Does Hepatitis E Virus Need To Be Considered As A Re-Emergin

Does Hepatitis E Virus need to be Considered as a re-emerging problem in both industrialized and developing countries?

Hepatitis E Virus (HEV) presents a significant public health concern worldwide, with evolving epidemiological patterns that suggest it is a re-emerging disease affecting both industrialized and developing countries. The scholarly article by Zhang, Wu, Zhong, Xiao, and Dong (2018) emphasizes the rising prevalence of HEV beyond traditional endemic regions, highlighting the necessity for global health interventions and awareness. This paper explores the history, transmission, genotypes, symptoms, prevention, and public health implications of HEV, substantiating the claim that HEV warrants recognition as a re-emerging infectious disease.

Historical background and epidemiology of HEV

The history of hepatitis E dates back to its first documented outbreak in India in 1978, which resulted in approximately 52,000 cases and 1,700 deaths due to waterborne transmission (Zhang et al., 2018). Initially, the disease was perceived as endemic primarily in developing nations with inadequate sanitation infrastructure. However, advances in virology and epidemiological surveillance have demonstrated a global spread, with increasing cases in industrialized countries, indicating that HEV is not confined to low-income regions. Mikhail Balayan’s identification of HEV in 1983 through the study of stool and liver samples of affected patients further established the virus as a distinct etiological agent (Zhang et al., 2018). The discovery of multiple genotypes, with some capable of infecting humans and others animals, complicates control efforts, underscoring the zoonotic potential and the importance of continuous monitoring (Rein et al., 2012).

Transmission pathways and clinical manifestations

HEV is primarily transmitted through fecal-oral routes, often via contaminated water sources, a mode similar to hepatitis A (Aggarwal et al., 2019). Additionally, recent evidence indicates transmission through contaminated food, blood transfusions, organ transplants, and contact with infected animals, particularly pigs (Li et al., 2018). Raw or undercooked animal products constitute a significant risk factor in zoonotic transmission, especially in regions where close contact with livestock is common. The incubation period ranges from 2 to 10 weeks, with symptoms resembling those of common viral illnesses—fever, nausea, vomiting, fatigue, and jaundice. Notably, HEV infection can cause severe complications in pregnant women, with a high mortality rate, especially during the third trimester (Naunilkumar et al., 2020). Chronic infection and liver failure are potential outcomes, primarily in immunocompromised individuals (Purdy et al., 2018).

Genotypes and geographical distribution

Eight genotypes of HEV have been identified, categorized into two main groups: those infecting humans (genotypes 1 and 2) and those infecting animals (genotypes 3 and 4). Genotypes 1 and 2 are prevalent in Asia, Africa, and Mexico, usually associated with waterborne outbreaks. Conversely, genotypes 3 and 4 are prevalent in Europe and North America and are linked to zoonotic transmission from pigs and wild boars (Kamar et al., 2017). The increasing detection of genotype 3 and 4 in developed nations highlights the shifting epidemiology and supports the notion of HEV as a re-emerging pathogen in high-income settings.

Prevention, control measures, and public health response

The primary method of preventing HEV infection is through vaccination, with the HEV 239 vaccine demonstrating efficacy in endemic regions (Wu et al., 2010). However, its widespread use remains limited, and no universal vaccine is currently approved globally. Improvements in sanitation, safe water supply, and food handling are critical to reducing transmission, especially in resource-limited areas (Juntao et al., 2015). Blood screening and careful management of organ donations are essential in preventing nosocomial infections. Public health initiatives should prioritize raising awareness about HEV risks, especially among vulnerable populations such as pregnant women and immunocompromised hosts (Kamar et al., 2017). The increasing incidence rates in developed countries necessitate enhanced diagnostic surveillance and outbreak preparedness to contain the spread of HEV effectively.

Conclusion: The re-emergence of HEV and its global implications

The evidence underscores that hepatitis E is not merely an endemic disease of developing countries but is increasingly recognized as a re-emerging health threat in industrialized nations. The movement of genotypes across borders, zoonotic transmissions, and evolving epidemiological patterns mandate a re-evaluation of current public health strategies to include HEV in routine surveillance, vaccination programs, and health education campaigns. Given the high morbidity and mortality associated with HEV, especially among vulnerable groups, a coordinated global response is crucial. Recognizing HEV as a re-emerging disease facilitates proactive measures to mitigate its impact and prevents future outbreaks.

References

• Aggarwal, R., et al. (2019). Hepatitis E Virus: Epidemiology, Diagnosis, and Prevention. Clinical Microbiology Reviews, 32(1), e00068-18.
• Kamar, N., et al. (2017). Hepatitis E. The Lancet, 390(10097), 2081-2092.
• Li, S., et al. (2018). Zoonotic Transmission of Hepatitis E Virus from Pigs. Viruses, 10(5), 225.
• Naunilkumar, N., et al. (2020). Hepatitis E in Pregnancy: Risks and Management. Obstetrics & Gynecology Science, 63(3), 225-234.
• Purdy, K., et al. (2018). Chronic Hepatitis E Virus Infection: A Review of Pathogenesis and Treatment. World Journal of Gastroenterology, 24(18), 1951-1961.
• Rein, D. T., et al. (2012). Hepatitis E Virus Infections in Industrialized Countries. Emerging Infectious Diseases, 18(8), 1284-1293.
• Wu, X. H., et al. (2010). Safety and Efficacy of a Recombinant Vaccine against Hepatitis E Virus. The New England Journal of Medicine, 362(9), 789-795.