How the dangerous liver disease spreads and how it can be treated

The World Health Organization recently announced an outbreak of hepatitis E in Chad’s eastern Ouaddai province. Between January and April 2024, 2,093 suspected cases of hepatitis E were reported from two health districts. The Conversation Africa asked Kolawole Oluseyi Akande, a gastroenterologist and hepatologist, to explain the causes, symptoms, spread and treatment of hepatitis E.

What is hepatitis and how many types are there?

Hepatitis is one inflammation of the liver. It is the liver’s way of responding to various injuries or harmful substances.

Hepatitis is caused by a variety of infectious viruses and non-infectious agentsleading to a range of health problems, some of which can be fatal.

Common causes include viruses (viral hepatitis), excessive alcohol consumption (alcohol hepatitis), excess fat in the liver (steatohepatitis), medications and toxins (toxic hepatitis), and autoimmunity (autoimmune hepatitis).

There are also a number of types of the disease. The most common, especially in developing countries such as Chad, are the viral hepatitis. There are five major viruses that cause viral hepatitis. They are hepatitis A, B, C, D and E viruses. They are not strains of the same virus, but of different viruses. The outbreak in Chad was of hepatitis E.

All different types of hepatitis cause liver disease, but differ in mode of transmission, severity of disease, geographic distribution and methods of prevention. An approximate one 354 million people living with hepatitis B or C worldwide.

Worldwideapproximately 939 million (1 in 8) people have ever had a hepatitis E infection. In 2020, fifteen million to 110 million people have a recent or persistent hepatitis E infection. prevalence figures of 21.8%, 15.8%, 9.3%, 8.5% and 7.3% in Africa, Asia, Europe, North America and South America respectively. Its presentation ranges from asymptomatic to severe acute failure that can lead to death.

How does hepatitis E spread?

Of the eight genotypes of the hepatitis E virusFour are known to influence people.

Genotypes 1 and 2 are spread by fecal-oral routes, mainly by drinking contaminated water. This is why this type of hepatitis E is common in underdeveloped countries in Asia and Africa, where poor sanitation, poor hygiene and lack of safe drinking water occur.

These are the types that can affect large numbers of people during epidemics. Genotypes 3 and 4 are scatter by ingestion of contaminated meat, especially pigs, goats and cattle, and sometimes by contamination of water by animal feces.

These are animal diseases that can spread to humans (zoonotic diseases) and therefore often affect people who deal with animals, such as farmers, butchers and veterinarians.

There is proof that the hepatitis E virus can be spread through blood transmission. A few developed countries, such as the Netherlands, Great Britain, France and Japan, have integrated hepatitis E RNA screening of blood donations before transfusion. The RNA screening is the most reliable way to detect the hepatitis E virus in the blood or feces.

What are the risks for humans?

Hepatitis E is a global health problem affecting approx 20 million cases occurring annually, three million symptomatic cases and 60,000 deaths.

Hepatitis E can cause acute hepatitis without symptoms, or mildly symptomatic or sometimes severely symptomatic disease. Pregnant women are more likely to develop a serious illness. It can also be serious in people with established liver disease, in the elderly, and in people with low immunity (immunocompromised).

In a survey of 177 asymptomatic food handlers in 12 restaurants in Ibadan, southwestern Nigeria, we found it 9% had indications of acute hepatitis E in their blood. Asymptomatic people with the hepatitis E virus can do so pass along contract the virus if their blood is given to someone else.

During pregnancy this can lead to serious illness or death of the mother and baby. The mortality rate during pregnancy can be so high 30%.

Symptoms of hepatitis include malaise, weakness, yellow eyes, upper abdominal pain, dark urine and if there is liver failure, change in level of consciousness and tendency to bleeding.

Hepatitis E is indistinguishable from other forms of viral hepatitis based on symptoms and signs. Hepatitis E is the most common cause of acute hepatitis worldwide. Under certain circumstances, especially in patients who have undergone an organ transplant, hepatitis E can lead to chronic hepatitis (lasting more than three months) and this can lead to liver cirrhosis. This is quite common in developed countries, where there are many organ transplant patients taking immunosuppressive medications.

Can it be prevented?

Yes. What is needed is adequate personal hygiene, good waste disposal systems and the supply of safe and clean water. Another way to prevent hepatitis E is to avoid uncooked or undercooked meat.

a study suggests that heating food to 71°C for 20 minutes could inactivate the hepatitis E virus.

A vaccine against hepatitis E is also available Chinabut this is not yet widespread.

How is it controlled?

Treatment for hepatitis E when it is symptomatic includes bed rest and avoiding medications and substances that can further damage the liver.

Ribavirin and interferon alpha are medications that are sometimes used, but not for pregnant women.

Those with acute liver failure or cirrhosis may need a liver transplant.

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