emerson S, Ahmed A, Duncan J, Rafiqui AR, Malik IA, Purcell RH (1994) Epidemic hepatitis E in Pakistan: patterns of serologic response and evidence that antibody to hepatitis E virus protects against disease. J Infect Dis 170: 517–521PubMedGoogle Scholar
  19. 19.
    Khuroo MS, Rustgi VK, Dawson GJ, Mushawar IK, Yattoo GN, Kamili S, Khan BA (1994) Spectrum of hepatitis E virus infection in India. J Med Virol 42: 281–286CrossRefGoogle Scholar
  20. 20.
    Lin CX, Wu T, Wu XL, Xie MH, Cheng T, Li SW, Zhang J, Xia NS (2007) Priming with an HEV Th epitope can improve the humoral immunogenicity of its native protein (Chinese). Sheng Wu Gong Cheng Xue Bao 23: 310–314PubMedGoogle Scholar
  21. 21.
    Tsarev SA, Tsareva TS, Emerson SU, Govindarajan S, Shapiro M, Gerin JL, Purcell RH (1994) Successful passive and active immunization of Cynomolgus monkeys against hepatitis E. Proc Natl Acad Sci USA 91: 10198–10202PubMedCrossRefGoogle Scholar

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© Birkhäuser Verlag Basel/Switzerland 2008

Authors and Affiliations

  • Axel Schmidt
    • 1
  • Manfred H. Wolff
    • 2
  1. 1.Faculty of MedicinePrivate University of Witten/HerdeckeWittenGermany
  2. 2.Institute of Microbiology and VirologyPrivate University of Witten/HerdeckeWittenGermany

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