Why is Hepatitis E of Increasing Importance for Developing as well as Developed Countries - Essay Example

Why is hepatitis E of increasing importance for developing as well as developed countries College: Introduction Hepatitis E is a liver disease that is caused by the Hepatitis E Virus (HEV). HEV is primarily transmitted through the fecal-oral route via water supplies that is contaminated. HEV is a trifling non-enveloped virus with a single-strand RNA genome. Direct contact with infected animals or consumption of contaminated animal’s meat results to transmission of HEV zoonotically. HEV has one serotype but four genotypes. Humans are infected exclusively by genotypes 1 and 2 HEV while genotype 3 and 4 HEV infect humans as well as other mammals including pigs since they are zoonotic. Poor sanitation is the major contributor to the outbreak of hepatitis E. Persons with preexisting liver cirrhosis and pregnant women are the population that experience severe cases of hepatitis E as well as young adults (Denman & Goodman 2011, p.972). Why the Case for Hepatitis E is Significant The disease was considered to be limited to residents of developing countries in the past, however the wider geographic and distribution of host species is of great significance. In the recent years, there has been a resurgence of interests in Hepatitis E infection due to the increase in HEV infection on humans and several animals’ species in the developed world. Another of the reasons as to why this case is important is the fact that HEV is not part and parcel of the front line diagnostic panel in Hepatitis E patients whose risk factors are unknown (Kruttgen et al 2010, p.175). As thus, this cases is seemingly relevant to those physicians actively engaged in the treatment of infectious diseases, epidemiology or pediatrics (Kruttgen et al 2010, p.175) Causes and Effects A vast number of individuals have been wondering about the specific causes of Hepatitis E. In an effort to answer their query, professionals in the medical field have noted that this infection is solely as a result of infection with the HEV, which is in most cases so happens via fecal-oral transmission. This kind of transmission does take place in the event that an individual either drinks or eats something that has been polluted with the stool of another individual who had been infected with HEV (Pickerings 2000, p.24). Hepatitis E can also be as a result of placing a utensil or any other infected object into one’s mouth. It is as a result of the above mentioned reason that Hepatitis E virus is spread with ease in those areas where sanitary conditions are considerably poor or where humans hardly observe good personal hygiene. A great percentage of the infections are as a result of contamination of water supplies- and more especially after monsoon floods. It is also likely that animals can spread HEV since a number of animal types are predisposed to the infection. More often than not, these animals are non-human primates and include such as cows, pigs, goats, sheep as well as rodents (Aggarwal & Jameel 2011, p.2220). With Hepatitis E virus being known for causing around 20 million infections on an annual basis, approximately 3 million acute illnesses have been associated with the same virus, with the number of deaths recorded on a yearly basis clocking 70,000. Notably, the HEV is predominantly catastrophic for pregnant women since they are more predisposed to developing an acute form of the disease that is fatal in 20% of the documented cases (Miyamura 2011, p.41). In the developing countries, Hepatitis E virus is the foremost cause of the infection and the resulting deaths as well as a disproportionate cause of the deaths among expectant mothers. Despite the fact that HEV vaccine trials- including various trials which have been carried out in populaces in Southern Asia, have indicated that candidate vaccines are well-tolerated and effective, the same vaccines have hardly been manufactured or availed to those populations which are considered to be the most vulnerable (Miyamura 2011, p.43). Hepatitis E in Developed Countries In developed countries, Hepatitis E is sporadic and uncommon since the mostly affected groups included travelers to endemic regions who developed the disease thereafter, soldiers dispatched to endemic areas, diplomats, foreign tourists, and foreign aid workers exposed to HEV infection all of which are associated with imported HEV cases from endemic countries (Miyamura 2011, p.45). In addition, the disease is continuously recognized to be related to zoonotic transmission and these cases are sporadic among the elderly with coexisting illnesses. Immunosuppressed persons in developed countries experience chronic infection of the disease which contributes to liver cirrhosis. The increased number of hepatitis E reflected by sporadic cases and occasional food-borne outbreaks relates to autochthonous HEV. The genotype 3 and 4 which affects both man and animals are profound in developed countries given that most of the cases are attributed to zoonotic spread infection. The sporadic cases of HEV in developed countries are thus attributed to consumption of uncooked or undercooked pig livers and other infected meats (Miyamura 2011, p.46). HEV3 and 4 infections which are autochthonous are present in New Zealand, Europe, North America, France, UK and Japan. Person-to-person transmission of the disease is common especially during transplants, blood transfusion. The middle aged and elderly men contributes to a large percentage of infected individuals and this raises concern on the host factors since exposure is unrelated to age or sex (Miyamura 2011, p.46). The clinical features of autochthonous hepatitis infection do range from asymptomatic infection to mild hepatitis and later to sub-acute liver failure. For instance in a UK-based hospital study, it has been documented that out if the patients with unexplained hepatitis, forty of them had autochthonous hepatitis E, out of which around 75% were icteric. This static also indicated that the affected persons were a representation of individuals displaying other non-specific symptoms (Zhang et al 2012, p.346). A table showing the symptoms present in 40 cases of autochthonous hepatitis E in the United Kingdom Symptom Number of Patients with Symptoms Jaundice 30 Aneroxia 15 Malaise/lethargy 15 Abdominal pain 14 Nausea 13 Fever/chills 8 Vomiting 7 Myalgia 5 Pruritis 4 Weight loss 3 Headaches 3 Back pain 2 Arthralgia 2 No symptoms 2 Rash 1 Paraesthesia 1 Source: Harry Dalton, Royal Cornwall Hospital and Peninsula College of Medicine and Densistry, Truro: UK. Rerieved:http://www.kliinikum.ee/infektsioonikontrolliteenistus/doc/oppematerjalid/Referaadid/8%28698%29.pdf In developed countries, the incubation period for hepatitis E ranges between two and nine weeks. In addition, the demonstration of HEV in plagued individuals in these countries is seemingly similar to that from the endemic regions. Nonetheless, the mortality rate in these countries in relatively higher’ ranging between 8 per cent and 11 per cent. This is so evidenced in the below comparison charts in both the developing and the developed countries (Purdy & Khudyakov 2011, p.37). Source: National Institute of Health, South Drive: USA As equated with Hepatitis E infections in the developing countries, in the developed world, a greater percentage of the infections have been reported among the middle-aged and the elderly. Moreover, and as is the case in the endemic areas, secondary and intra-familial spread have hardly been reported (Meng 2011, p.29). Despite the fact that the greater percentage of the autochthonous HEV infections is self-limiting, detailed follow-up studies evidence that 15% of the individuals infected with HEV in the developed countries have had complications. In addition, between 8% and 11% of these HEV-infected patients develop both fulminant hepatitis and liver failure. The outcome is in the offing of being markedly poor among those individuals with causal chronic liver disease, with the rate of mortality approaching 70 per cent (Sanford et al 2012, p.6252). In the developed regions, hepatitis E is more often than not diagnosed as drug-induced liver injury and as a shared problem occurring with the increasing frequency in the elderly people. This diagnosis is founded on the presence of a time-based overtone between the commencement of drug therapy and biochemical confirmation of liver injury, termination of drug therapy and enhancement in liver biochemistry and the elimination of unconventional diagnoses. Until recently, chronic HEV infection had been thought not to be in existence. On the contrary, Hepatitis E infection has been reported among patients in receipt of immunosuppressive therapy resulting from organ transplantation (Colson 2012, p.182). According to some study carried out in France on this infection among solid organ transplant recipients, eight patients out of fourteen developed protracted liver disease with an indefatigably upstretched trans-aminase concentration, importunate viraemia and progressive swelling and fibrosis on liver biopsy. Hepatitis E in Developing Countries Hepatitis E in developing countries is majorly caused by HEV1 and HEV 2. In these countries, this infection is considered to be an endemic disease, especially due to the poor sanitary conditions within the tropical and/or subtropical regions. The key outbreaks of severe hepatitis are linked with fecal contamination of drinking water or flooding in developing countries (Zhang et al 2012, p.341). In respect to these, North Africa, Middle East, and Central and South Asia are the most endemic region of HEV infection globally with high cases of sporadic acute hepatitis infections. Thus person to person infection is rare in this region although the household factors contribute to the disease outbreaks. Fulminant hepatic failure and obstetric complications contribute to the higher maternal mortality rate in the third trimester. The mortality rate is however higher in pregnant women and infants below 2 years of age and this calls for concern in identifying the major cause of these ((Miyamura 2011, p.44). Risk Factors of Hepatitis E in Developed Countries The HEV is primarily transmitted via the fecal-oral route; however, the mode of contamination differs for people in developed and developing countries. As consumption of focally contaminated water is the principal cause of Hepatitis E in developing countries; while in developed countries, the intermittent Hepatitis E is both zoonotic and food-borne (Purdy & Khudyakov 2011, p.35). Consumption of contaminated, uncooked or undercooked meat or pigs’ viscera, deer and boars form the major risk factor in developed countries. Other risk factors include blood transfusion, hemodialysis patients in endemic and non-endemic countries, chemotherapy and post-transplant immune-suppression and immune-compromised patients are subjected to HEV infections. Further, the HEV infection outbreak in hospital has made in-hospital spread of HEV to be a potential risk factor in developed countries (Teshale, Hu & Holmberg 2010, p.335). Control Measures need to be adopted globally to combat the epidemic through adoption of dependable internationally standardized anti-HEV examination system and effective sharing of information of different genotypes that are quarantined from different parts of the world. This will facilitate global thinking and local acting in mitigating the infectious disease in the population (Meng 2011, p.25). In addition, people living in endemic countries should be vaccinated as HEV vaccines will offer long-lasting immunity against hepatitis E given that it is readily available, effective and low in cost. Furthermore, developed countries should employ preventive vaccines for its high risk population, including travelers, soldiers, and long-term visitors. To enhance efficiency of the HEV vaccine, vaccines for Hepatitis A virus should be combined with HEV vaccine (Sanford et al 2012, p.6251). In summary, HEV control and prevention strategies ordinarily entail improving one’s hygienic conditions as well as provision of safe drinking water. On the other hand, and since it has been evidenced that person-to-person spread of the virus is on the increase, it is therefore advisable that various strategies geared toward reducing transmission via this route be put Iin place. These may include such as washing one’s hands with soap. Furthermore, and owing to the fact that the success of the present intervention is somehow limited, there is a need to not only develop, but also test and thereafter avail a reliable Hepatitis E vaccine (Colson 2012, p.182). The self-limiting nature of the disease has made HEV to lack specific treatment. Hepatitis E needs to be prevented in order to mitigate the disease. Providing water that is safe for drinking, effective discarding of human waste and proper education on personal hygiene, chlorination and boiling of water during outbreaks is crucial in developing countries. On the other hand, appropriate cooking of pig meat and deer meat and sanitary handling will help to combat zoonotic transmitted hepatitis E in developed countries (Bartnof 2000, p.10). The fact that the disease has multifarious epidemiology with water borne transmission, human­-to-human transmission and zoonotic transmission is characterized with restricted treatment alternatives given that its pathogenetic mechanism is ill understood. To combat the disease, serious attention should be adopted by researchers and physicians in the development of effective vaccines In conclusion, hepatitis E is a serious epidemic in all parts of the globe, both in developing and developed countries. The zoonotic nature and chronicity of HEV has made its control to be difficult. Efforts should be embraced to fully understand the reservoir and transmission of HEV so as to facilitate accurate and prompt diagnostic system, effectual anti-viral and effective preventive vaccines (Chandra et al 2008, p.453). Being an infection entity whose causative agent is reasonably freshly described, a lot is left to be understood as regards to HEV. With the high global burden of sporadic and epidemic Hepatitis E, high mortality among expectant women and the children of very tender ages and the likely threat resulting from the widespread prevalence of HEV in both human and swine populaces, it is believed that there is a need for further expansion of clinical trials, epidemiological and intervention studies of Hepatitis E vaccine. The availability of a well-validated and accurate diagnostic test of HEV is in the offing of enhancing the care received by patients with acute hepatitis as well as play a pivotal role in promoting the understanding of the true incidence of Hepatitis E across the globe (Kamal et al 2012, p.2286). References Aggarwal, R & Jameel, S 2011, ‘Review: Hepatitis E’, Hepatology 54: 2218-2226. Bartnof HS 2000, Hepatitis E Emerges as Significant Cause of Liver Inflammation World-wide, 10th International Symposium of Viral Hepatitis and Liver Disease, April, Atlanta: Georgia. Chandra, V, Taneja, S, Kalia, M & Jameel, S 2008, ‘Molecular Biology and Pathogenesis of Hepatitis E Virus’, Journal of Bioscience, 33:451-464. Colson, P 2012, ‘Circulation of Almost Genetically Identical Hepatitis E Virus of Genotype 4 in France’, Journal of Clinical Virology, 55:181-183. Denman, B & Goodman, SR 2011, ‘Emerging and Neglected Tropical Disease: Translational Application of Proteomics’, Experimental Biology and Medicine, 236:972-976. Kamar, N, Legrand-Abravanel, F, Izopet, J & Rostaing, L 2012, ‘Hepatitis E Virus: What Transplant Physicians Should Know’, American Journal of Transplantation 12: 2218-2287. Meng, X 2011, ‘From Barnyard to Food Table: The Omnipresence of Hepatitis E Virus and Risk for Zoonotic Infection and Food Safety’, Virus Research, 161: 23-30. Miyamura, T 2011, ‘Hepatitis E Virus Infection in Developed Countries’, Virus Research 161: 40-46. Pickerings, L 2000, Red Book 2000 Report of the Committee on Infectious Disease, 25th ed. American Academy of Pediatrics. Purdy, MA & Khudyakov, YE 2011, ‘The Molecular Epidemiology of Hepatitis E Virus Infection’, Virus Research, 161: 31-39. Sanford, BJ, Opriessnig, T, Kenney, SP, Dryman, BA, Cordoba, L & Meng, X 2012, ‘Assessment of the cross-protective capability of recombinant capsid proteins derived from pig, rat, and avian hepatitis E viruses (HEV) against challenge with a genotype 3 HEV in pigs’, Vaccine, 30:6249-6255. Teshale, EH, Hu, DJ & Holmberg, SD 2010, ‘The Two Faces of Hepatitis E Virus’, Emerging Infections, 51: 328-334. Zhang, J, Li, S, Wu, T, Zhao, Q, Ng, M & Xia, N 2012, ‘Hepatitis E Virus: Neutralising Sites, Diagnosis and Protective Immunity’, Reviews in Medical Virology, 22:339-349. Read More