Hepatitis E: The new challenges of a peculiar viral hepatitis

DATE: June 03, 2021

TIME:  6:00am PDT

HEV, with over 3 million clinical cases, 70,000 deaths, and 3,000 stillbirths, mostly in Asia and Africa, causing 3.3% of all deaths from viral hepatitis worldwide.

HEV infection mostly affects persons living in resource-limited settings with poor access to clean water and sanitation and can be particularly severe in pregnant women and neonates. In particular, HEV is a significant contributor to global maternal mortality, with reported case-fatality rates of 20–30%. In high-income countries, HEV represents a growing concern particularly in immunocompromised individuals and in patients with chronic liver disease, that are at high risk for the severe disease after HEV infection.

HEV infection is not confined to the liver but may also affect other organs. Several diseases, including Guillain-Barré syndrome, neuralgic amyotrophy, glomerulonephritis, cryoglobulinemia, pancreatitis, lymphoma, thrombopenia, meningitis, thyroiditis and myocarditis have been observed in the setting of HEV infection presumably as a consequence of the direct cytopathic tissue damage by HEV replication, along with an overwhelming host immune response. To date, there is a limited availability and usage of diagnostic tools for the serologic and/or molecular diagnosis of hepatitis E infection, as well as a paucity of treatment options for severe disease, making effective outbreak response challenging. Moreover, though an anti-HEV vaccine exists, it is only licensed and available in the private market in China and has not been authorized by WHO for use in endemic settings and outbreaks, yet.

Overall, this body of evidence strongly highlights the need to implement the global efforts aimed to improve diagnostic and epidemiologic tools and to extend vaccination and therapeutic strategies against HEV infection, particularly in highly endemic areas.

Learning objectives:

• Discuss virological and pathological aspects of HEV infection
• Describe epidemiological aspects of HEV infection 
• How to diagnose and to follow-up patients for HEV infection
• Describe current and upcoming HEV treatment and prevention strategies

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