Ibadan: The World Health Organization Recently announced outbreak of hepatitis e In the eastern Ouadi province of Chad.
Between January and April 2024, 2,093 suspected hepatitis E cases were reported from two health districts.
The Conversation Africa asked Kolawole Oluseyi Akande, a consultant gastroenterologist and hepatologists, to explain the causes, symptoms, prevalence, and treatment of hepatitis E.
What is hepatitis and how many types are there?
Hepatitis is inflammation of the liver. This is the way the liver reacts to various injuries or harmful agents.
Hepatitis is caused by a variety of infectious viruses and noninfectious agents, causing a variety of health problems, some of which can be fatal.
Common causes include viruses (viral hepatitis), excessive alcohol consumption (alcohol hepatitis), excessive fat in the liver (steato-hepatitis), medications and toxins (toxic hepatitis), and autoimmunity (autoimmune hepatitis).
There are many types of diseases. The most common, especially in developing countries like Chad, are viral hepatitis.
There are five main viruses that cause viral hepatitis. They are hepatitis A, B, C, D and E viruses. These are not strains of the same virus but different viruses. There was an outbreak of hepatitis E in Chad.
All cause different types of hepatitis liver disease But there is variation in modes of transmission, severity of disease, geographic distribution, and methods of prevention. It is estimated that 354 million people globally suffer from hepatitis B or C.
Globally, approximately 939 million (one in eight) individuals have ever experienced hepatitis E infection. Fifteen million to 110 million individuals have recent or ongoing hepatitis E infection as of 2020. It is widespread in Africa, Asia, Europe with prevalence rates of 21.8 percent, 15.8 percent, 9.3 percent, 8.5 percent and 7.3 percent, respectively. North America and South America respectively. Its presentation ranges from asymptomatic to severe acute failure which can lead to death.
How is hepatitis E spread?
Four of the eight genotypes of hepatitis E virus are known to affect humans.
Genotypes 1 and 2 are spread by fecal-oral routes, especially by drinking contaminated water. This is why this type of hepatitis E is common in underdeveloped countries in Asia and Africa due to poor sanitation, hygiene, and lack of safe drinking water.
These are the types that could affect large numbers of people in a pandemic.
Genotypes 3 and 4 are spread by consumption of contaminated meat, especially pigs, goats, and cattle, and sometimes by contamination of water with animal feces.
So, these are animal diseases that can spread to humans (zoonotic diseases) and hence affect people dealing with animals such as farmers, butchers and veterinarians.
There is evidence that hepatitis E virus can spread through blood transmission. Some developed countries such as the Netherlands, United Kingdom, France and Japan have included hepatitis E RNA screening of blood donations before transfusion. RNA screening is the most reliable way to detect hepatitis E virus in blood or stool.
What are the risks to humans?
hepatitis e is a global health The problem is that there are approximately 20 million cases annually, three million symptomatic cases and 60,000 deaths.
Hepatitis E can cause acute hepatitis with no symptoms, or disease with mild symptoms, or sometimes severe symptoms.
Pregnant women are more likely to experience serious illness. It can also be severe in people with already established liver diseases, the elderly and those who are immunocompromised.
In a survey of 177 asymptomatic food handlers in 12 restaurants in Ibadan, southwest Nigeria, we found that 9 percent had evidence of acute hepatitis E in their blood. Asymptomatic people with hepatitis E virus can spread the virus if their blood is given to another person.
During pregnancy, it can cause serious illness or death of mother and child. The mortality rate during pregnancy can be up to 30 percent.
Symptoms of hepatitis include malaise, weakness, yellowing of the eyes, upper abdominal pain, dark urine and if there is liver failure, altered level of consciousness and tendency to bleed.
Hepatitis E cannot be distinguished from other forms of viral hepatitis based on symptoms and signs. Hepatitis E is the most common cause of acute hepatitis globally.
In some circumstances, especially in organ transplant patients, hepatitis E can cause chronic hepatitis (lasting more than three months) and can cause liver cirrhosis, This is quite common in developed countries where there are many organ transplant patients who are taking immunosuppressive medications.
Can it be stopped?
Yes. Adequate personal hygiene, proper waste disposal systems and provision of safe and clean water are required. Another way to prevent hepatitis E is to avoid raw or undercooked meat.
One study shows that heating food to 71°C for 20 minutes can inactivate the hepatitis E virus.
A vaccine against hepatitis E is also available in China, but it is not yet widespread.
How is it controlled?
Treatment of hepatitis E when symptoms appear includes bed rest and avoiding medications and substances that can cause further damage to the liver.
Ribavirin and interferon alfa are drugs that are sometimes used, although not for pregnant women.
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