Abstract
Hepatitis E virus (HEV) infection is a leading cause of acute viral hepatitis worldwide. Approximately 20 million people are infected with HEV annually, resulting in more than three million annual cases of acute HEV and ~70,000 associated deaths (World Health Organization. Hepatitis E (Factsheet No. 280). World Health Organization, 2014; World Health Organization. Prevention and control of viral hepatitis: a framework for global action. World Health Organization. www.who.int/topics/hepatitis, 2012). Although HEV infection among children is often asymptomatic, infection can also lead to a range of symptoms from mild hepatitis to fulminant liver failure and to extrahepatic disease such as pancreatitis, Guillain-Barre syndrome, or Henoch-Schonlein purpura (Verghese VP, Robinson JL. Clin Infect Dis 59(5):689–697, 2014). Among tropical and subtropical climates, HEV is a leading cause of waterborne epidemic viral hepatitis and a major cause of morbidity in developing settings (Gerbi GB et al. Am J Trop Med Hyg 92(2):411–414, 2015; Tsega E et al. Clin Infect Dis 14(4):961–965, 1992). Pregnant women and individuals with underlying liver disease are at highest risk for morbidity and mortality, with few treatment options currently available at this time (Navaneethan U, Al Mohajer M, Shata MT. Liver Int 28(9):1190–1199, 2008). Among children, the risk of HEV infection increases with age, with serologic studies demonstrating peak incidence in early adulthood.
While the overall significance of HEV infection on the majority of immunocompetent children remains unclear, the risk of zoonotically acquired acute and chronic HEV infection among immunocompromised individuals, particularly solid organ transplant (SOT) recipients, has become increasingly apparent (Dalton HR et al. Eur J Gastroenterol Hepatol 20(8):784–790, 2008; Kamar N et al (2008) Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med 358(8):811–817; Kamar N et al. Am J Transplant 8(8):1744–1748, 2008; Halac U et al. Gut 61(4):597–603, 2012; Purcell RH, Emerson SU. J Infect Dis 202(6):819–821, 2010). This chapter will highlight the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment approaches to HEV infection among children and those in high-risk groups, such as pregnant women, SOT recipients, and other immunocompromised hosts (Mushahwar IK. J Med Virol 80(4):646–658, 2008; Mizuo H et al. J Med Virol 76(3):341–349, 2005; Takahashi M, Okamoto H. Hepatol Res 44(1):43–58, 2014; 15. Okamoto H. Virus Res 127(2):216–228, 2007; 16. Mjahed K et al. Arch Gynecol Obstet 274(6):349–353, 2006).
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Sue, P.K., Karnsakul, W. (2019). Hepatitis E Virus Infection in Children. In: Chang, MH., Schwarz, K. (eds) Viral Hepatitis in Children. Springer, Singapore. https://doi.org/10.1007/978-981-13-0050-9_14
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