Hepatitis E.

from Wikipedia, the free encyclopedia
Classification according to ICD-10
B17.2 Acute viral hepatitis E.
ICD-10 online (WHO version 2019)

The Hepatitis E is a viral , infectious hepatitis in humans caused by the hepatitis E virus (HEV). Hepatitis E can develop into an epidemic , especially when floods in Southeast Asia during the monsoon season , as it is transmitted through water and is also associated with animals as a reservoir for the pathogen . In Europe, undercooked pork is the main route of infection for humans. A vaccine has been approved in the People's Republic of China since April 2012.

Pathogen and Epidemiology

Hepatitis E virus
Hepatitis E virus.jpg

Hepatitis E virus virions in the TEM

Systematics
Classification : Viruses
Area : Riboviria
Empire : Orthornavirae
Phylum : Kitrinoviricota
Class : Alsuviricetes
Order : Hepelivirales
Family : Hepeviridae
Genre : Orthohepevirus
Taxonomic characteristics
Genome : (+) ss RNA linear
Baltimore : Group 4
Symmetry : icosahedral
Cover : no
Scientific name
Orthohepevirus A
Short name
HEV
Left
NCBI  Taxonomy: 186677
ICTV Taxon History: 201853665
ICTVdB Virus Code : 00.084.0.01
Worldwide distribution of the hepatitis E virus genotypes. In genotypes 1 and 2, fecal-oral transmission takes place from person to person, in genotypes 3 and 4 pork and pork are probably the main transmission reservoir.
Genotype 1 Genotype 2 Genotype 3 Genotype 4 Genotypes 1 and 2 Genotypes 1 and 3 Genotypes 2 and 3 Genotypes 1 and 4 Genotypes 3 and 4 no data










The causative agent is Orthohepevirus A aka hepatitis E virus (HEV). It is a non-enveloped single (+) - strand RNA virus of 32-34 nm size. Formerly assigned to the Caliciviridae family , it is now divided into the Hepeviridae family . Several human pathogenic subtypes of HEV have been described. The disease usually occurs in an anicteric form and was first discovered in India in 1980.

The former genus Hepevirus was from the International Committee on Taxonomy of Viruses (ICTV) in Orthohepevirus renamed and redistributed. In the new genus Orthohepevirus , in addition to the species mentioned with 8 genotypes (1a to 8a), there are also three other species, namely Orthohepevirus B ( avian hepatitis E virus , AHEV), Orthohepevirus C (affects rats and polecats) and Orthohepevirus D (infects Bats). Non-terrestrial vertebrates, however, are hosts of at least one other genus from the Hepeviridae family .

After the establishment of the Orthohepevirus species A to D, the genotypes were also renamed, the new types 1a to 8a belong to the Orthohepevirus A species . Previously, 5 genotypes were known, scattered across the species, with the human pathogenic types 1 to 4 (for Orthohepevirus A ) and the avian (only occurring in birds) Type 5 (for Orthohepevirus B ). The global distribution of genotypes is different. Genotype 3 is predominantly found in Europe. There are different pathogen reservoirs for the different HEV genotypes. Genotypes 1 and 2 are overwhelmingly only transmitted from person to person. Typically, infections with these genotypes are therefore found in countries with poor drinking water hygiene . HEV genotype 1/2 cases diagnosed in Central Europe are predominantly infections imported from southern countries.

The HEV genotypes 3 and 4 could be repeatedly detected in animals, especially in domestic pigs and wild boars as well as in pork . Transmission to humans via this route is the suspected main source of infection in industrialized nations. The HEV genotype 3/4 infection can thus be described as a zoonosis .

The Robert Koch Institute determined an HEV antibody prevalence of 16.8% for Germany , i. H. 16.8% of those examined had antibodies against the virus, which suggests previous contact. Since most HEV infections have no significant symptoms, i.e. H. clinically inapparent, one can deduce from these numbers about 320,000 HEV infections annually in Germany. The number of cases reported in France, Germany and the UK has increased tenfold over the past decade, with a total of 21,000 cases in that period.

The risk groups in which a hepatitis E virus is more likely to cause hepatitis E include people with acute or chronic immunodeficiency as well as people who are immunocompromised due to several previous illnesses. The Federal Institute for Risk Assessment (BfR) advises people belonging to these risk groups against consuming raw, short-matured and air-dried house and wild boar products such as ground meat, fresh sausage, and domestic and wild boar meat that is not heated to at least 70 ° C. The viruses are usually inactivated or destroyed at temperatures above 70 ° C.

So far, no widespread exposure to hepatitis E viruses has been found in the beef sold in Germany.

Blood transfusions are another source of infection, as donor blood is generally not tested for hepatitis E viruses due to the lack of an inexpensive test method. Heart transplant recipients, for example, who often lose so much blood during surgery that blood transfusions are necessary, have more hepatitis E viruses in their blood immediately after the operation than other transplant patients. But here too, only members of the above-mentioned risk groups are usually at risk.

A large-scale study limited to China also demonstrated the contamination of drinking water with hepatitis E. In Germany, samples from drinking water reservoirs are regularly checked for hepatitis E viruses in order to prevent them from spreading through drinking water. In Europe, drinking water is not a transmission route.

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 has increased in recent years. In 2007 and 2008, the majority of new cases in Germany were caused by virus strains native to Germany. According to more recent findings from the RKI, however, the hepatitis E virus has been native to Central Europe for a long time and is mainly transmitted via contaminated pork and game meat. The number of cases reported to the RKI for Germany has developed as follows since 2005:

Development of the number of cases in Germany
year reported case numbers
2005 54
2006 51
2007 73
2008 104
2009 108
2010 221
2011 238
2012 338
2013 442
2014 661
2015 1264
2016 1983
2017 2951
2018 3400
2019 3706

transmission

Transmission is possible through the consumption of meat that has not been fully cooked ( domestic pigs , wild boar or deer ), by contact infection or smear infection fecal-oral by infected people and in many countries via the water. The transmission from person to person by means of droplet infection has not been proven. In Germany, by order of the Paul Ehrlich Institute , blood donations will be tested for hepatitis E from January 2020 and only HEV-free preparations will be released.

Clinical course

The disease has an incubation period of 30 to 40 days and is clinically indistinguishable from hepatitis A. However, it is more severe and even fatal in 0.5 to 4% of cases. Pregnant women in particular should not travel to endemic areas, as infection during pregnancy is associated with a mortality rate of around 25% for the expectant mother. After organ transplantation , hepatitis E can develop into a chronic form and lead to liver cirrhosis .

therapy

A causal therapy for hepatitis E infection is not yet known. Therapy is limited to symptomatic supportive measures.

vaccination

A vaccine is in clinical trials. The effectiveness was proven in March 2007 in a phase 2 study that was carried out in Nepal . In 2010, a Chinese study with 56,302 vaccinated people and an equally large control group demonstrated the effect of the vaccine to be statistically significant. None of the vaccinated people contracted the disease in twelve months, while 15 people in the control group became ill. The vaccine was approved as HEV 239 in the People's Republic of China in April 2012.

Reporting requirement

In Germany, all acute viral hepatitis (including acute hepatitis E) must be reported by name in accordance with Section 6 of the Infection Protection Act (IfSG) . This concerns the suspicion of an illness, the illness and death. In addition, any direct or indirect evidence of the hepatitis E virus must be reported by name in accordance with Section 7 IfSG, provided the evidence indicates an acute infection.

In Austria, after § 1 1 para. Epidemics Act 1950 of suspicion, illness and deaths from infectious hepatitis (hepatitis A, B, C, D, E) , including hepatitis E, notifiable .

Also in Switzerland is subject to hepatitis E of the reporting requirement and that according to the Law on Epidemics (EpG) in connection with the epidemic Regulation and Annex 1 of the Regulation of EDI on the reporting of observations of communicable diseases of man . The reporting criteria for this report by doctors, hospitals, etc. is a positive laboratory analysis result. Laboratories must report a positive laboratory analysis result for PCR analysis or a negative laboratory analysis result for the hepatitis E virus in accordance with Annex 3 of the above-mentioned EDI ordinance.

literature

Review article

Web links

Individual evidence

  1. ↑ RKI - RKI-Ratgeber - Hepatitis E. Accessed on July 29, 2018 .
  2. ↑ a b c European Food Safety Authority , Hepatitis E: Raw pork is the main cause of infections in the EU , 2017-Jul-11 (seen 2017-Jul-29)
  3. ↑ ICTV Master Species List 2018b v1 MSL # 34, Feb. 2019
  4. ↑ a b c d ICTV: ICTV Master Species List 2019.v1 , New MSL including all taxa updates since the 2018b release, March 2020 (MSL # 35)
  5. ↑ Blood working group, subgroup «Evaluation of blood-associated pathogens»: Hepatitis E Virus . In: Transfus Med Hemother . tape 36 , no. 1 , February 2009, p. 40-47 , doi : 10.1159 / 000197321 , PMID 21048820 .
  6. ↑ SIB: Orthohepevirus , on: ViralZone
  7. ↑ a b S. Pischke, P. Behrendt, CT Bock, Jilg W, Manns MP, Wedemeyer H: Hepatitis E in Germany - an underestimated infectious disease. In: Dtsch Arztebl Int. 2014; 111 (35-36), pp. 577-583; doi: 10.3238 / arztebl.2014.0577
  8. ↑ O. Wichmann, S. Schimanski, J. Koch, M. Kohler, C. Rothe, A. Plentz, W. Jilg, K. Stark: Phylogenetic and case-control study on hepatitis E virus infection in Germany. In: The Journal of Infectious Diseases . Volume 198, Number 12, December 2008, pp. 1732-1741, doi: 10.1086 / 593211 . PMID 18983248 .
  9. ↑ A. Schielke, K. Sachs, M. Lierz, B. Appel, A. Jansen, R. Johne: Detection of hepatitis E virus in wild boars of rural and urban regions in Germany and whole genome characterization of an endemic strain. In: Virology journal. Volume 6, 2009, p. 58, doi: 10.1186 / 1743-422X-6-58 . PMID 19442307 . PMC 2689194 (free full text).
  10. ↑ Mirko S. Faber, Jürgen J. Wenzel, Wolfgang Jilg, Michael Thamm, Michael Höhle: Hepatitis E Virus Seroprevalence among Adults, Germany . In: Emerging Infectious Diseases . tape 18 , no. 10 , p. 1654–1657 , doi : 10.3201 / eid1810.111756 , PMID 23018055 , PMC 3471611 (free full text) - ( cdc.gov [accessed June 16, 2016]).
  11. ↑ Questions and answers on the transmission of the hepatitis E virus by wild and domestic pigs and the foods obtained from them. Federal Institute for Risk Assessment, accessed on August 31, 2016 .
  12. ↑ Hepatitis E from raw pork. NDR, Visite, accessed on August 31, 2016 .
  13. ↑ Hepatitis E - expert interview. NDR, Visite, accessed on August 31, 2016 .
  14. ↑ Hepatitis E - Epidemiology and Risk Factors in Germany. In: Epidemiological Bulletin of the RKI. No. 49/2008, December 5, 2008.
  15. ↑ Hepatitis E virus spreads , July 28, 2015
  16. ↑ Epidemiological Bulletin No. 3 of the RKI , January 19, 2007.
  17. ↑ Epidemiological Bulletin No. 3 of the RKI , January 18, 2008.
  18. ↑ Epidemiological Bulletin No. 3 of the RKI , January 19, 2009.
  19. ↑ Epidemiological Bulletin No. 3 of the RKI , January 25, 2010.
  20. ↑ Epidemiological Bulletin No. 3 of the RKI , January 24, 2011.
  21. ↑ Epidemiological Bulletin No. 3 of the RKI , January 23, 2012.
  22. ↑ Epidemiological Bulletin No. 3 of the RKI , January 21, 2013.
  23. ↑ a b Epidemiological Bulletin No. 3 of the RKI , January 20, 2014.
  24. ↑ Epidemiological Bulletin No. 3 of the RKI , January 19, 2015.
  25. ↑ Epidemiological Bulletin No. 3 of the RKI , January 25, 2016.
  26. ↑ Epidemiological Bulletin No. 7 of the RKI , February 16, 2017.
  27. ↑ Epidemiological Bulletin No. 3 of the RKI , January 18, 2018.
  28. ↑ a b Epidemiological Bulletin No. 3 of the RKI , January 16, 2020.
  29. ↑ European Food Safety Authority , Public health risks associated with hepatitis E virus (HEV) as a food-borne pathogen , 2017-Jul-11 (seen 2017-Jul-29)
  30. ↑ Paul Ehrlich Institute - Completed procedures / notices - Announcement on the approval of drugs - Defense against drug risks - Ordering of testing of blood donors to prevent transmission of hepatitis E virus through blood components for transfusion and stem cell preparations for haematopoietic reconstitution - From 5 February 2019. Retrieved November 29, 2019 .
  31. ↑ https://www.aerzteblatt.de/nachrichten/95901/Paul-Ehrlich-Institut-endung-Hepatitis-E-Virus-Testung-von-Blutspenden-an
  32. ↑ https://www.swr.de/swr2/programm/sendung/impuls/neue-regel-fuer-blutspende/-/id=1853902/did=22260032/nid=1853902/4glp96/index.html
  33. ↑ A. Kumar, M. Beniwal, P. Kar, JB Sharma, NS Murthy: Hepatitis E in pregnancy. In: International journal of gynecology and obstetrics. Volume 85, Number 3, June 2004, pp. 240-244, doi: 10.1016 / j.ijgo.2003.11.018 . PMID 15145258
  34. ↑ N. Kamar, J. Selves, JM Mansuy, L. Ouezzani, JM Péron, J. Guitard, O. Cointault, L. Esposito, F. Abravanel, M. Danjoux, D. Durand, JP Vinel, J. Izopet, L. Rostaing: Hepatitis E virus and chronic hepatitis in organ-transplant recipients. In: The New England Journal of Medicine . Volume 358, Number 8, February 2008, pp. 811-817, doi: 10.1056 / NEJMoa0706992 . PMID 18287603 .
  35. ↑ R. Gérolami, V. Moal, P. Colson: Chronic hepatitis E with cirrhosis in a kidney-transplant recipient. In: The New England Journal of Medicine . Volume 358, Number 8, February 2008, pp. 859-860, doi: 10.1056 / NEJMc0708687 . PMID 18287615 .
  36. ↑ Gerd Herold et al. a .: internal medicine. Cologne, 2012, pp. 525f.
  37. ↑ MP Shrestha, RM Scott, DM Joshi, MP Mammen, GB Thapa, N. Thapa, KS Myint, M. Fourneau, RA Kuschner, SK Shrestha, MP David, J. Seriwatana, DW Vaughn, A. Safary, TP Endy, BL Innis: Safety and efficacy of a recombinant hepatitis E vaccine. In: The New England Journal of Medicine . Volume 356, Number 9, March 2007, pp. 895-903, doi: 10.1056 / NEJMoa061847 . PMID 17329696 .
  38. ↑ FC Zhu, J. Zhang, XF Zhang, C. Zhou, ZZ Wang, SJ Huang, H. Wang, CL Yang, HM Jiang, JP Cai, YJ Wang, X. Ai, YM Hu, Q. Tang, X. Yao, Q. Yan, YL Xian, T. Wu, YM Li, J. Miao, MH Ng, JW Shih, NS Xia: Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomized, double -blind placebo-controlled, phase 3 trial. In: The Lancet . Volume 376, Number 9744, September 2010, pp. 895-902, doi: 10.1016 / S0140-6736 (10) 61030-6 . PMID 20728932 .
  39. ^ A. Proffitt: First HEV vaccine approved. In: Nature Biotechnology . 30, 2012, pp. 300-300, doi: 10.1038 / nbt0412-300a .
  40. ↑ Hepatitis E. RKI-Ratgeber. In: rki.de. Robert Koch Institute, November 2, 2015, accessed on March 18, 2020 .
  41. ↑ Fabienne Riklin: There is a risk of hepatitis lurking in the Mortadella liver sausage In: tagesanzeiger.ch , October 23, 2018, accessed on October 23, 2018.