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Hepatitis E - What is Hepatitis E?Hepatitis E is a viral hepatitis (liver inflammation) caused by infection with a virus called hepatitis E virus (HEV). Many people mistakenly think that Hepatitis means Viral Hepatitis, and that all forms of hepatitis are contagious.
Hepatitis may occur with limited or no symptoms, but often leads to yellow discoloration of the skin, mucus membranes, and conjunctivae, poor appetite and malaise.
It can spread through sex (100 times more efficient than the HIV virus), blood transfusions (mostly before 1975), and needle sharing by intravenous drug addicts.
It is usually spread through contact with blood or contaminated needles, including tattoo needles.
Immunization of children (1-18 years of age) consists of two or three doses of the vaccine.
Safe and effective vaccines provide protection against Hepatitis B for 15 years and possibly much longer. Hepatitis B virus (HBV) infection has a worldwide distribution, with approximately 300 million individuals having chronic infection and are at risk for development of hepatocellular carcinoma1. It is crucial to be selective in offering treatment for chronic hepatitis B (Cl IB) for three reasons: a) not all patients require therapy.
I lepatitis B surface antigen (HbsAg) is often the first serologic marker which signifies the presence of HBV infection. On the basis of the serologic pattern, three common subgroups of patients can be identilied viz: chronic }IBV carrier state. The chronic HBV carrier state does not require any treatment even in those patients with minimal ALT elevations.
The aims of treatnient in patients with chronic hepatitis B are: sustained suppression of HBV replication. Interferon alpha (IFN) was the first agent to be approved for use in chronic HBV infection. The nucleoside analogues work by incorporating themselves into the active binding site of the viral HBV DNA polvmerase. Lamivudine is equally effective in both interferon native patients as well nonresponders to IFN. Lamivudine monotherapy has been shown to be as effective as IFN and lamivudine combination therapy.
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Hepatitis A infection which was previously known as infectious hepatitis is an acute disease of the liver which is caused due to hepatitis A virus.
In the United States it is the youngsters who travel to places where the risk of contracting the infection is high have this infection.
The initial signs and symptoms of hepatitis A resemble that of a common influenza infection but generally infected people especially children experience no symptoms up until at least a month and a half. Although this virus is eliminated from the body via stool, a confirmatory diagnosis of hepatitis A is made when specific IgM antibodies are found in blood draws. The CDC in the United States had reported in the 1990s of about 4 deaths per 1000 people who are infected in the normal population, the risk of which increases in people who are above the age of 50.
Patients being treated for chronic hepatitis C become less likely to take their medications over time, according to a new study from the Perelman School of Medicine at the University of Pennsylvania.
Patients being treated for chronic hepatitis C become less likely to take their medications over time, according to a new study. For the first time in two years, your members and doctors have suggested a cause for my medical problem that actually makes perfect sense to me. The site is not a replacement for professional medical opinion, examination, diagnosis or treatment.
Adding a direct acting anti-viral drug to the standard treatment regimen for hepatitis C significantly increases the cure rate in the most difficult to treat patients, according to a research report published Monday in the online edition of the journal The Lancet. An estimated 3.2 million Americans and 170 million people worldwide are infected with the hepatitis C virus, but many do not know it. Currently fewer than half of patients with genotype 1 hepatitis C are treated effectively by the standard combination of two drugs, peginterferon alfa-2b plus ribavirin, which is typically given for 48 weeks. Adding the drug boceprevir increased the cure rate to as high as 75 percent in those who received 48 weeks of the three-drug combination therapy, compared to 38 percent of those in the control group, who received the standard two-drug treatment for 48 weeks, said Dr. To test whether the addition of boceprevir could make it possible to shorten treatment times, some patients were randomly selected to receive the three-drug combination for 28 weeks, some for 48 weeks. Researchers also investigated whether a 4 week lead-in with the standard two-drug combination prior to the addition of boceprevir to the treatment regime could improve sustained virologic response rates. In another arm of the trial, researchers tested whether a lower dose of ribavirin could reduce the anemia side effects while still treating the virus effectively. The best results were reported for the 103 patients who were treated for four weeks with the standard two drug regiment, followed by 44 weeks of the three-drug regimen including boceprevir: 75 percent of these patients tested negative for evidence of the virus six months after the end of treatment.

67 percent of those who received the three drug regimen for 48 weeks with no lead-in treatment tested negative for the virus (103 patients). 56 percent of those who received the two-drug lead-in for four weeks, followed by 24 weeks of the three drug treatment tested negative for the virus (103 patients).
54 percent of those who received the three-drug treatment for 28 weeks with no lead-in tested negative for the virus (107 patients). 38 percent of the control group, who received the standard two-drug treatment for 48 weeks tested negative for the virus (104 patients). Patients receiving the low-dose of ribavirin did not fare as well – just 36 percent were virus-free after 48 weeks of treatment. Actually, the word Hepatitis is a catch-all term that refers to any inflammation of the liver — the irritation or swelling of liver cells from any cause. Most people recover from the virus within six months, but sometimes the virus will cause a lifelong chronic infection, possibly resulting in serious liver damage. The virus can pass from mother to child at birth or soon afterward; the virus can also pass between adults and children to infect whole families.
Currently, the Centre for Disease Control and Prevention recommends that all new-borns and individuals up to 18 years of age, and adults at risk of infection be vaccinated. Diese Form der Hepatitis kommt in Asien, Nord- und Nordostafrika, Mittel- und Sudamerika vor. Pakistan and it’s neighboring countries, fall in the category of intermediate prevalence for HBV infection (3-50%)1.
Clinically, its persistence for longer than six months after an acute infection suggess chronic HBV infection. HBV polvmerase is the enzyme primarily responsible for the replication ot HBV by reverse transcription, therefore interference with it’s action inhibits virus production.
Given the choice of two agents for antiviral therapy, it is at times hard to decide which to pick in an individual patient.
These agents are in clinical trials presently, and preliminarv results are very encouraging.
This virus is transmitted into humans by ingesting adulterated food or water or via direct contact with a person who is suffering from this infection. The estimated duration of symptoms in an infected individual is generally a couple of months even though in some people it may be prolonged to as long as six months. This antibody can be detected after a couple of weeks of contracting the infection and be present in the blood for as long as four months. There are two kinds of vaccinations available for prevention of this virus, one contains the inactivated form of the virus and the other contains a live form of the virus but both are effective in providing immunity from the disease. People who are affected are advised to stay well hydrated, avoid foods containing fats, avoiding alcohol is imperative for affected people as it may cause minor relapses. There is increased risk of liver failure from this infection with increase in age and in people who already have an underlying liver disease. Learn which specialists treat Hep and what to expect when you visit the doctor for medical tests. Learn how doctors treat different types of hepatitis, and how to protect yourself against infection. In the United States, 70 percent of affected individuals are infected with genotype 1 hepatitis C, the most difficult to treat. The goal was to see if allowing the interferon and ribavirin to reach steady state levels -- which would activate the immune system and reduce virus levels -- before adding boceprevir would improve the response rates as well as reduce the virus' ability to develop resistance to boceprevir, said Kwo. Boceprevir directly targets the hepatitis C virus, Kwo noted, while peginterferon and ribavirin are less specific, acting more generally to stimulate the body's virus-fighting immune system. The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis. Hepatitis A is the least dangerous form of Hepatitis because individual affected by them almost always recuperate naturally.
Three injections over a six to twelve month period are required to provide full protection. The measures for prevention of HBV infection, by infant and adult immunization, are being aggressively pursued in our country at all levels, since it is the only strategy which is likely to have an impact on the incidence of HBV infection. More commonly, patients present with HbsAg positivit with or without elevation of serum alanie aminotransferase (ALT) in the absence of a history of acute HBV infection tests for virus replication: hepatitis B e antigen (HbeAg).
Unfortunately, the cost, adverse effects and limited efficacy restricts its use to a very selective population of CHB patients. The future of antiviral therapy for HBV infection lies in combination therapy with two or more nucleoside analogues. The presence of this antibody signifies that the acute phase of the disease is finished and the body becomes immune to any further infection. Children who are infected with this disease recover within a month of the onset of symptoms. Although there may be no symptoms for years, long-term infection can cause cirrhosis and the disease is a leading cause of liver cancer and liver transplantation.
Unfortunately, people already infected with the virus do not benefit from the present immunization therapy. Hence, a brief introduction of the serology in chronic hepatitis B is mandatory before making any comments about antiviral therapy.

The oral administration and scarcity of adverse effects makes it a very attractive alternative to interferon in most patients. In these individuals, further deterioration in liver function can be halted and there have been reports of improvement in liver function to the extent that liver transplantation was either postponed or averted8.
The Asian Hepatitis Lamivudine Trial Group Pyretherapy alanine aminotransferase level as determinants for Hepatitis B e antigen seroconversion during lamivudine therapy in patients with chronic Hepatitis B. The estimated time between contracting the infection and the onset of symptoms is about a month and a half. When this disease is at its acute stage, the levels of ALT in blood is significantly high than normal due to injury to the liver cells due to the virus. Hepatitis C infections occur mainly through transmission of infected blood, such as via injection drug use, and there is no vaccine. But about 15% of people with Hepatitis A become so ill that they need hospitalization; that is why anyone at risk of infection, as well as all people with any form of chronic liver disease, should get the Hepatitis A vaccine. Therefore, in general, interferon therapy is restricted to individuals with replicative CHB infection with raised ALT levels in the absence of cirrhosis. Elderly individuals with comorbid illness and cirrhosis mav far better with lamivudine whereas a young patient could have the benefit of trying IFN first and reserve lamivudine for IFN failure.
The risk of having this disease is primarily high in developing countries and in regions where the standard of hygiene is below average. Patients with normal ALT should not be considered for IFN despite the presence of active viral replicative markers, because the response in this subgroup of patients is poor.
Similar to interferon therapy, individuals with replicative HBV infection are candidates for lamivudine therapy. The presence of HbsAg and hepatitis B core antibody (lgG) is suggestive of hepatitis B carrier state. In patients who respond to IFN there is usually a flare in the liver disease prior to response, in those with cirrhosis this flare can precipitate decompensation2. The presence of these mutants during therapy is detected by re-emergence of HBV DNA and elevation of serum ALT levels.
ORF1 encode a methyltransferase, protease, helicase and replicase; ORF2 encode the capsid protein and ORF3 encodes a protein of undefined function. Therefore, IFN is avoided in individuals with cilThosis unless administered in a closely monitored setting. Generally lamivudine monotherapy for 1 year is associated ith a 30% HbeAg loss and 16-18% IlbeAg seroconversion rate5-6. Once again pretreatment ALT level is also an important determinant of response to lam ivudine therapy. Careful monitoring for hematologic, psychiatric and endocrine side effects is recommended during therapy. The HbeAg seroconversion rate in patients with pretreatment ALT5 times ULN could be as high as 64%7.
Interferon therapy is associated with approximately 35% HBV DNA and HbeAg loss and only 10% HbsAg clearance3, However, the response is durable and there is also data to support improved histology and clinical outcome together with a decrease in risk for hepatocellular carcinoma in sustained responders to interferon4.
There is convincing data that responders to lamivudine also have improvement in inflammation and fibrosis in the liver6. Though children often contract this infection as well, they less frequently become symptomatic. Mortality rates are generally low, for Hepatitis E is a a€?self-limitinga€? disease, in that it usually goes away by itself and the patient recovers.
However, during the duration of the infection (usually several weeks), the disease severely impairs a persona€™s ability to work, care for family members, and obtain food.
Hepatitis E occasionally develops into an acute severe liver disease, and is fatal in about 2% of all cases.
Clinically, it is comparable to hepatitis A, but in pregnant women the disease is more often severe and is associated with a clinical syndrome called fulminant hepatic failure. Pregnant women, especially those in the third trimester, suffer an elevated mortality rate from the disease of around 20%. It is widespread in Southeast Asia, northern and central Africa, India, and Central America. It is spread mainly through fecal contamination of water supplies or food; person-to-person transmission is uncommon. Outbreaks of epidemic Hepatitis E most commonly occur after heavy rainfalls and monsoons because of their disruption of water supplies.
Major outbreaks have occurred in New Delhi, India (30,000 cases in 1955-1956), Burma (20,000 cases in 1976-1977), Kashmir, India (52,000 cases in 1978), Kanpur, India (79,000 cases in 1991), and China (100,000 cases between 1986 and 1988). There was an outbreak in Chad in which, as of September 27, were 1,442 reported cases and 46 deaths. Thus, prevention strategies of this disease are similar to those of many others that plague developing nations, and they require large-scale international financing of water supply and water treatment projects.

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