Hepatitis E virus (HEV) infection is a common disease that frequently goes undiagnosed. This single-stranded RNA virus spreads mostly through contaminated water and food, resulting in hepatitis E, a potentially fatal liver infection.

In this article, we delve into the complexities of HEV, investigating its transmission, symptoms, and preventative techniques to shed light on this little-known but vital public health topic.

Hepatitis E is a liver infection caused by the Hepatitis E virus (HEV). It is typically spread by contaminated water or food and causes hepatitis symptoms such as jaundice, fatigue, and abdominal discomfort. 

Unlike some other hepatitis viruses, HEV normally goes away without causing long-term sickness.

Hepatitis E infection is widespread worldwide but is more frequent in low and middle-income countries where access to essential water, sanitation, hygiene, and healthcare services is limited. 

Here's how it typically transmits:

• In these areas, the disease expresses itself as sporadic instances and outbreaks, which are frequently caused by faecal contamination of drinking water sources and afflict many people, particularly during conflicts or humanitarian crises. 
• Sporadic cases, especially involving the genotype 1 virus, are also linked to water contamination. 
• In contrast, regions with greater sanitation and water availability have uncommon hepatitis E infections, which are largely genotype 3-related and are often connected with the intake of raw animal meat, particularly pork, and are unrelated to water or food contamination.

Hepatitis E frequently causes a variety of symptoms that might range in severity. Chronic hepatitis E, unlike some other types of hepatitis, is uncommon, but it can be severe, especially in pregnant women, the elderly, and people with impaired immune systems.

• Flu-like symptoms

Hepatitis E infection frequently begins with flu-like symptoms such as fever, tiredness, and general malaise.

• Gastric diseases

Nausea, vomiting, loss of appetite, and stomach pain are frequent symptoms of gastrointestinal distress.

• Jaundice

Jaundice develops as the illness proceeds, causing yellowing of the skin and eyes, black urine, and pale faeces.

• Muscle Aches and Joint Pain

Many people suffer muscle and joint pain, which adds to their discomfort.

The Hepatitis E virus (HEV) is the primary cause of Hepatitis E, with multiple unique transmission routes:

• Contaminated Water 

In many parts of the world, particularly in low-resource areas, HEV spreads by drinking polluted water containing infected faeces, which occurs frequently during floods or inadequate sanitation conditions.

• Contaminated Food

Consuming raw or undercooked shellfish and handling or eating food produced by sick people can lead to HEV infection.

• Animal Transmission

HEV strains of genotypes 3 and 4 can originate in animals, particularly pigs and wild game. Infection can occur when people consume raw meat, particularly pork or game meat.

• Person-to-Person Transmission

Although less prevalent, HEV can be transmitted through direct contact with infected people or their bodily fluids, such as blood, sperm, and breast milk.

• Vertical Transmission

HEV-infected pregnant women can pass the virus on to their unborn children, increasing the risk of problems.

• Blood Transfusion

HEV can be transferred by blood transfusions or organ transplants from infected donors, albeit this is uncommon.

Hepatitis E cases cannot be distinguished clinically from other kinds of acute viral hepatitis. However, diagnosis is frequently strongly suspected in inappropriate epidemiologic settings, such as when several cases occur in known disease-endemic areas.

• In settings with a risk of water contamination when the disease is more severe in pregnant women or when hepatitis A has been ruled out.
• A definitive diagnosis in common Hepatitis E regions often relies on detecting anti-HEV IgM antibodies in the blood using rapid tests.
• In addition, Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) identifies Hepatitis E virus RNA in blood and faeces, requiring specialised lab equipment.
• RT-PCR becomes crucial where Hepatitis E is rare or for persistent HEV infections, offering precise diagnostic capabilities beyond antibody testing.

Hepatitis E treatment focuses mostly on symptom management and supportive care, as the illness generally disappears independently. 

However, medical intervention may be required in extreme situations or for specific patient groups:

• Rest and Nutrition

Rest, appropriate hydration, and a balanced diet are all necessary for the body to fight the illness and heal. Alcohol and certain liver-damaging drugs should be avoided.

• Hospitalisation

Severe cases, particularly in pregnant women or people with weakened immune systems, may necessitate hospitalisation for close monitoring and IV fluids to prevent dehydration.

• Antiviral Drugs

Antiviral drugs such as ribavirin may be administered in some cases, notably in chronic or fulminant hepatitis E. Because of the potential for side effects, this treatment is normally reserved for severe patients and is constantly monitored.

• Liver Transplant

When Hepatitis E causes acute liver failure, a liver transplant may be required in extremely rare cases.

• Vaccination

Vaccination against Hepatitis E is available in some areas where the virus is prevalent and can protect against infection.

Hepatitis E prevention entails a mix of hygienic measures, vaccination (where available), and knowledge of the virus's transmission channels. Here are some unique Hepatitis E preventive tips:

• Following Safe Water Practises

It is critical to have access to clean, safe drinking water and to avoid water sources that are prone to pollution. Water filters or boiling water can be beneficial in areas with low sanitation.

• Ensuring Proper Food Handling

To kill the virus, properly cook meat, particularly pork and game. Avoid eating raw or undercooked shellfish and eating food prepared by infected people.

• Maintaining Hand Hygiene

It is critical to wash your hands frequently with soap and clean water, especially before handling food and after using the restroom.

• Maintaining Sanitation

Creating and maintaining proper sanitation facilities and sewage disposal systems can greatly reduce Hepatitis E transmission in communities.

• Following Pregnancy Precautions 

Because Hepatitis E can be fatal during pregnancy, pregnant women should practise good food and water cleanliness to limit their risk of infection.

• Ensuring Blood Safety

By ensuring the safety of blood and organ donations through stringent screening, it is possible to prevent transmission via transfusions or transplants.

• Promoting Public Awareness

Community outreach initiatives can improve knowledge of the virus and promote preventive practices, particularly in high-risk areas.

Awareness of Hepatitis E risk factors is critical for prevention and early identification, allowing for appropriate intervention when necessary.

• Geographic Location

Living in areas with inadequate sanitation and limited access to safe drinking water raises the risk of exposure to contaminated sources.

• Pregnancy

Pregnant women, especially those in their third trimester, are more vulnerable to severe Hepatitis E, which can lead to difficulties.

• Weak Immune System

Individuals with weakened immunity, such as those with HIV/AIDS or undergoing immunosuppressive therapy, are at a higher risk of developing severe or persistent infections.

• Age 

Older persons are more likely to experience severe symptoms and consequences.

• Occupational Exposure

Certain activities that involve contact with animals or raw meat can increase the risk, especially in areas where zoonotic Hepatitis E strains are present.

• Travel

Travelling to Hepatitis E-endemic areas, particularly engaging in dangerous behaviours, increases the risk of infection.

• Transfusions/Organ Transplants

Receiving infected blood or organs presents a minimal but probable risk of transmission.

Hepatitis E is usually easy to treat, despite the discomfort associated with the disease, because the body usually clears the virus within 4 to 6 weeks. Despite their rarity, serious and potentially fatal consequences during infection highlight the importance of constant medical surveillance.