Global Alert and Response (GAR)

Hepatitis E

Prevention and treatment

- Guidelines for epidemic measures
- Future considerations

As almost all HEV infections are spread by the faecal - oral route, good personal hygiene, high quality standards for public water supplies and proper disposal of sanitary waste have resulted in a low prevalence of HEV infections in many well developed societies.29

For travellers to high endemic areas, the usual elementary food hygiene precautions are recommended. These include avoiding drinking water and/or ice of unknown purity and eating uncooked shellfish, uncooked fruits or vegetables that are not peeled or prepared by the traveller.

Vaccines or specific IG preparations are currently under development.48

As no specific therapy is capable of altering the course of acute hepatitis E infection, prevention is the most effective approach against the disease.41, 48

As with hepatitis A, hepatitis E patients generally do not require hospitalization.48

Admission is required for fulminant hepatitis and should be considered for infected pregnant women.48

Guidelines for epidemic measures

  1. Determination of mode of transmission.
  2. Identification of the population exposed to increased risk of infection.
  3. Elimination of common source of infection.
  4. Improvement of sanitary and hygienic practices to eliminate faecal contamination of food and water.

Future considerations
The development of more sensitive and more specific serologic tests for IgM and total anti-HEV antibodies will provide insight into the epidemiology of the disease.

The manufacture of hyperimmune E globulin and the production of a vaccine are essential for the control of the disease.

There is a need for determining the durability of anti-HEV neutralizing antibody after natural infection or vaccination.

The development of differential diagnostic tests to distinguish between infections with swine HEV and human HEV is necessary.33

The pathogenesis of the disease, especially in infected pregnant women, needs to be elucidated.

International measures should be established.