The hepatitis E virus (HEV) is widespread globally. For a long time, hepatitis E was considered a travel sickness, similar to hepatitis A. In countries with restricted hygiene standards, the hepatitis E virus (HEV) - like hepatitis A - is transmitted mainly via drinking water and food contaminated with excrement containing the virus. In these countries, major epidemics with thousands of people suffering from the virus occur time and again.
Recently, an increase in infections with another type of the hepatitis E virus has been observed in industrialised countries, which is transmitted from animals to humans via the food chain. Consumption of raw or undercooked meat, and in particular meat products containing raw pig liver, is considered risky. In Switzerland, the incidence of disease is increasing. Since 1 January 2018, the Federal Office of Public Health FOPH has therefore introduced an obligation to report hepatitis E.
The incubation period, i.e. the time from contact with the virus until the outbreak of the disease, lasts three to eight weeks in the case of the hepatitis E virus. In most cases, the disease proceeds without symptoms. However, the typical hepatitis symptoms such as yellowing of the skin and eyes, enlarged liver, abdominal pain, nausea, vomiting and fever can also occur. The disease usually lasts four to six weeks. Pregnant women are particularly at risk. The infection can lead to miscarriage, stillbirth or liver failure. A chronic infection is very rare and is only observed in immunocompromised patients.
An increase in liver values can be an indication of hepatitis E infection. An antibody test gives further indication of an existing infection. However, a positive antibody test must still be confirmed by a virus detection test (a so-called PCR test) in the stool or blood to determine whether an active infection is present. This is because the antibodies remain in the blood for a lifetime after contact. In immunocompromised patients, virus detection should be carried out immediately if an infection is suspected, as the antibody test is unreliable in these patients.
In most cases the infection heals spontaneously. In people with risk factors such as immunosuppression, the disease can take a severe course. In this case, the reduction of drugs that suppress the immune system and/or treatment with ribavirin can help. Persons at risk and immunosuppressed persons with a chronic infection should consult specialists for treatment.
Two rules of thumb offer some protection: in the distribution areas, always boil the drinking water and do not eat uncooked fruit and vegetables. The rule of thumb is: Cook it, boil it, peel it or leave it.
Care should be taken when eating raw meat and shellfish, and immunocompromised persons, pregnant women and persons with pre-existing liver disease should avoid eating them altogether. Pork or game should be fully cooked.
Vaccination is currently not available in Switzerland. An effective vaccine has so far only been approved in China. In the future it could be used in immunocompromised patients, patients with liver disease, people waiting for an organ transplant or people travelling to areas with an increased incidence of hepatitis E.