Page 118 - Journal of Special Operations Medicine - Fall 2017

An Ongoing Series

Hepatitis E

Mark W. Burnett, MD

Introduction Vaccination
A vaccine against hepatitis E has been developed in China and
Little known in industrialized countries, hepatitis E is one of is used to a small extent in countries around the world. No
the most common causes of acute icteric hepatitis in develop- vaccine against hepatitis E has been approved for use in the
ing nations, infecting tens of millions globally and resulting in United States.
more than 50,000 deaths annually. Most commonly infected
are those living in displaced-persons camps after natural disas-
ters or other humanitarian emergencies, where the purity of Importance in a Deployed Setting
the water supply has been compromised. Within these popula- Hepatitis E can spread rapidly in medically vulnerable popula-
tions, pregnant women are at most risk of severe disease, with tions found in displaced-persons camps after natural disasters
case-fatality rates approaching 25% of those infected.
and during complex humanitarian emergencies. Special Op-
erations medical personnel should be aware of this potentially
Background and Clinical Presentation deadly illness, its routes of transmission, and steps to take to
Hepatitis E is caused by the hepatitis E virus, an RNA virus mitigate the spread of this developing world killer.
in the Hepeviridae family of viruses. It has four main geno-
types: genotypes 1 and 2 are found in developing nations and Disclaimer
transmission is primarily by the fecal-oral route through con- The views expressed in this publication are those of the au-
taminated water; genotypes 3 and 4 are foodborne and have a thor and do not reflect the official policy or position of the
zoonotic transmission from animal to human. Genotypes 1, 2, Department of the Army, Department of Defense, or the U.S.
and 4 primarily infect young adults, whereas genotype 3 most Government.
commonly infects older adults and those who are immuno-
compromised or have preexisting liver conditions.
Disclosure
The author has nothing to disclose.
After being exposed through ingestion of water contaminated
by infected feces (genotype 1 or 2) or ingestion of uncooked Bibliography
or undercooked meat from infected animals (genotype 3 or Aggarwal R. Hepatitis E: historical, contemporary and future
4), the incubation period can range from 15 to 60 days be- perspectives J Gastroenterol Hepatol. 2011;26(suppl 1):
fore symptoms develop. Most infections are asymptomatic; if 72–82.
symptoms do develop, they are often indistinguishable from Hartl J, Wehmeyer MH, Pischke S. Acute hepatitis E: two sides
other types of viral hepatitis and include fever, nausea, vomit- of the same coin. Viruses. 2016;8(11): pii: E299.
ing, anorexia, abdominal pain, jaundice, darkened urine, and Kim JH, Nelson KE, Panzer U, et al. A systematic review of the
light-colored stools.
epidemiology of hepatitis E virus in Africa. BMC Infect
Dis. 2014;14:308.
Diagnosis Sayed IM, Vercouter AS, Abdelwahab SF, et al. Is hepatitis E
The diagnosis of hepatitis E is challenging because its presen- an emerging problem in industrialized countries? Hepa-
tation is similar to that of other types of acute viral hepatitis. tology. 2015;62(6):1883–1892.
Testing for the presence of antibody to hepatitis E virus is lim-
ited in the United States and may be impossible to obtain in Recommended Internet Links
the developing world.
https://www.cdc.gov/hepatitis/hev/hevfaq.htm
http://www.who.int/mediacentre/factsheets/fs280/en/
Treatment
The treatment of hepatitis E for most patients is mainly sup-
portive and consists of fluids, rest, and avoidance of alcohol. Keywords: infectious disease; hepatitis E virus; acute icteric
Medical personnel caring for those affected should observe hepatitis
strict hand hygiene to avoid becoming infected as well.

COL Burnett is currently chief of Pediatric Infectious Diseases at Tripler Army Medical Center in Hawaii and is the pediatric subspecialties
consultant to the U.S. Army Surgeon General. He has served overseas in Korea, Germany, Kosovo, Iraq, Afghanistan, and Kuwait and as the
JSOTF-P Surgeon in the Philippines.

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