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Hepatitis E (HEV) (Serological Time Course (IgG (Specific, Causes tend to…
Hepatitis E (HEV)
General
Hepeviridae family
Hepatotrophic - Stable in bile fluid
Found as a result of discovery of NANB waterborune epidemics
Isolates found in various animals
Fish
Chickens
Not a new virus
People with jaundice similar to HEV in 1794...
Clinical Features
Generally acute hepatitis
Chronic
In immunosuppressed
Incubation Period
40 days average
15-60 day range
Fatality
1-3% (low)
Pregnant Women: 15-25%
Severity increases with age
Serological Time Course
Liver Damage (ALT)
Peak ALT in blood ~week 6
Peaks with viremia peak
Viremia
From weeks 2-10
Decreases with the introduction of IgG
IgM
Peaks with ALT peak
IgG
Specific
Causes tend to zero
Persists
Similar to HAV
Resolved
Features
HEV Seroprevelance doesn't always correlate with HAV prev
India
HEV Ig low in children
Increase in young adults
Common epidemics
Egypt
HEV Ig common in children
Epidemics rare
Genotype (GT) Distribution
1
93% of isolates are human
Asia, Africa, Mexico
2
Fewest isolates
May reflect lack of diagnostic testing
100% Human
Contained to Africa
3
Most isolates
26% Human, 68% Pig
Australia/SE Asia
4
67% Human, 30% Pig
SE Asia
Transmission
Animal Reservoirs
Pigs reservoir for GT 3
Maybe wild boar/deer
Model
GT 3 spreads from animals-humans
Provides some protection
GTs 1+2
Cause small epidemics
Waterbourne transmission
Probable domestic transmission
Excess mortality in pregnant women
GTs 3+4
Zoonotic
Increased seropositivity among pig handlers
Transmission eating infected undercooked meat
Low frequency of person-to-person
Prevention
Therapy not normally needed
Chronic Infections/Severe
Ribavirin, effective
Vaccines
Trailed
56kDa
From recom. baculovirus-infected insect cells
26kDa
Expressed in
E.coli
Forms pseudoparticles
Protects against types 1+4