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1. https://www.youtube.com/watch?v=FD7iD3k02P8

2. https://www.youtube.com/watch?v=weXyMVX6pQg

3. https://www.webmd.com/hepatitis/what-is-hepatitis-e

4..https://www.cdc.gov/hepatitis/hev/index.htm#:~:text=Hepatitis%20E%20is%20a%20liver,virus%20%E2%80%93%20even%20in%20microscopic%20amounts.

5. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-e

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1. https://www.youtube.com/watch?v=VSzn-B0w0fE
2. https://www.youtube.com/watch?v=x38OjoKMzqk

3. https://www.youtube.com/watch?v=BlbZY8W0Pc4

4. https://www.mdis.edu.sg/blog/hepatitis-a/

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Pathophysiology

The virus gets into the host via the oral route into the gastrointestinal tract. The virus then reaches to the liver via the portal vein, then replicates and released into the bile and blood stream. Infectious viral particles occur in the bile, faces and blood stream during the late incubation phase(32days) of the hepatitis E, which persist for a week or 2 before the onset of the clinical diseases. Anti HEV antibodies of the IgA, IgG, and IgM types appear in the blood during the course of the disease.

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Hepatitis E                                                         Epidemiology Hepatitis E is a liver disease caused by an infection with the hepatitis E virus (HEV). Every year, there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E. Hepatitis E is present all across the world, but it is most common in East and South Asia. There are at least four different variants of the virus: genotypes 1, 2, 3, and 4. For human genotypes 1 and 2 have been discovered. Genotypes 3 and 4 are found in a variety of species (including pigs, wild boars, and deer) and rarely infect people. Infection of Hepatitis E can be found all over the world. There are 2 different patterns that hepatitis E is found: resource-poor places with frequent water contamination and areas with safe drinking water supplies. The disease is frequent in low- and middle-income countries where there is a lack of access to essential water, sanitation, hygiene, and health services. In these places, the disease appears as outbreaks as well as sporadic cases. It is estimated that around 20 million people globally are infected with HEV each year, with 44000 of these infections resulting in deaths.  Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.  

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Hepatitis E                                                         Epidemiology Hepatitis E is a liver disease caused by an infection with the hepatitis E virus (HEV). Every year, there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E. Hepatitis E is present all across the world, but it is most common in East and South Asia. There are at least four different variants of the virus: genotypes 1, 2, 3, and 4. For human genotypes 1 and 2 have been discovered. Genotypes 3 and 4 are found in a variety of species (including pigs, wild boars, and deer) and rarely infect people. Infection of Hepatitis E can be found all over the world. There are 2 different patterns that hepatitis E is found: resource-poor places with frequent water contamination and areas with safe drinking water supplies. The disease is frequent in low- and middle-income countries where there is a lack of access to essential water, sanitation, hygiene, and health services. In these places, the disease appears as outbreaks as well as sporadic cases. It is estimated that around 20 million people globally are infected with HEV each year, with 44000 of these infections resulting in deaths.  Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.  

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Pathophysiology

The incubation period of hepatitis A virus (HAV) is 15-45 days (average, 4 weeks). The virus is excreted in stool during the first few weeks of infection, before the onset of symptoms. Young children who are infected with HAV usually remain asymptomatic. Acute hepatitis A is more severe and has higher mortality in adults than in children. The explanation for this is unknown. Typical cases of acute HAV infection are marked by several weeks of malaise, anorexia, nausea, vomiting, and elevated aminotransferase levels. Jaundice develops in more severe cases. Some patients experience a cholestatic hepatitis, marked by the development of an elevated alkaline phosphatase (ALP) level, in contrast to the classic picture of elevated aminotransferase levels. Other patients may experience several relapses during the course of a year. Less than 1% of cases result in fulminant hepatic failure (FHF). HAV infection does not persist and does not lead to chronic hepatitis.

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Hepatitis A - Epidemiology                               Hepatitis A virus (HAV) is found in the feces of infected people but is most commonly spread through the intake of contaminated food or water. Particular sex behaviors might also spread HAV. The hepatitis A virus is generally not harmful. Almost everyone that has it improves. However, since it can take a bit of time to go away, individuals must take care of them self in the meantime. HAV infection occurs all over the world. Each year, an estimated 1.4 million cases occur worldwide. Hepatitis A can arise in sporadic or outbreaks. This is widespread in many countries, particularly those lacking proper sanitation. Hepatitis outbreaks were reported in a range of settings, such as society outbreaks caused by contaminated water or food (cooked foods could still transmit HAV if the cooking temperature is insufficient to kill the virus or if the food is contaminated after cooking), outbreaks in healthcare facilities, and outbreaks amongst those homeless. To prevent HAV, there are safe and effective vaccinations available.       

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Hepatitis A - Epidemiology                               Hepatitis A virus (HAV) is found in the feces of infected people but is most commonly spread through the intake of contaminated food or water. Particular sex behaviors might also spread HAV. The hepatitis A virus is generally not harmful. Almost everyone that has it improves. However, since it can take a bit of time to go away, individuals must take care of them self in the meantime. HAV infection occurs all over the world. Each year, an estimated 1.4 million cases occur worldwide. Hepatitis A can arise in sporadic or outbreaks. This is widespread in many countries, particularly those lacking proper sanitation. Hepatitis outbreaks were reported in a range of settings, such as society outbreaks caused by contaminated water or food (cooked foods could still transmit HAV if the cooking temperature is insufficient to kill the virus or if the food is contaminated after cooking), outbreaks in healthcare facilities, and outbreaks amongst those homeless. To prevent HAV, there are safe and effective vaccinations available.       

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Diagnosis

Cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis. However, diagnosis can often be strongly suspected in appropriate epidemiologic settings, for example when several cases occur in localities in known disease-endemic areas, or in settings with risk of water contamination, when the disease is more severe in pregnant women, or if hepatitis A has been excluded.

Definitive diagnosis of hepatitis E infection is usually based on the detection of specific IgM antibodies to the virus in a person’s blood; this is usually adequate in areas where disease is common. Rapid tests are available for field use.

Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis E virus RNA in blood and/or stool; this assay requires specialized laboratory facilities. This test is particularly needed in areas where hepatitis E is infrequent, and in cases with chronic HEV infection.

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Transmission

The hepatitis E virus is transmitted mainly through the fecal-oral route due to fecal contamination of drinking water. This route accounts for a very large proportion of clinical cases with this disease. The risk factors for hepatitis E are related to poor sanitation, allowing virus excreted in the faeces of infected people to reach drinking water supplies.

Other routes of transmission have been identified but appear to account for a much smaller number of clinical cases. These routes of transmission include:
-      ingestion of undercooked meat or meat products derived from infected animals (e.g. pork liver);
-      transfusion of infected blood products; and
-      vertical transmission from a pregnant woman to her baby.

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Diagnosis

Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific Immunoglobulin G (IgM) antibodies in the blood. Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA and may require specialized laboratory facilities.

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The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. In families, this may happen though dirty hands when an infected person prepares food for family members. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water. The virus can also be transmitted through close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus

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HEPATITIS E PREVENTION                                                 Avoid drinking water and beverages with ice of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not peeled or prepared by traveler.   

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HEPATITIS E PREVENTION                                                 Avoid drinking water and beverages with ice of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not peeled or prepared by traveler.   

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HEPATITIS E TREATMENT
- There is no medical treatment for Hepatitis E.

-  The aim of treatment is to alleviate symptoms through bed rest and fluid replacement.

- There is no vaccination for hepatitis E.

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1. wash hands frequently

o   after going to the toilet

o   before preparing food

o   after handling nappies and condoms

2.  Avoid sharing food, cutlery & crockery,

3.  cigarettes and drinks with other people.

4.  In a natural disaster, listen to warnings about contaminated drinking water and follow any instructions issued by the relevant authorities.

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HEPATITIS A TREATMENT

a. No medical treatment available to treat the virus.

b. Symptoms of hepatitis A can be relieved to some extent with rest and a healthy diet.

c. People who have close contact with someone who has hepatitis A:

o   should receive normal human immunoglobulin within 2 weeks of exposure

o   Hepatitis A vaccine can be given at the same time as the immunoglobulin.