Hepatitis A and Hepatitis E: Clinical and Epidemiological Features, Diagnosis, Treatment, and Prevention

Glynn W Webb, Sophie Kelly, Harry R Dalton, Glynn W Webb, Sophie Kelly, Harry R Dalton

Abstract

Hepatitis A and E are both ancient diseases but have only been properly recognized as being caused by distinct pathogens in modern times. Despite significantly different genomic structures, both viruses employ remarkably similar strategies to avoid host detection and increase environmental transmission. There are millions of cases of acute viral hepatitis due to hepatitis A virus (HAV) and hepatitis E virus (HEV) each year, resulting in tens of thousands of deaths. The presentations can be clinically indistinguishable, but each virus also has a range of less common but more specific phenotypes. The epidemiology of HAV is complex, and is shifting in countries that are making improvements to public health and sanitation. HEV presents a significant public health challenge in resource-limited settings but has historically been incorrectly regarded as having little clinical relevance in industrialized countries.

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Figures

Figure 1
Figure 1
Virus detection and serological and biochemical response to acute HEV infection (a) and acute HAV infection (b).

References

    1. Cuthbert JA. Hepatitis A: old and new [Published correction appears in Clin Microbiol Rev 2001;14(3):642] Clin Microbiol Rev. 2001;14:38–58.
    1. Khuroo MS. Discovery of hepatitis E: the epidemic non-A, non-B hepatitis 30 years down the memory lane. Virus Res. 2011;161:3–14.
    1. Purcell RH, Emerson SU. Hepatitis E: an emerging awareness of an old disease. J Hepatol. 2008;48:494–503.
    1. Drexler JF, Corman VM, Lukashev AN, van den Brand JMA, Gmyl AP, Brünink S. Evolutionary origins of hepatitis A virus in small mammals. Proc Natl Acad Sci U S A. 2015;112:15190–15195.
    1. Lee GH, Tan BH, Teo EC, Lim S, Dan Y, Wee A. Chronic infection with camelid hepatitis E virus in a liver transplant recipient who regularly consumes camel meat and milk. Gastroenterology. 2016;150:355. 7.e3.
    1. Li TC, Bai H, Yoshizaki S, Ami Y, Suzaki Y, Doan YH. Genotype 5 hepatitis E virus produced by a reverse genetics system has the potential for zoonotic infection. Hepatol Commun. 2018;3:160–172.
    1. Lemon SM. Type A viral hepatitis. New developments in an old disease. N Engl J Med. 1985;313:1059–1067.
    1. Feng Z, Hirai-Yuki A, McKnight KL, Lemon SM. Naked viruses that aren’t always naked: quasi-enveloped agents of acute hepatitis. Annu Rev Virol. 2014;1:539–560.
    1. World Health Organisation Hepatitis A fact sheet. 2020.
    1. World Health Organisation Hepatitis E fact sheet. 2020.
    1. European Association for the Study of the Liver Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol. 2018;68(6):1256–1271.
    1. Ndumbi P, Freidl GS, Williams CJ, Mårdh O, Varela C, Avellón A. Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017. Euro Surveill. 2018;23:1700641.
    1. Foster M, Ramachandran S, Myatt K, Donovan D, Bohm S, Fiedler J. Hepatitis A virus outbreaks associated with drug use and homelessness: California, Kentucky, Michigan, and Utah, 2017. MMWR Morb Mortal Wkly Rep. 2018;67:1208–1210.
    1. Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine. 2010;28:6653–6657.
    1. Kim YJ, Lee HS. Increasing incidence of hepatitis A in Korean adults. Intervirology. 2010;53:10–14.
    1. Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J. Hepatitis E [published correction appears in Lancet. 2012 Aug 25;380(9843):730] Lancet. 2012;379:2477–2488.
    1. Khuroo MS, Khuroo MS, Khuroo NS. Transmission of hepatitis E virus in developing countries. Viruses. 2016;8:253.
    1. Webb GW, Dalton HR. Hepatitis E: an underestimated emerging threat. Ther Adv Infect Dis. 2019;6 2049936119837162.
    1. Guillois Y, Abravanel F, Miura T, Pavio N, Vaillant V, Lhomme S. High proportion of asymptomatic infections in an outbreak of hepatitis E associated with a spit-roasted piglet, France, 2013. Clin Infect Dis. 2016;62:351–357.
    1. European Centre for Disease Prevention and Control . European Centre for Disease Prevention and Control; Stockholm: 2017. Hepatitis E in the EU/EEA, 2005–2015.
    1. Thom K, Gilhooly P, McGowan K, Malloy K, Jarvis LM, Crossan C. Hepatitis E virus (HEV) in Scotland: evidence of recent increase in viral circulation in humans. Euro Surveill. 2018;23:17–00174.
    1. Khuroo MS, Kamili S, Yattoo GN. Hepatitis E virus infection may be transmitted through blood transfusions in an endemic area. J Gastroenterol Hepatol. 2004;19:778–784.
    1. Hoad VC, Seed CR, Fryk JJ, Harley R, Flower RLP, Hogema BM. Hepatitis E virus RNA in Australian blood donors: prevalence and risk assessment. Vox Sang. 2017;112:614–621.
    1. Sridhar S, Yip CC, Wu S, Chew NF, Leung K, Chan JF. Transmission of rat hepatitis E virus infection to humans in Hong Kong: a clinical and epidemiological analysis. Hepatology. 2020 10.1002/hep.31138.
    1. Jeong SH, Lee HS. Hepatitis A: clinical manifestations and management. Intervirology. 2010;53:15–19.
    1. Mackinney-Novelo I, Barahona-Garrido J, Castillo-Albarran F, Santiago-Hernández JJ, Méndez-Sánchez N, Uribe M. Clinical course and management of acute hepatitis A infection in adults. Ann Hepatol. 2012;11:652–657.
    1. Schiff ER. Atypical clinical manifestations of hepatitis A. Vaccine. 1992;10(Suppl 1):S18–S20.
    1. Gordon SC, Reddy KR, Schiff L, Schiff ER. Prolonged intrahepatic cholestasis secondary to acute hepatitis A. Ann Intern Med. 1984;101:635–637.
    1. Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D. Relapsing hepatitis A. Review of 14 cases and literature survey. Medicine. 1992;71:14–23.
    1. Teshale EH, Howard CM, Grytdal SP, Handzel TR, Barry V, Kamili S. Hepatitis E epidemic, Uganda. Emerg Infect Dis. 2010;16:126–129.
    1. Kumar Acharya S, Kumar Sharma P, Singh R, Kumar Mohanty S, Madan K, Kumar Jha J. Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death. J Hepatol. 2007;46:387–394.
    1. Adlhoch C, Avellon A, Baylis SA, Ciccaglione AR, Couturier E, de Sousa R. Hepatitis E virus: assessment of the epidemiological situation in humans in Europe, 2014/15. J Clin Virol. 2016;82:9–16.
    1. Dalton HR, Stableforth W, Thurairajah P, Hazeldine S, Remnarace R, Usama W. Autochthonous hepatitis E in southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease. Eur J Gastroenterol Hepatol. 2008;20:784–790.
    1. Dalton HR, Bendall RP, Rashid M, Ellis V, Ali R, Ramnarace R. Host risk factors and autochthonous hepatitis E infection. Eur J Gastroenterol Hepatol. 2011;23:1200–1205.
    1. Blasco-Perrin H, Madden RG, Stanley A, Crossan C, Hunter JG, Vine L. Hepatitis E virus in patients with decompensated chronic liver disease: a prospective UK/French study. Aliment Pharmacol Ther. 2015;42:574–581.
    1. Haim-Boukobza S, Coilly A, Sebagh M, Boumoud M, Antonini T, Roche B. Hepatitis E infection in patients with severe acute alcoholic hepatitis. Liver Int. 2015;35:870–875.
    1. Bergløv A, Hallager S, Weis N. Hepatitis E during pregnancy: maternal and foetal case-fatality rates and adverse outcomes—a systematic review. J Viral Hepat. 2019;26:1240–1248.
    1. Kumar A, Beniwal M, Kar P, Sharma JB, Murthy NS. Hepatitis E in pregnancy. Int J Gynaecol Obstet. 2004;85:240–244.
    1. Khuroo MS, Kamili S, Khuroo MS. Clinical course and duration of viremia in vertically transmitted hepatitis E virus (HEV) infection in babies born to HEV-infected mothers. J Viral Hepat. 2009;16:519–523.
    1. Bigna JJ, Modiyinji AF, Nansseu JR, Amougou MA, Nola M, Kenmoe S. Burden of hepatitis E virus infection in pregnancy and maternofoetal outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020;20:426.
    1. Lhomme S, Marion O, Abravanel F, Izopet J, Kamar N. Clinical manifestations, pathogenesis and treatment of hepatitis E virus infections. J Clin Med. 2020;9:331.
    1. Inman RD, Hodge M, Johnston ME, Wright J, Heathcote J. Arthritis, vasculitis, and cryoglobulinemia associated with relapsing hepatitis A virus infection. Ann Intern Med. 1986;105:700–703.
    1. Shenoy R, Nair S, Kamath N. Thrombocytopenia in hepatitis A—an atypical presentation. J Trop Pediatr. 2004;50:241–242.
    1. Dalton HR, Kamar N, van Eijk JJ, Mclean BN, Cintas P, Bendall RP. Hepatitis E virus and neurological injury. Nat Rev Neurol. 2016;12:77–85.
    1. van Eijk JJ, Madden RG, van der Eijk AA, Hunter JG, Reimerink JHJ, Bendall RP. Neuralgic amyotrophy and hepatitis E virus infection. Neurology. 2014;82:498–503.
    1. van Eijk JJJ, Dalton HR, Ripellino P, Madden RG, Jones C, Fritz M. Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy. Neurology. 2017;89:909–917.
    1. Dalton HR, van Eijk JJJ, Cintas P, Madden RG, Jones C, Webb GW. Hepatitis E virus infection and acute non-traumatic neurological injury: a prospective multicentre study. J Hepatol. 2017;67:925–932.
    1. Jacobs BC, Rothbarth PH, van der Meché FG, Herbrink P, Schmitz PI, de Klerk MA. The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study. Neurology. 1998;51:1110–1115.
    1. Kamar N, Izopet J, Cintas P, Garrouste C, Uro-Coste E, Cointault O. Hepatitis E virus-induced neurological symptoms in a kidney-transplant patient with chronic hepatitis. Am J Transplant. 2010;10:1321–1324.
    1. Hartl J, Otto B, Madden RG, Webb G, Woolson KL, Kriston L. Hepatitis E seroprevalence in Europe: a meta-analysis. Viruses. 2016;8:211.
    1. Kmush BL, Labrique AB, Dalton HR, Ahmed ZB, Ticehurst JR, Heaney CD. Two generations of “gold standards”: the impact of a decade in hepatitis E virus testing innovation on population seroprevalence. Am J Trop Med Hyg. 2015;93:714–717.
    1. Kamar N, Abravanel F, Behrendt P, Hoffman J, Pageaux GP, Barbet C. Ribavirin for hepatitis E virus infection after organ transplantation: a large European retrospective multicenter study. Clin Infect Dis. 2019
    1. Nelson NP, Weng MK, Hofmeister MG, Moore KL, Doshani M, Kamili S. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020;69:1–38.
    1. British Association for Sexual Health and HIV 2017 interim update of the 2015 BASHH National Guidelines for the Management of the Viral Hepatitides. 2017.

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