Hepatitis E

Question 1

Is hepatitis E nationally notifiable?

Answer 1

Yes - routine, labs and doctors

Question 2

What is the organism responsible for Hepatitis E?

Answer 2

Hepatitis E virus – at least 4 genotypes

Question 3

How is Hepatitis E transmitted?

Answer 3

• Faecal-oral
• Foodborne
• Bloodborne
• Perinatal

Contaminated drinking water is the main route worldwide, with raw/undercooked pork being a specific concern in Australia.

Question 4

What are clinical features of Hepatitis E?

Answer 4

• Asymptomatic
• Mild disease (usually)
• Self-limiting 1-4 weeks
• Anorexia, abdominal pain, jaundice, dark urine, pale stools, nausea/vomiting, fever

Question 5

What is the case fatality rate (CFR) for women in the third trimester of pregnancy with Hepatitis E?

Answer 5

20%

Question 6

What groups are at high-risk of Hepatitis E?

Answer 6

• Pregnant women in 2nd/3rd trimester
• Immunocompromised individuals
• Chronic liver disease

Question 7

What is the incubation period for Hepatitis E?

Answer 7

15-62 days

Question 8

What diagnostic methods are used for Hepatitis E?

Answer 8

PCR/electron microscopy, serology

Question 9

What is the infectious period for Hepatitis E?

Answer 9

A few days before symptom onset to 2 weeks after, but may be up to 6 weeks after

Question 10

What is the epidemiology of Hep E in Australia?

Answer 10

• Most cases overseas acquired
• Locally acquired cases following consumption of pork livers/pork pate/pork liver sausages, also venison or wild boar meat.

Question 11

How can Hepatitis E be prevented?

Answer 11

• Quality standards for public water supplies, proper disposal systems for human faeces
• Hygienic practices, caution while travelling regarding water/ice/food
• Cooking pork productscorrectly

Question 12

What actions should be taken for a confirmed case of Hepatitis E?

Answer 12

• Call clinician
• Case interview (symptoms, risk factors, exposure history including travel, food, water, contacts)

T - supportive, usually self-limiting
I - do not provide personal care, don’t prepare food for others, no sex, no sharing drug paraphernalia; exclude cases from childcare facilities, HCW, food handlers while infectious
E - sx, transmission, prevention

Question 13

Who are considered contacts for a Hepatitis E case?

Answer 13

Immediate family, household members, sexual partners

Question 14

How are contacts of Hep A managed?

Answer 14

T - NA
I - nil
M - monitor, test if sx - facilitate testing
E - education re risk of infection; careful hygiene esp for food handlers

Question 15

What environmental management is required?

Answer 15

VASH
* Site visit
* Sampling if food source implicated
* Review IPS if child attends childcare
* Water source unlikely in Australia but consider reviewing treatment procedures and bacteriological quality if unexpected cluster
* Consider failured sewage disposal system

Question 16

What should be done if the food source is implicated in a Hepatitis E case?

Answer 16

Consider inspection and food sampling, review infection prevention and control if a child attends childcare

Question 17

What should be monitored in contacts of a Hepatitis E case?

Answer 17

Symptoms to monitor, careful hygiene especially for food handlers

Question 18

What is the role of public health actions in managing Hepatitis E cases?

Answer 18

Educate about risk of infection, symptoms to monitor, facilitate testing/management to reduce further cases